Journal of Spinal Cord Medicine最新文献

Context: Upper limb (UL) splinting interventions are commonly delivered to people following spinal cord injury (SCI) as part of multi-modal rehabilitation; however, their clinical efficacy remains unclear and a wide variety of splinting interventions are used in clinical practice and described in the literature.

Objective: This study aimed to map out the available evidence and guidelines on the topic, to summarize the breadth of knowledge and identify knowledge gaps.

Methods: A scoping review was conducted using the Arksey & O'Malley's methodological framework. Seven electronic databases were searched for literature evaluating upper limb splinting interventions for SCI rehabilitation. Two independent reviewers screened results. Findings were synthesized narratively and reported according to the PRISMA-ScR checklist.

Results: 21 primary studies evaluating traditional (n = 13) and non-traditional (n = 3) splints, five qualitative studies and 15 clinical guidelines were included. Most studies evaluated hand and wrist-based splints, which were predominantly used to optimize hand function. Large variations in terms of purpose, type, dosage, outcome assessment and impact of splinting interventions were identified. All clinical guidelines lacked detail and acknowledged the need for tailoring.

Conclusion: Considerable heterogeneity amongst the UL splinting literature and guidelines for SCI rehabilitation exists, with sub-optimal reporting of recommendation for the interventions. Studies were limited by weak methodological designs and small samples sizes, highlighting the need for high-quality mixed-methods trials that have been co-designed by patient and clinical stakeholders. There is a need to develop more robust clinical guidelines specifically for SCI rehabilitation.

Context: Clean intermittent self-catheterization (CISC) is a first-line bladder management strategy for patients with spinal cord injury (SCI). However, complications such as urinary tract infections and stone formation are relatively common. The retention of the catheter as an intravesical foreign body is an exceedingly rare event and can present with symptoms similar to infection or radiolucent calculi.

Findings: A 36-year-old male with a history of chronic spinal cord injury (T12, AIS A) utilizing clean intermittent self-catheterization (CISC) presented with urinary frequency and the presence of "gravel-like debris". The patient was afebrile, and initial plain radiography yielded no significant findings. A computed tomography (CT) revealed a high-density tubular structure within the bladder. Cystoscopy successfully removed two urinary catheters, leading to symptom resolution. On gross inspection, neither showed any apparent tear or breakage. An attempt to use a handled catheter was not tolerated; however, after reinforced technique education, including the caregiver, the patient has remained symptom-free for over 12 months with no recurrence.

Conclusion/clinical relevance: In CISC users with persistent lower urinary tract symptoms despite empiric UTI management and negative first-line imaging, intravesical foreign bodies should be considered. Early non-contrast CT can clarify radiolucent or atypical etiologies and expedite definitive cystoscopic treatment. Prevention should pair ergonomic catheter selection (e.g. flared or handled designs as tolerated) with structured skills refreshers during routine SCI follow-up; caregiver participation can be included when appropriate.

Background: Bone loss following spinal cord injury (SCI) leads to an increased risk of fragility fractures, especially at the knee and hip. While research to date has primarily focused on mitigating bone loss in the acute phase, our recent publication demonstrated an improvement in bone mineral and strength at the lumbar spine and hip, but not the knee, in women with chronic SCI and osteoporosis after 12 months of romosozumab therapy. This paper presents 12 months of follow-up treatment with oral alendronate, which aimed to determine whether prior gains could be maintained with transition of therapy in the same sample.

Methods: Ten study participants completed the alendronate treatment. Dual-energy X-ray absorptiometry (DXA) and computed tomography (CT) scans were taken at the end of the treatment year to quantify changes to bone mineral density (BMD) and CT-based finite element (FE) estimations of fracture strength. Second year results were compared to the first year of romosozumab treatment data using non-parametric analyses.

Results: No significant changes between the month-12 and month-24 visits were observed for BMD at the lumbar spine (P = .432) or total hip (P = .432). Correspondingly, no significant change in FE-derived strength at the proximal femur (P = .695) was observed. There were no appreciable changes in BMD or bone strength at the knee following the alendronate intervention.

Conclusions: Overall, one year of treatment with monthly romosozumab followed by one year of treatment with weekly alendronate, significantly increased and maintained bone mineral at the hip, but not the knee, in women with chronic SCI and secondary osteoporosis.

Study design: Retrospective non-controlled intervention study.

Objectives: To assess indications, feasibility, safety and efficacy of dorsal rhizotomy at the level of conus medullaris (conus deafferentation - CDAF) in individuals with spinal cord injury/disease (SCI/D).

Setting: Two specialized tertiary German centers for spinal cord injuries.

Methods: In addition to a detailed description of the surgical procedure (including two technical variants: hemilaminectomy and osteoplastic laminotomy), an analysis of the surgical reports on intra- and postoperative complications and an evaluation of the pre- and postoperative paraplegiologic and neuro-urologic parameters of SCI/D patients with CDAF are presented.

Results: A total of 30 patients, 6 of them women, 22 with complete, 8 with incomplete SCI/D underwent CDAF. The most common indications were therapy-refractory detrusor overactivity, spasticity of the lower limbs and autonomic dysreflexia, usually with several simultaneous indications.Except for one antibiotic-treated wound infection, no severe CDAF-associated complications were documented. Urodynamic parameters (maximum detrusor pressure, maximum cystometric capacity) improved significantly (p < .001). In addition, all clinical targets (autonomic dysreflexia, spasticity triggered by bladder and bowel dysfunction, recurrent urinary tract infections, urinary incontinence) were also significantly improved.Quality of life (SCI-QoL-BDS) was significantly improved (p < .001) from 10 (IQR 6-16) to 17 (IQR 9.75-21), while neurogenic bowel dysfunction (NBD) score did not significantly change.

Conclusions: The present study identified different indications for the use of CDAF that can be performed safely and efficiently with very few intraoperative and postoperative complications. We see a high potential in this method for the improvement of the paraplegiological and neuro-urological therapy spectrum.

Context/objective: The 13-item Patient Activation Measure (PAM-13) is the most widely used generic patient activation measure, but spinal cord injury (SCI) related psychometric evaluation of PAM-13 has not been explored globally. This study aimed to assess the validity of the Chinese version of the PAM-13 (PAM-13-C) for individuals with chronic spinal cord injury (CSCI).

Design: Cross-sectional study.

Setting: Shanghai Sunshine Rehabilitation Center, and some participants were recruited in a WeChat group (the most commonly used social media platform in China).

Participants: 284 individuals with spinal cord injury who had lived with the injury for ≥0.5 year.

Interventions: NA.

Outcome measures: The PAM-13-C, global QoL, seven-item generalized anxiety disorder scale (GAD-7) and nine-item patient health questionnaire (PHQ-9), and General Self-Efficacy Scale (GSES) were used.

Results: The mean (SD) PAM-13-C score was 57.4 (16.5). The highest percentage of NA could be observed in item 9 (12.0%). Floor and ceiling effects of the total scores of PAM-13-C were small (0.7% and 6.7%), but a ceiling effect could be observed among all items. Exploratory Factor Analysis supported a one-factor model of the PAM-13-C (CFI = 0.97; RMSEA = 0.07). Construct validity was established through correlation analysis among the PAM-13-C, GAD-7/PHQ-9, global QoL, and GSES. The PAM-13-C demonstrated excellent internal consistency (Cronbach's α = 0.95) and acceptable test-retest reliability.

Conclusion: The PAM-13-C is a reliable and valid measure of patient activation for individuals with CSCI in China.

Objectives: This study aims to elucidate the relationship between red blood cell (RBC) count and D-dimer levels in patients with spinal cord injury, with the goal of identifying potential therapeutic targets for minimizing D-dimer levels.

Study design: An observational, retrospective, cross-sectional, single center study.

Setting: Individuals with SCI (576 cases) admitted to a rehabilitation medicine department.

Outcome measures: After exclusions, we divided the participants (n = 308) into two groups based on their D-dimer levels: Group 1 (≤0.5  mg/L, n = 64) and Group 2 (>0.5  mg/L, n = 244). Key variables such as deep vein thrombosis (DVT), anticoagulant therapy, pulmonary infection, injury characteristics, and hematological parameters were analyzed for their association with RBC counts and D-dimer levels.

Results: DVT and anticoagulant therapy emerged as significant covariates. A comprehensive analysis identified a negative linear correlation between RBC counts and D-dimer levels, markedly more pronounced in Group 2. For every 1.00 × 10¹²/L increase in RBC, D-dimer levels decreased by 1.93  mg/L in Group 2, compared to a 0.02  mg/L decrease in Group 1.

Conclusions: Higher RBC counts might be associated with lower D-dimer levels in patients with SCI, especially in those with higher initial D-dimer levels. This association highlights a potential therapeutic focus on managing RBC counts to decrease D-dimer level, which may mitigate the risk of DVT formation in patients with SCI.

Background: To explore the effects of Buyang Huanwu Decoction (BYHWD) on neurons in the red nucleus of rats with spinal cord injury (SCI) based on autophagy.

Methods: 120 Sprague-Dawley (SD) rats were randomly divided into 6 groups: Control Group, SCI Group, Bafilomycin A1 Group, Rapamycin Group, BYHWD low-dose group (BL Group, 6.25 g/kg), BYHWD high-dose group (BH Group, 25.00 g/kg), with 20 animals in each group. A rat rubrospinal tract (RST) transection model was established and treated for 28 days. The recovery of motor function of rats was observed through inclined plate test and spontaneous upright exploratory behavior test. Nissl's staining was used to observe the cell morphology of injured red nucleus neurons. Reverse Transcription PCR (RT-PCR) and immunofluorescence were used to detect the expression of ATG5 and Beclin1 mRNA. The Western blot method was used to observe the expression levels of Synaptophysin (SYP), Synaptosomal-associated Protein of 25 kDa (SNAP-25), Postsynaptic density protein 95 (PSD-95), ATG5, and Beclin1 proteins in red nucleus tissue.

Results: Compared with the SCI group, both BL and BH groups significantly improved the forelimb motor function and improved the status of red nucleus neurons in SCI rats. BYHWD increased SYP, SNAP-25, PSD-95, and decreased the red core Beclin1 and ATG5.

Conclusions: BYHWD enhances synaptic regeneration and limb activity in red nucleus neurons of SCI rats by inhibiting autophagy.

Objective: To identify the prevalence and risk factors for low bone density (LBD) in young adults with spinal cord injury (SCI).

Design: Retrospective cross-sectional study.

Setting: National Rehabilitation Center in Seoul, Korea.

Participants: SCI patients aged 20-49 years hospitalized from January 2010 to October 2021.

Interventions: Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry of the lumbar spine, femoral neck, and total hip.

Outcome measures: Areal BMD, Z-score and T-score of each region and prevalence of LBD.

Results: Osteopenia and osteoporosis were diagnosed in 451 (58.2%) and 156 (20.1%) of 775 patients, respectively. Among 181 patients within 3 months of onset, 105 (58%) and 20 (11%) were diagnosed with osteopenia and osteoporosis, respectively. Additionally, the percentage of LBD increased significantly as the time from injury increased. On multivariate analysis, the risk factors for LBD in patients with early SCI within 12 months of onset were female sex (odds ratio [OR] = 2.49; 95% confidence interval [CI], 1.34-4.46; p = 0.002), body mass index (OR = 0.86; 95% CI, 0.81-0.92; p < 0.001), and age (OR = 1.04; 95% CI, 1.01-1.07; p = 0.005). Alcohol or smoking history, etiology, neurological level, or completeness of injury, and the Korean version of the spinal cord independence measure-III score were not significantly correlated with LBD.

Conclusions: The prevalence of osteopenia and osteoporosis is high in young adults with SCI. In addition, the diagnosis rate is high in the test performed at the initial stages after injury. Therefore, early bone health monitoring should be performed in young adults with SCI.