Journal of Spinal Cord Medicine最新文献

Context: Current guidelines recommend four weeks of stress ulcer prophylaxis following traumatic spinal cord injury.

Objectives: Assess the current literature on the incidence, timing, and risk factors for gastrointestinal bleeding/clinically important gastrointestinal bleeding in the acute setting following a traumatic spinal cord injury and whether the use of stress ulcer prophylaxis has been shown to reduce the rates of gastrointestinal bleeding.

Methods: A systematic review was performed in PubMed, Embase, Web of Science, and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results: A total of 24 articles met the inclusion/exclusion criteria. The average rate of gastrointestinal bleeding among all studies was 5.5% (95% CI = 5.4-5.6%; n = 26,576). The average rate of clinically important gastrointestinal bleeding was 1.8% (95% CI = 1.79-1.82%; n = 3,857). The mean time since injury to when gastrointestinal bleeding occurred ranged from 5 to 22.5 days. For clinically important gastrointestinal bleeding the average time was 16 days or less. Those with cervical injuries had a higher incidence of clinically important gastrointestinal bleeding compared to those with non-cervical injuries (2.7% vs. 0.7%). No study found any difference in the use of stress ulcer prophylaxis in participants with or without gastrointestinal bleeding.

Conclusions: The overall incidence of clinically important gastrointestinal bleeding among studies was found to be low. Individuals with non-cervical injury were not found to be at high risk of clinically important gastrointestinal bleeding. There was also insufficient evidence to indicate that use of stress ulcer prophylaxis reduces the rate of gastrointestinal bleeding in those with traumatic spinal cord injury.

Objectives: Assess pateint-reported effects of transcutaneous spinal cord stimulation (tSCS) on spasticity after multiple treatment.

Design: An uncontrolled prospective case series study.

Setting: A rehabilitation hospital.

Participants: A convenience sample of hospitalized adults with spinal cord injury (SCI) and lower-body spasticity limiting physical function and/or reducing quality of life (i.e. pain, sleep disturbance).

Interventions: Participants received 30 minutes of tSCS (continuous, asymmetrical, biphasic rectangular impulses, 100 Hz) applied for 3-6 consecutive days using NeuroTrac multiTENS® (http://quintet.no). Two electrodes were placed paravertebrally at Th11-Th12 level and two on lower abdomen.

Outcome measures: Penn`s Spasm Frequency and Severity Scales were used for quantifying spasticity, Numeric Rating Scales (NRS 0-10) for perceived impact of spasticity on one chosen activity of a daily living, sleep-disturbance, and pain in trunk/lower limbs due to spasticity. The outcome measures were completed through interviews conducted before the first treatment, and immediately after the last treatment.

Results: Seventeen people participated; injury levels C6-T12, AIS A-D, and mean age 51 years (SD 14). Fourteen participants reported a clinical important improvement in ADL performance, sleep disturbance and/or a decrease in pain due to spasticity (≥ two points on NRS). Minimal change was reported on Penn`s Spasm frequency and Severity Scales. No adverse events were observed.

Conclusions: The majority of the participants perceived clinically relevant improvements on at least one patient-reported outcome measure, and no adverse events were reported. This is a simple and a non-invasive treatment that may have a potential of reducing the troublesome effects of spasticity.

Objectives: This study serves a methodological reference and provides epidemiological profile for Ecuador's first population-based survey on spinal cord injury.

Methods: We determined sample size and eligibility using data from the National Council for Disability Equality. The survey was developed with translation, cultural adaptation, and pilot testing. In collaboration with the National Federation of People with Physical Disabilities of Ecuador, data were collected. Participants were classified by SCI etiology and severity to describe the cohort profile. Additionally, incidence and mortality rates from 2017 to 2022 were estimated using hospital discharge data.

Results: The survey involved 633 individuals, with a final cohort of 521 eligible participants, 75.2% of whom were male. The mean age was 45 years. Traumatic SCIs constituted 83.4% of cases, with 80.8% being paraplegic. The median age at onset was 27 years, and participants had lived with the injury for a median of 14 years. Traffic accidents were the leading cause of traumatic injuries (36.1%), followed by violence (16.6%) and work accidents (15.9%). Nontraumatic injuries primarily resulted from spinal degeneration (31.4%) and infections (29.1%). Traumatic injuries were more common in younger males, while nontraumatic injuries were more frequent among older females. Annually, Ecuador sees 516 new SCI cases, equating to three cases per 100,000 people, with a hospital mortality rate during the acute period of 3%.

Conclusion: This study presents the first national epidemiological profile of SCI in Ecuador, showing that injuries predominantly affect young individuals, primarily due to traffic accidents. The findings highlight areas for intervention and provide valuable insights into data collection and rehabilitation strategies for future research.

Context: While healthcare disparities related to race and ethnicity are well reported for non-emergent conditions, the literature on disparities in outcomes of emergent spinal conditions such as cauda equina syndrome (CES) remains sparse.

Objective: To evaluate racial disparities in complication, mortality, and readmission rates following surgical intervention for CES.

Methods: This retrospective analysis of The Statewide Planning and Research Cooperative System (SPARCS) database demonstrates that among patients surgically treated for CES in New York between 2015 and 2020. Bivariate and multivariate logistic regression analysis was performed to analyze the association of race and outcome variables after controlling for age, sex, comorbidities, length of stay, insurance, and hospital characteristics.

Results: Overall, 2,114 patients who underwent lumbar surgery for CES were identified. The study population was comprised of Black patients (177, 8%), White patients (79%, 1680), and Asian patients (257, 12%). Options for surgery included lumbar decompression (821, 38.8%), fusion (746, 35.3%), or both (547, 25.9%). On multivariate analysis, the odds of 30-day mortality were 2.98-fold greater in Black patients than in other patients (P = 0.029). By 180 and 360 days, the odds of mortality were 4.27 and 3.05-fold greater in Black patients than in other patients, respectively (P < 0.001 each). Thirty-day readmissions were 1.87-fold greater in Black patients than others (P = 0.004). No difference in overall complication rate was found between Black patients and all other race groups (P = 0.306).

Conclusions: Black patients surgically treated for CES face significantly higher rates of mortality and readmission than their non-Black counterparts.

Context: Falling is common after spinal cord injury (SCI). Falls can cause a fear of falling and reduced participation in activities. Interventions that target falls self-efficacy may change fall-related behaviors, such as reduced participation.

Objective: The primary objective was to investigate the impact of a photovoice intervention on falls self-efficacy in individuals with chronic SCI. The secondary objectives were to examine the effects of photovoice on participation, quality of life, fear of falling and falls.

Methods;: Convergent mixed methods study with 34 adults with chronic SCI; 17 used a wheelchair (WC) and 17 ambulated (AM). The six-week, virtual photovoice intervention focused on fall prevention and consisted of photo-assignments, individual interviews and group meetings facilitated by a peer mentor. The primary measures were questionnaires of falls self-efficacy and falling concern. The secondary measures included questionnaires of participation, quality of life and fear of falling, and number of falls. Quantitative data were compared over time for WC and AM groups separately with a repeated measures ANOVA or Friedman's test. Semi-structured interviews and thematic analysis were used to collect and analyze qualitative data. A joint display merged quantitative and qualitative findings.

Results: Scores did not change over time for both groups (p≥0.109) with the exception of participation. The AM group's participation scores were significantly improved three months post-intervention (p≤0.028). Overall, divergence between quantitative and qualitative data was observed, with some participants describing improvements in self-efficacy and quality of life.

Conclusions: A photovoice intervention focused on fall prevention may benefit ambulatory individuals with chronic SCI.Trial registration: ClinicalTrials.gov identifier: NCT04864262.

Background: Between January 2020 and December 2023, the United States reported over 103 million COVID-19 cases and 1.1 million related deaths. Veterans with spinal cord injuries and disorders (VSCI/D) are particularly vulnerable due to chronic health conditions and comorbidities, which increases COVID-19 infection and mortality risk from exposure to others who they depend on for care. This manuscript highlights factors associated with COVID-19 vaccine uptake in VSCI/D.

Objective: This study aimed to explore Veteran demographic and clinical factors associated with COVID-19 test positivity, vaccine uptake, and COVID-19-related mortality among VSCI/D in the 2-year period following the start of the pandemic.

Methods: This observational cohort study used the Veterans Health Administration's (VHA) Spinal Cord Injuries and Disorders Registry to identify VSCI/D alive on March 20, 2020. Outcome measures included COVID-19 test positivity, vaccine uptake, and mortality within 30 days of a positive test over a 2-year period.

Results: Among 17,522 VSCI/D, 12% had a positive COVID-19 test at least once in the two-year period following March 20, 2020, 73% received at least one COVID-19 vaccine dose in the 2-year period, and 47% received at least three doses. COVID-related mortality occurred in 67 (0.4%; 67/17,522) VSCI/D in the first year of the pandemic and 46 in the second year (0.6% two-year mortality; 113/17,522).

Conclusion: Less than half of VSCI/D received three COVID-19 vaccine doses, suggesting opportunities for quality improvement efforts. Peer support services may help improve vaccine uptake among VSCI/D in the future.

Context: Self-management (SM) is essential for individuals with spinal cord injury (SCI) to manage complex health needs and maintain autonomy post-rehabilitation. While early research focused on medical aspects, recent studies increasingly explore psychosocial and contextual challenges. However, the evolution of SCI SM research and its alignment with real-world implementation remains understudied.

Objective: To map two decades of SCI SM research, describing design, topic, population and setting trends, and synthesizing evidence on day-to-day SM practices and unmet needs.

Methods: Applying Arksey & O'Malley's scoping framework, JBI guidance and PRISMA-ScR standards, we searched PubMed, ScienceDirect, CINAHL, Scopus and Cochrane Library. Trend analyses summarized study characteristics; thematic synthesis integrated reported experiences of everyday SM.

Results: Sixty-one articles (51 studies) met inclusion criteria, mostly published between 2019-2025. Findings reveal methodological diversification, with growing qualitative and mixed-methods research alongside quantitative designs. Studies increasingly span inpatient and community settings, reflecting emphasis on early SM skill development. Three thematic dimensions are identified: Individual factors (knowledge, psychological well-being, integration of SM into daily life), Interpersonal and societal influences (patient-provider relationships, societal contexts), and Technological integration (enhancement of SM outcomes, usability and feasibility). While medical management dominates, emotional and role management remain comparatively under-examined.

Conclusions: SCI SM research is expanding in scope but remains uneven in supporting practical implementation. This review highlights the need for interventions that go beyond behavior change to address everyday adaptation, contextual barriers, and sustained SM skills. More longitudinal and participatory research is needed to ensure SM strategies match the lived realities of individuals with SCI.

Context: The psychosocial consequences of a Spinal Cord Injury or Disorder (SCI/D) can include increased loneliness. However, differences in the measurement of loneliness confound the available evidence.

Objectives: To compare levels of loneliness between adults with a SCI/D and the general population (Touch Test data) using the UCLA Loneliness Scale (any version). A secondary aim was to explore potential subgroups vulnerable to loneliness.

Methods: Observational studies examining loneliness in SCI/D were identified via CINAHL, PubMed, PsycINFO, MEDLINE, Embase, Web of Science (up until 9th Sept 2025), Google Scholar (first 100 results), and targeted citation searching. Standardized mean group differences (Hedges' g) were pooled using random effects modelling and the methodological quality of included studies evaluated (QualSyst tool). Study characteristics and bivariate correlations of loneliness in SCI/D were additionally examined.

Results: Thirteen observational studies (N = 3029 adults with SCI/D) were included in the analysis. Average UCLA scores (revised Version 3, 20-item and 3-item) for the pooled SCI/D sample and the general population were comparable, with both groups reporting moderate levels of loneliness (g_w = .01; CI: -.43 to .46, P = .951). Individual effect estimates among the SCI/D studies were, however, characterized by imprecision and heterogeneity. Associations between loneliness, demographic and SCI/D characteristics were inconsistent although those who were lonely did report adverse health and social outcomes.

Conclusions: The underlying personal, social and environmental factors which contribute to loneliness in SCI/D should be monitored and addressed. Ongoing research is also needed to develop a more culturally nuanced understanding of loneliness in disability. Protocol registration: https://osf.io/s6723/.

Context/objective: spinal cord injury (SCI) is a debilitating condition that can lead to severe motor deficits. This study aimed to evaluate the therapeutic effects of hederagenin, a Chinese herbal medicinal ingredient, on motor recovery and the inflammatory response in rat models of SCI.

Design: We used the Allen weight-drop technique to create a Sprague-Dawley rat model of spinal cord injury. We then administered hederagenin (10 mg/kg) via intraperitoneal injection for 28 consecutive days.

Setting: Third-class first-class hospital.

Outcome measures: The Basso-Beattie-Bresnahan (BBB) scores were evaluated. Histological analyses were performed via hematoxylin and eosin staining. The levels of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) in SCI rat spinal cord tissues were evaluated by immumohistochemical staining. Microglial activation markers (Iba-1) and M2 phenotypic markers (CD206) were assessed by Immunofluorescence staining. PPAR-γ in rats were assessed by western blotting (WB).

Results: The Basso-Beattie-Bresnahan (BBB) scoring system assessed locomotor function, and revealed significant improvements in BBB score in hederagenin-treated rats starting from the fifth day post-surgery. We also found elevated levels of pro-inflammatory cytokines (IL-1β, IL-6, and TNF-α) in the spinal cord tissues of SCI rats, which significantly decreased after hederagenin Treatment. We also analyzed Microglial activation markers were analyzed, including Iba-1. Our results showed increased expression of CD206 in response to hederagenin, indicating that it promotes M2 polarization and reduces microglial activation. Additionally, hederagenin increased the expression of peroxisome proliferator-activated receptor-γ (PPAR-γ) in rats with SCI. However, the PPAR-γ inhibitor GW966 reversed the above roles of hederagenin.

Conclusion: Our results indicate that hederagenin not only aids in the recovery of motor function in SCI rats but also diminishes inflammation while fostering neuroprotection via the modulation of microglial activity. This effect may be linked to the activation of the PPAR-γ signaling pathway. These results provide compelling evidence for the potential of hederagenin as a therapeutic agent for SCI and warrant further investigation into its clinical applications in neuroregeneration and inflammation modulation.