A multicentre follow-up of clinical aspects of traumatic spinal cord injury

✓ Sixty-nine patients with traumatic spinal cord injuries were evaluated for changes in their functional neurological status at discharge from the hospital, and at 1 year, 3 years, and 5+ years following injury. The neurological examinations were used to classify patients' spinal cord injury according to the Frankel scale. This analysis revealed that the majority of improvement in neurological function occurred within the 1st year following injury; however, changes in the patients' status continued for many years. Follow-up examinations at an average of 3 years postinjury revealed that 23.3% of the patients continued to improve, whereas 7.1% had deteriorated compared to their status at 1 year. An examination at an average of 5+ years demonstrated further improvement in 12.5%, with 5.0% showing deterioration compared to the examinations at 3 years. These results demonstrate that, in patients with spinal trauma, significant changes in neurological function continue for many years.

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Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up

Spinal Cord ◽

10.1038/sc.2014.41 ◽

2014 ◽

Vol 52 (6) ◽

pp. 462-467 ◽

Cited By ~ 11

Author(s):

N Yıldız ◽

◽

Y Akkoç ◽

B Erhan ◽

B Gündüz ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neurogenic Bladder ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

Injury Treatment

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Acute, severe traumatic spinal cord injury: improving urinary bladder function by optimizing spinal cord perfusion

Journal of Neurosurgery Spine ◽

10.3171/2021.3.spine202056 ◽

2021 ◽

pp. 1-8

Author(s):

Florence R. A. Hogg ◽

Siobhan Kearney ◽

Eskinder Solomon ◽

Mathew J. Gallagher ◽

Argyro Zoumprouli ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Urinary Bladder ◽

Perfusion Pressure ◽

Bladder Function ◽

Traumatic Spinal Cord Injury ◽

Injury Site ◽

Bladder Compliance ◽

Cord Injury

OBJECTIVE The authors sought to investigate the effect of acute, severe traumatic spinal cord injury on the urinary bladder and the hypothesis that increasing the spinal cord perfusion pressure improves bladder function. METHODS In 13 adults with traumatic spinal cord injury (American Spinal Injury Association Impairment Scale grades A–C), a pressure probe and a microdialysis catheter were placed intradurally at the injury site. We varied the spinal cord perfusion pressure and performed filling cystometry. Patients were followed up for 12 months on average. RESULTS The 13 patients had 63 fill cycles; 38 cycles had unfavorable urodynamics, i.e., dangerously low compliance (< 20 mL/cmH2O), detrusor overactivity, or dangerously high end-fill pressure (> 40 cmH2O). Unfavorable urodynamics correlated with periods of injury site hypoperfusion (spinal cord perfusion pressure < 60 mm Hg), hyperperfusion (spinal cord perfusion pressure > 100 mm Hg), tissue glucose < 3 mM, and tissue lactate to pyruvate ratio > 30. Increasing spinal cord perfusion pressure from 67.0 ± 2.3 mm Hg (average ± SE) to 92.1 ± 3.0 mm Hg significantly reduced, from 534 to 365 mL, the median bladder volume at which the desire to void was first experienced. All patients with dangerously low average initial bladder compliance (< 20 mL/cmH2O) maintained low compliance at follow-up, whereas all patients with high average initial bladder compliance (> 100 mL/cmH2O) maintained high compliance at follow-up. CONCLUSIONS We conclude that unfavorable urodynamics develop within days of traumatic spinal cord injury, thus challenging the prevailing notion that the detrusor is initially acontractile. Urodynamic studies performed acutely identify patients with dangerously low bladder compliance likely to benefit from early intervention. At this early stage, bladder function is dynamic and is influenced by fluctuations in the physiology and metabolism at the injury site; therefore, optimizing spinal cord perfusion is likely to improve urological outcome in patients with acute severe traumatic spinal cord injury.

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Mortality after traumatic spinal cord injury: 50 years of follow-up

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.2009.178798 ◽

2009 ◽

Vol 81 (4) ◽

pp. 368-373 ◽

Cited By ~ 74

Author(s):

E. M. Hagen ◽

S. A. Lie ◽

T. Rekand ◽

N. E. Gilhus ◽

M. Gronning

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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Incidence of skeletal fractures after traumatic spinal cord injury: a 10-year follow-up study

Clinical Rehabilitation ◽

10.1177/0269215513501905 ◽

2013 ◽

Vol 28 (4) ◽

pp. 361-369 ◽

Cited By ~ 40

Author(s):

Laia Gifre ◽

Joan Vidal ◽

Josep Carrasco ◽

Enric Portell ◽

Josep Puig ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Traumatic Spinal Cord Injury ◽

Follow Up Study ◽

Cord Injury

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Survival in Persons With Traumatic Spinal Cord Injury Receiving Structured Follow-Up in South India

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2013.11.003 ◽

2014 ◽

Vol 95 (4) ◽

pp. 642-648 ◽

Cited By ~ 5

Author(s):

Apurba Barman ◽

Devika Shanmugasundaram ◽

Rohit Bhide ◽

Anand Viswanathan ◽

Henry Prakash Magimairaj ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

South India ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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Urodynamic study of Bladder Behaviour in Traumatic Spinal Cord Injury Patients in Response to Rehabilitation

Indian Journal of Physical Medicine and Rehabilitation ◽

10.5005/ijopmr-24-4-87 ◽

2013 ◽

Vol 24 (4) ◽

pp. 87-91

Author(s):

Singh Ningthoujam Jungindro ◽

Keshkar Sanjay, ◽

Singh Naorem Ajit ◽

Kumar Ratnesh

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Neuron ◽

Neurogenic Bladder ◽

Traumatic Spinal Cord Injury ◽

Urodynamic Study ◽

Rehabilitation Intervention ◽

Cord Injury ◽

Bladder Rehabilitation

Abstract Objective To study the bladder behaviour in response to rehabilitation intervention in traumatic spinal cord injury (SCI) patients using urodynamic study (UDS) and to compare the nature of the bladder in a rehabilitated and nonrehabilitated neurogenic bladder of traumatic SCI. Study design Prospective follow-up study. Setting Rehabilitation ward of National Institute for the Orthopaedically Handicapped. Material and Method Thirty traumatic SCI patients mean age 31.4±7.9 years, 26 males and 4 females, admitted for rehabilitation were done UDS to see the bladder behaviour in response to rehabilitation intervention and compare the nature of bladder of the rehabilitated and that of the non-rehabilitated neurogenic bladder. Rehabilitation of the bladder was done at least for three months. The study lasted for 2 years with a minimum of one year follow-up. Result In upper motor neuron (UMN) neurogenic bladders there were significant changes in the max. cystometric capacity (p=0.018) after rehab intervention. The compliance, Pdet. at first desire to void and Pdet. at max. cystometric capacity of these patients were also found to have significant correlations (p=0.012, 0.010 and 0.014 respectively). But the volume at the first desire to void does not show must significant changes after rehab intervention (p=0.45). Significant reduction of amplitude and frequency was found in involuntary contractions (detrusor hyper-reflexia). In similar comparison of the lower motor neuron (LMN) neurogenic bladder significant changes after rehab intervention, could be found only in the max. cystometric capacity (p=0.018). Other variables like compliance, volume at first desire to void, Pdet. at first desire to void, and Pdet. at max. cystometric capacity were found to have no significant changes after rehab intervention (p=0.168, 0.194, 0.324, 0.302 respectively). Conclusion The change in the nature of the rehabilitated neurogenic bladder is different with the type of bladder.

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Association of Secondary Health Conditions With Future Chronic Health Conditions Among Persons With Traumatic Spinal Cord Injury

Topics in Spinal Cord Injury Rehabilitation ◽

10.46292/sci20-00020 ◽

2020 ◽

Vol 26 (4) ◽

pp. 283-289

Author(s):

Yue Cao ◽

Nicole DiPiro ◽

James S. Krause

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Anxiety Disorder ◽

Chronic Health Conditions ◽

Blood Cholesterol ◽

Health Conditions ◽

Traumatic Spinal Cord Injury ◽

Chronic Health ◽

Cord Injury

Background: Secondary health conditions (SHC) are physical and mental health conditions that are causally related to disabilities. Studies have found that SHC increase risk of negative health outcomes among people with traumatic spinal cord injury (TSCI). However, little has been done to assess the association of SHC with the risk of chronic health conditions (CHC) after TSCI. Objectives: To identify the prevalence of CHC in adults with TSCI, changes in CHC at follow-up, and the associations of baseline SHC with future CHC. Methods: Participants included 501 adults with TSCI of at least 1-year duration, identified through a population-based surveillance system. Baseline and follow-up self-report assessments were completed. We measured seven SHC: fatigue, spasticity, pain, pressure ulcers, subsequent injury, fracture, and anxiety disorder, and measured seven CHC: diabetes, heart attack, coronary artery disease, stroke, cancer, hypertension, and high blood cholesterol. Control variables included gender, race/ethnicity, age at injury, years post injury, injury severity, smoking status, binge drinking, and taking prescription medication. We implemented a Poisson regression model for the multivariate analyses. Results: The total number of CHC, the percentage of participants having at least one CHC, and prevalence of three individual CHC (diabetes, cancer, and high cholesterol) increased from baseline to follow-up. After controlling for demographic, injury characteristics, and behavioral factors, pain interference and anxiety disorder at baseline were associated with the total number of CHC at follow-up. Conclusion: CHC are common among adults with TSCI and increase significantly over time. Pain and anxiety disorders appear to be risk factors for future CHC.

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Traumatic versus non traumatic spinal cord injury: Characteristics and functional outcome in a Tunisian rehabilitation centre

10.32512/jmr.1.2.2018/12.21 ◽

2018 ◽

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Functional Outcome ◽

Considerable Proportion ◽

Traumatic Spinal Cord Injury ◽

Physical Medicine ◽

Injury Characteristics ◽

Injury Group ◽

Cord Injury

Background: Understanding of the underlying mechanisms of Spinal cord injury (SCI) would help in the development of treatment strategies and enhance neurological recovery. Aim: The aim of this study was to describe clinical and demographic data of SCI in a physical medicine department and to compare neurological and functional outcome in Traumatic Spinal Cord Injury group (TSCI) and Non Traumatic Spinal Cord Injury group (NTSCI) during two years of follow up. Materials and methods: This study was conducted in a physical medicine and rehabilitation department of a tertiary hospital (January 2008-December 2014). Medical records of 177 patients with spinal cord injury (SCI) were reviewed. Two groups were defined: traumatic (TSCI) and non-traumatic (NTSCI) spinal cord injury. Characteristics and functional outcome were analyzed and compared. Results: Patients of NT group were significantly older. Most of injuries in both groups had a cervical level. ASIA scale scores and MIF scales were significantly higher in NT group at admission and after two years of follow up. The impairment was more remarkable in this group. Conclusions: Our study suggests that non traumatic SCI represent a considerable proportion of SCI rehabilitation admissions. Although different characteristics and injury patterns, functional outcomes maybe comparable to traumatic SCI. Key words: spinal cord injury, epidemiology, etiology, rehabilitation

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Neurological recovery following traumatic spinal cord injury: a systematic review and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2018.10.spine18802 ◽

2019 ◽

Vol 30 (5) ◽

pp. 683-699 ◽

Cited By ~ 15

Author(s):

MirHojjat Khorasanizadeh ◽

Mahmoud Yousefifard ◽

Mahsa Eskian ◽

Yi Lu ◽

Maryam Chalangari ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Recovery Rate ◽

Meta Analysis ◽

Neurological Recovery ◽

Traumatic Spinal Cord Injury ◽

Mechanism Of Injury ◽

Cord Injury ◽

Lower Recovery

OBJECTIVEPredicting neurological recovery following traumatic spinal cord injury (TSCI) is a complex task considering the heterogeneous nature of injury and the inconsistency of individual studies. This study aims to summarize the current evidence on neurological recovery following TSCI by use of a meta-analytical approach, and to identify injury, treatment, and study variables with prognostic significance.METHODSA literature search in MEDLINE and EMBASE was performed, and studies reporting follow-up changes in American Spinal Injury Association (ASIA) Impairment Scale (AIS) or Frankel or ASIA motor score (AMS) scales were included in the meta-analysis. The proportion of patients with at least 1 grade of AIS/Frankel improvement, and point changes in AMS were calculated using random pooled effect analysis. The potential effect of severity, level and mechanism of injury, type of treatment, time and country of study, and follow-up duration were evaluated using meta-regression analysis.RESULTSA total of 114 studies were included, reporting AIS/Frankel changes in 19,913 patients and AMS changes in 6920 patients. Overall, the quality of evidence was poor. The AIS/Frankel conversion rate was 19.3% (95% CI 16.2–22.6) for patients with grade A, 73.8% (95% CI 69.0–78.4) for those with grade B, 87.3% (95% CI 77.9–94.8) for those with grade C, and 46.5% (95% CI 38.2–54.9) for those with grade D. Neurological recovery was significantly different between all grades of SCI severity in the following order: C > B > D > A. Level of injury was a significant predictor of recovery; recovery rates followed this pattern: lumbar > cervical and thoracolumbar > thoracic. Thoracic SCI and penetrating SCI were significantly more likely to result in complete injury. Penetrating TSCI had a significantly lower recovery rate compared to blunt injury (OR 0.76, 95% CI 0.62–0.92; p = 0.006). Recovery rate was positively correlated with longer follow-up duration (p = 0.001). Studies with follow-up durations of approximately 6 months or less reported significantly lower recovery rates for incomplete SCI compared to studies with long-term (3–5 years) follow-ups.CONCLUSIONSThe authors’ meta-analysis provides an overall quantitative description of neurological outcomes associated with TSCI. Moreover, they demonstrated how neurological recovery after TSCI is significantly dependent on injury factors (i.e., severity, level, and mechanism of injury), but is not associated with type of treatment or country of origin. Based on these results, a minimum follow-up of 12 months is recommended for TSCI studies that include patients with neurologically incomplete injury.

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