scholarly journals Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study

2013 ◽  
Vol 35 (1) ◽  
pp. E10 ◽  
Author(s):  
Jau-Ching Wu ◽  
Chin-Chu Ko ◽  
Yu-Shu Yen ◽  
Wen-Cheng Huang ◽  
Yu-Chun Chen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Cervical Spondylotic Myelopathy ◽  
Incidence Density ◽  
Control Group ◽  
Cord Injury ◽  
National Cohort ◽  
Age And Sex

Object This study aimed to determine the age- and sex-specific incidence of cervical spondylotic myelopathy (CSM) and its associated risk of causing subsequent spinal cord injury (SCI). Methods Using the National Health Insurance Research Database (NHIRD), a 12-year nationwide database in Taiwan, this retrospective cohort study analyzed the incidence of hospitalization caused by CSM. All patients diagnosed with and admitted for CSM were identified during the study period. The CSM patients were divided into 2 groups, a control group and an operated group. An incidence density method was used to estimate age- and sex-specific incidence rates of CSM. The Kaplan-Meier method and Cox regression analyses were performed to compare the risk of SCI between the 2 groups. Results From 1998 to 2009, covering 349.5 million person-years, 14,140 patients were hospitalized for CSM. The overall incidence of CSM-related hospitalization was 4.04 per 100,000 person-years. Specifically, males and older persons had a higher incidence rate of CSM. During the follow-up of these patients for 13,461 person-years, a total of 166 patients were diagnosed with SCI. The incidence of SCI was higher in the control group than the operated group (13.9 vs 9.4 per 1000 person-years, respectively). During the follow-up, SCI was more likely to occur in CSM patients who were treated conservatively (crude HR 1.48, p = 0.023; adjusted HR 1.57, p = 0.011) than in those who underwent surgery for CSM. Conclusions In a national cohort of eastern Asia, the incidence of CSM-caused hospitalization was 4.04 per 100,000 person-years, with higher incidences observed in older and male patients. Subsequent SCI was more likely to develop in patients who received nonoperative management than in those who underwent surgery. Therefore, patients with CSM managed without surgery should be cautioned about SCI. However, further investigations are still required to clarify the risks and complications associated with surgery for CSM.

scholarly journals Health promotion and cardiovascular risk reduction in people with spinal cord injury: physical activity, healthy diet and maintenance after discharge— protocol for a prospective national cohort study and a preintervention- postintervention study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030310 ◽  
Author(s):  
Nicolaj Jersild Holm ◽  
Tom Møller ◽  
Lis Adamsen ◽  
Line Trine Dalsgaard ◽  
Fin Biering-Sorensen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Cardiovascular Risk ◽  
Primary Study ◽  
Cord Injury ◽  
National Cohort ◽  
Test Retest Reliability

IntroductionSpinal cord injury (SCI) predisposes those who suffer from it to physical inactivity and weight gain; consequently, death due to cardiovascular diseases is more frequent among people with SCI than in the general population. The literature documents a consensus about an interdisciplinary multimodal approach for the prevention and treatment of cardiovascular risk factors including overweight and obesity in people with SCI, focusing on diet, physical activity (PA) and behavioural interventions. This study will investigate implementation of recommendations from a recent clinical practice guideline for identification and management of cardiometabolic risk after SCI through multimodal patient education in a subacute clinical setting.Methods and analysisAll patients who are aged 18 years or older with an SCI within the previous 12 months and admitted to highly specialised rehabilitation are included, regardless of SCI aetiology or neurological level. A primary study designed as a controlled, pragmatic, preintervention- postintervention study with 6-month follow-up evaluates the effect of the clinical intervention; a prospective national cohort study on body mass index (BMI) serves as a historical control. The intervention consists of a standardised approach to patient education about cardiovascular risk factors, PA and a healthy diet that begins at the outset of primary SCI rehabilitation and is integrated into existing settings and workflows. Outcome measures are collected at admission, discharge and 6 months after discharge and include peak oxygen uptake (VO2peak) (primary outcome), BMI, body composition, metabolic profile, neurological status, level of functioning, depression, quality of life, objective PA (accelerometry), self-reported PA, self-assessed PA ability, shared decision making, and dietary habits. Test–retest reliability of four VO2peak test protocols are investigated, as is test–retest reliability of a multisensor accelerometer in a rehabilitation setting.Ethics and disseminationThe project is approved by the Committees on Health Research Ethics in the Capital Region of Denmark on 10 July 2018 (Journal-nr.: H-18018325). The principal investigator obtains informed consent from all participants. The interventions in the project are closely related to existing rehabilitation care, and the risk of pain and discomfort is considered modest. Any unintended events related to the elements of the intervention are reported, according to existing regional procedures. Data are stored in a secure web-based database (Redcap). The primary study and prospective cohort study are registered at Clinicaltrials.gov. Positive and negative results will be submitted to relevant scientific journals related to SCI for publication. Important protocol modifications are reported to the Committees on Health Research Ethics in the Capital Region of Denmark.Trial registration numbersNCT03689023 and NCT03369080.

scholarly journals All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland

Spinal Cord ◽  
2019 ◽  
Vol 58 (2) ◽  
pp. 157-164 ◽  
Author(s):  
A. Buzzell ◽  
◽  
J. D. Chamberlain ◽  
I. Eriks-Hoogland ◽  
K. Hug ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Clinical Care ◽  
Population Based ◽  
Future Research ◽  
Cord Injury ◽  
Specific Mortality ◽  
National Cohort

Abstract Study design Observational cohort study. Objective To benchmark all-cause and cause-specific mortality following NTSCI to the general population (GP). Setting Specialized rehabilitation centers in Switzerland. Methods Longitudinal data from the Swiss Spinal Cord Injury (SwiSCI) Medical Record study were probabilistically linked with cause of death (CoD) information from the Swiss National Cohort. Standardized mortality ratios (SMRs) were estimated for all-cause and cause-specific mortality. Competing risk frameworks were used to estimate the probability of death due to specific CoD. Results One thousand five hundred and one individuals were admitted for first rehabilitation with NTSCI between 1990–2011; CoD information was available for 454 individuals of the 525 individuals that died. Overall, the mortality rate for persons with NTSCI was 1.6 times greater than that of the GP. Deaths due to cardiovascular disease (39.8%), neoplasms (22%), and infection (9.9%) were most often reported. Individuals with an SCI due to a vascular etiology indicated the greatest burden of mortality from infection compared with the GP (SMR 5.4; 95% CI, 3.1 to 9.2). Conclusions Cause-specific SMRs varied according to etiology. This supports the need for targeted clinical care and follow-up. Cardiovascular disease, neoplasms, and infection, emerged as main causes of death following NTSCI and should thus be targets for future research and differential clinical management approaches.

scholarly journals Risk of spinal cord injury in patients with cervical spondylotic myelopathy and ossification of posterior longitudinal ligament: a national cohort study

2016 ◽  
Vol 40 (6) ◽  
pp. E4 ◽  
Author(s):  
Li-Fu Chen ◽  
Tsung-Hsi Tu ◽  
Yu-Chun Chen ◽  
Jau-Ching Wu ◽  
Peng-Yuan Chang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Lower Incidence ◽  
Cervical Spondylotic Myelopathy ◽  
Cox Regression ◽  
Posterior Longitudinal Ligament ◽  
Incidence Rates ◽  
Cord Injury ◽  
Male Patients

OBJECTIVE This study aimed to estimate the risk of spinal cord injury (SCI) in patients with cervical spondylotic myelopathy (CSM) with and without ossification of posterior longitudinal ligament (OPLL). Also, the study compared the incidence rates of SCI in patients who were managed surgically and conservatively. METHODS This retrospective cohort study covering 15 years analyzed the incidence of SCI in patients with CSM. All patients, identified from the National Health Insurance Research Database, were hospitalized with the diagnosis of CSM and followed up during the study period. These patients with CSM were categorized into 4 groups according to whether they had OPLL or not and whether they received surgery or not: 1) surgically managed CSM without OPLL; 2) conservatively managed CSM without OPLL; 3) surgically managed CSM with OPLL; and 4) conservatively managed CSM with OPLL. The incidence rates of subsequent SCI in each group during follow-up were then compared. Kaplan-Meier and Cox regression analyses were performed to compare the risk of SCI between the groups. RESULTS Between January 1, 1999, and December 31, 2013, there were 17,258 patients with CSM who were followed up for 89,003.78 person-years. The overall incidence of SCI in these patients with CSM was 2.022 per 1000 person-years. Patients who had CSM with OPLL and were conservatively managed had the highest incidence of SCI, at 4.11 per 1000 person-years. Patients who had CSM with OPLL and were surgically managed had a lower incidence of SCI, at 3.69 per 1000 person-years. Patients who had CSM without OPLL and were conservatively managed had an even lower incidence of SCI, at 2.41 per 1000 person-years. Patients who had CSM without OPLL and were surgically managed had the lowest incidence of SCI, at 1.31 per 1000 person-years. The Cox regression model demonstrated that SCIs are significantly more likely to happen in male patients and in those with OPLL (HR 2.00 and 2.24, p < 0.001 and p = 0.007, respectively). Surgery could significantly lower the risk for approximately 50% of patients (HR 0.52, p < 0.001). CONCLUSIONS Patients with CSM had an overall incidence rate of SCI at approximately 0.2% per year. Male sex, the coexistence of OPLL, and conservative management are twice as likely to be associated with subsequent SCI. Surgery is therefore suggested for male patients with CSM who also have OPLL.

scholarly journals Age, Sex, and Socio-Economic Status Affect the Incidence of Pediatric Spinal Cord Injury: An Eleven-Year National Cohort Study

PLoS ONE ◽  
2012 ◽  
Vol 7 (6) ◽  
pp. e39264 ◽  
Author(s):  
Li-Chien Chien ◽  
Jau-Ching Wu ◽  
Yu-Chun Chen ◽  
Laura Liu ◽  
Wen-Cheng Huang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Economic Status ◽  
Socio Economic Status ◽  
Cord Injury ◽  
Pediatric Spinal Cord Injury ◽  
National Cohort

Increased risk of stroke after spinal cord injury: A nationwide 4-year follow-up cohort study

Neurology ◽  
2012 ◽  
Vol 78 (14) ◽  
pp. 1051-1057 ◽  
Author(s):  
J.-C. Wu ◽  
Y.-C. Chen ◽  
L. Liu ◽  
T.-J. Chen ◽  
W.-C. Huang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Increased Risk ◽  
Cord Injury

scholarly journals Pharyngeal Dysphagia in Individuals With Cervical Spinal Cord Injury: A Prospective Observational Cohort Study

2019 ◽  
Vol 25 (4) ◽  
pp. 322-330
Author(s):  
Kazuko Shem ◽  
Joseph Wong ◽  
Ben Dirlikov ◽  
Kathleen Castillo
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Time Course ◽  
Cervical Spinal Cord ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Unit ◽  
Cord Injury

Objectives: To identify and describe the types and time course of dysphagia following cervical spinal cord injury (SCI). Methods: This was a prospective cohort study conducted in an SCI inpatient rehabilitation unit. Seventy-six individuals with SCI were enrolled. Inclusion criteria were age 18 years or older, admitted into SCI inpatient rehabilitation unit, and medically stable for participation in bedside swallow evaluation (BSE) and videofluoroscopic swallow study (VFSS). All participants first underwent a BSE, of whom 33 completed a VFSS. A follow-up BSE was conducted on individuals who tested positive on the initial BSE and continued to show signs of dysphagia. Diagnosis and type of dysphagia as well risk factors were collected. Results: Twenty-three out of 76 individuals with cervical SCI were diagnosed with dysphagia using the BSE. All participants with positive BSE and VFSS had pharyngeal dysfunction. For participants with a positive initial BSE and persisting dysphagia ( n = 14), a follow-up BSE demonstrated resolution within 34 days. Risk factors associated with dysphagia were older age, nasogastric tube, invasive mechanical ventilation, tracheostomy, and pneumonia. Posterior spinal surgery was associated with a decreased risk of dysphagia. Conclusion: Dysphagia was present in 30% of individuals based on the initial BSE. All individuals with dysphagia demonstrated pharyngeal phase dysfunction on the VFSS. No participants experiencing dysphagia were missed on the BSE as confirmed by VFSS. In the subset of individuals who received a follow-up BSE, the time course of resolution of dysphagia was at most 34 days from initial BSE.

scholarly journals Method of Decompression by durotomy and duroplasty for cervical spinal cord injury in patients without fracture or dislocation

2018 ◽  
Vol 1 (1) ◽  
pp. 158-164 ◽  
Author(s):  
Dionne Telemacque ◽  
Fengzhao Zhu ◽  
Kaifang Chen ◽  
Lin Chen ◽  
Zhengwei Ren ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Control Group ◽  
Cord Injury ◽  
Prevention And Treatment ◽  
The Mean ◽  
Spinal Cord Decompression ◽  
Experimental Group

Introduction:We developed the method of cervical spinal cord decompression through durotomy followed by duroplasty and analyzed its efficacy.Purpose:To develop a tactic of decompression durotomy and duroplasty for the treatment of severe spinal cord injury(SCI) with extensive edema of the spinal cord and without intramedullary hematoma, and to demonstrate the effectiveness of this method.Methods:From October 2016 to January 2018, 17 decompression operations were performed in the cervical spine in patients with SCI. Decompression laminectomy was done without durotomy in the first group of patients. In the second group, duroplasty of the spinal cord was performed after decompression durotomy. A total of 17 patients, 16 males (94%) and 1 female (6%), were operated on (ages from 32 to 66 years). The patients were divided into two groups: a control group and an experimental group. We used the ASIA scale for assessing the patients. The mean follow up time is 12 months (8−24 months).Results:The first group, i.e., the control group consisted of 10 patients who underwent decompression laminectomy without durotomy. The second group, i.e., the experimental group consisted of 7 patients who underwent durotomy followed by duroplasty. In this group, the positive dynamics were observed in 6 patients. Out of 2 patients with ASIA grade “A”, one showed improvement to ASIA grade “C”, and one improved to ASIA “D”. Two patients with ASIA grade “B” showed recovery to ASIA “D”. Two patients with ASIA grade “C” improved to grade “D” while one patient showed no change from ASIA “C”. Durotomy and duroplasty was effective in the experimental group.Conclusion:The performance of durotomy and duroplasty is an efficient method for the full-scale decompression of the spinal cord and the prevention of edema. This method aims at decreasing intraspinal pressure, as well as preventing ischemia and apoptosis, which is possible for the prevention and treatment of the spinal cord compartment syndrome or spinal cord intramedullary hypertension.

Increased risk of acute coronary syndrome after spinal cord injury: A nationwide 10-year follow-up cohort study

2013 ◽  
Vol 168 (2) ◽  
pp. 1681-1682 ◽  
Author(s):  
Yen-Kung Chen ◽  
Tzu-Jen Hung ◽  
Che-Chen Lin ◽  
Ruoh-Fang Yen ◽  
Fung-Chang Sung ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Acute Coronary Syndrome ◽  
Cohort Study ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Cord Injury

scholarly journals Clinical Outcomes Using Modest Intravascular Hypothermia After Acute Cervical Spinal Cord Injury

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. 670-677 ◽  
Author(s):  
Allan D. Levi ◽  
Gizelda Casella ◽  
Barth A. Green ◽  
W. Dalton Dietrich ◽  
Steven Vanni ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Outcomes ◽  
Cervical Spinal Cord ◽  
Phase 1 ◽  
Medical Society ◽  
Control Group ◽  
Complication Rates ◽  
Cord Injury

Abstract BACKGROUND Although a number of neuroprotective strategies have been tested after spinal cord injury (SCI), no treatments have been established as a standard of care. OBJECTIVE We report the clinical outcomes at 1-year median follow-up, using endovascular hypothermia after SCI and a detailed analysis of the complications. METHODS We performed a retrospective analysis of American Spinal Injury Association and International Medical Society of Paraplegia Impairment Scale (AIS) scores and complications in 14 patients with SCI presenting with a complete cervical SCI (AIS A). All patients were treated with 48 hours of modest (33°C) intravascular hypothermia. The comparison group was composed of 14 age- and injury-matched subjects treated at the same institution. RESULTS Six of the 14 cooled patients (42.8%) were incomplete at final follow-up (50.2 [9.7] weeks). Three patients improved to AIS B, 2 patients improved to AIS C, and 1 patient improved to AIS D. Complications were predominantly respiratory and infectious in nature. However, in the control group, a similar number of complications was observed. Adverse events such as coagulopathy, deep venous thrombosis, and pulmonary embolism were not seen in the patients undergoing hypothermia. CONCLUSION This study is the first phase 1 clinical trial on the safety and outcome with the use of endovascular hypothermia in the treatment of acute cervical SCI. In this small cohort of patients with SCI, complication rates were similar to those of normothermic patients with an associated AIS A conversion rate of 42.8%.

scholarly journals Epidemiology of Traumatic Spinal Cord Injuries in Colombia

2021 ◽  
Author(s):  
Yalisma Andrea Giraldo ◽  
José Luis Castro ◽  
Maria Ana Tovar-Sanchez ◽  
Annora A. Kumar ◽  
Sara G. Pacichana-Quinayaz ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Interpersonal Violence ◽  
Annual Incidence ◽  
Data Set ◽  
Referral Center ◽  
Cord Injury ◽  
The Mean

Abstract Study Design: Retrospective cohort study.Objectives: To determine the incidence and characteristics of newly injured individuals admitted to a traumatic spinal cord injury (TSCI) referral center during a 4-year period.Setting: University Hospital of Valle, Cali, Colombia.Methods: Individuals were identified, and their data was recorded based on the International Spinal Cord Injury Core Data Set. The outcome of interest was the American Spinal Injury Association Impairment Scale (AIS) grade at last follow-up.Results: There were 491 individuals admitted in the 4-year period. The mean annual incidence of TSCI was 56.27 per million inhabitants. Considering TSCI in individuals exclusively from Cali, the mean annual incidence was 27.78 per million. The leading cause of TSCI was interpersonal violence (47.25%) and falls (33.60%). There was a 96.52% (p<0.0001) correlation between AIS grade at admission and last follow-up. The most common AIS grade at last follow-up was E (34.01%) caused mostly by falls (57.48%), followed by A (31.16%) caused mostly by interpersonal violence (76.27%). The reported employment rate dropped from 75.56% to 18.94% before and after TSCI (p<0.05). AIS grade A was associated with more post-injury complications (p<0.05).Conclusions: This is the first cohort study in Colombia describing the incidence and AIS grades of individuals with TSCI from a trauma referral center. Interpersonal violence was overrepresented in this population. Future research should include the evaluation of prevention strategies, as well as research on interventions towards quality improvement in patient care and post discharge services especially for individuals with AIS grade A.

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