Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review

OBJECTIVE Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI. METHODS A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain. CONCLUSIONS This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.

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Selenium-Binding Protein 1 (SELENBP1) as Biomarker for Adverse Clinical Outcome After Traumatic Spinal Cord Injury

Frontiers in Neuroscience ◽

10.3389/fnins.2021.680240 ◽

2021 ◽

Vol 15 ◽

Author(s):

Julian Seelig ◽

Raban Arved Heller ◽

Patrick Haubruck ◽

Qian Sun ◽

Jochen Georg Klingenberg ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Cell Damage ◽

Cell Activity ◽

Mechanical Trauma ◽

Specific Cell ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

Sensory Functions

Graphical AbstractThe pathophysiology of traumatic spinal cord injury (TSCI) can be divided into two major phases. (A) The mechanical trauma is followed within minutes by a secondary phase consisting of local complex and intertwined acute responses, intercellular signaling and cell activity regulating pathways. Inflammatory processes, oxidative stress and hypoxia, leading to cell damage and death, and specific cell contents are released into the circulation (B). The motor and sensory deficits upon TSCI are assessed by using the American Spinal Injury Association (ASIA) impairment scale (AIS), ranging from AIS A as a complete absence of any motor and sensory functions under the lesion site, to AIS E with complete preservation of motor and sensory functions. (C) The concentrations of serum SELENBP1 were elevated in patients classified as AIS A as compared to less severely affected patients classified as AIS B, C or D. A cut-off was deduced [(SELENBP1) > 30.2 μg/L], reliably predicting whether a patient belongs to the group showing neurological recovery (G1) or not (G0) within 3 months after the trauma. The figure was created by using https://biorender.com.

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Profile of patients with spinal cord injuries and occurrence of pressure ulcer at a university hospital

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692006000300010 ◽

2006 ◽

Vol 14 (3) ◽

pp. 372-377 ◽

Cited By ~ 20

Author(s):

Paula Cristina Nogueira ◽

Maria Helena Larcher Caliri ◽

Vanderlei José Haas

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Retrospective Study ◽

Spinal Cord Injuries ◽

Tertiary Hospital ◽

University Hospital ◽

Traumatic Spinal Cord Injury ◽

Increased Risk ◽

Cord Injury ◽

Common Causes

Patients with traumatic spinal cord injury (TSCI) have an increased risk of developing pressure ulcers (PU). It is a retrospective study done by review of records in order to identify the characteristics of patients who were assisted at a tertiary hospital as well as the occurrence of PU. Most patients were male, white and 36,2% between 21 and 30 years. The most common causes of TSCI were wound by fire weapons followed by vehicle crash/overturn. There was a predominance of injury at the toracic level followed by cervical. The PU occurred in 20 pacientes (42,5%). The most frequent regions of occurrence were the sacral and heels. Only 25% of the records had PU's dimensions charted, 80% stated the aspect, and 52.1% did not state the stage. There is a need for better documentation of PU so that interventions used for treatment can be evaluated.

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Patterns and predictors of functional recovery from the subacute to the chronic phase following a traumatic spinal cord injury: a prospective study

Spinal Cord ◽

10.1038/s41393-019-0341-x ◽

2019 ◽

Vol 58 (1) ◽

pp. 43-52 ◽

Cited By ~ 2

Author(s):

Andréane Richard-Denis ◽

Rami Chatta ◽

Cynthia Thompson ◽

Jean-Marc Mac-Thiong

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Prospective Study ◽

Functional Recovery ◽

Chronic Phase ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

A Prospective Study

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Silent autonomic dysreflexia during a routine bowel program in persons with traumatic spinal cord injury: A preliminary study

Archives of Physical Medicine and Rehabilitation ◽

10.1053/apmr.2002.36070 ◽

2002 ◽

Vol 83 (12) ◽

pp. 1774-1776 ◽

Cited By ~ 54

Author(s):

Steven C. Kirshblum ◽

Jamie G. House ◽

Kevin C. O'Connor

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Autonomic Dysreflexia ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

Preliminary Study

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Healthcare Disparities Add Insult to Spinal Cord Injury

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001095 ◽

2021 ◽

pp. 10.1212/CPJ.0000000000001095

Author(s):

Miguel X. Escalon ◽

Amy Houtrow ◽

Felicia Skelton ◽

Monica Verduzco-Gutierrez

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Healthcare Disparities ◽

Black Americans ◽

Rehabilitation Services ◽

Traumatic Spinal Cord Injury ◽

Call To Action ◽

Increased Risk ◽

Cord Injury

AbstractThe authors describe the disparities and increased risk of traumatic spinal cord injury Black Americans face as a result of violence. The manuscript should serve as a realization of these inequities and as a call to action to improve the equity of rehabilitation services in this population to improve outcomes.

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Autonomic dysreflexia: a possible trigger for the development of heterotopic ossifications after traumatic spinal cord injury?

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-013-0353-8 ◽

2013 ◽

Vol 40 (6) ◽

pp. 721-726

Author(s):

C. Putz ◽

L. Helbig ◽

H. J. Gerner ◽

M. Zimmermann-Stenzel ◽

M. Akbar

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Autonomic Dysreflexia ◽

Traumatic Spinal Cord Injury ◽

Heterotopic Ossifications ◽

Cord Injury

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Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed

Advances in Urology ◽

10.1155/2011/538750 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Subramanian Vaidyanathan ◽

Bakul Soni ◽

Gurpreet Singh ◽

Peter Hughes ◽

Tun Oo

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Guide Wire ◽

Foley Catheter ◽

Autonomic Dysreflexia ◽

Flexible Cystoscopy ◽

Urethral Catheterisation ◽

Increased Risk ◽

Cord Injury ◽

Small Capacity

When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5–10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2) Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3) Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire.

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Clinical Characteristics and Challenges of Management of Traumatic Spinal Cord Injury in a Trauma Center of a Developing Country

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0039-1695696 ◽

2019 ◽

Vol 10 (03) ◽

pp. 393-399

Author(s):

Ayodeji Salman Yusuf ◽

Muhammad Raji Mahmud ◽

Dumura Jeneral Alfin ◽

Samue Isa Gana ◽

Samaila Timothy ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Trauma Center ◽

Spinal Injury ◽

Cervical Spinal Cord ◽

Prehospital Care ◽

Insurance Coverage ◽

Traumatic Spinal Cord Injury ◽

Optimal Care ◽

Cord Injury

Abstract Background Traumatic spinal cord injury (TSCI) is a major burden in trauma care worldwide. Most victims are young, and the injury results in economic loss and psychological and social burden on the individual and the society. The outcome depends on the severity of primary spinal cord injury, interventions to prevent secondary insults to the damaged cord, and access to a specialized care. The lack of standard prehospital care and dedicated facilities for spine care coupled with challenges of inadequate health insurance coverage impact negatively on the outcome of care in patients with spinal cord injury in our practice. Objectives This study was performed to determine the clinical profile of patients with TSCI and to highlight the factors that determine the early outcome in a resource-constrained trauma center. Materials and Methods This study was a retrospective review of trauma registry and medical records of all the patients with acute TSCI at the National Trauma Center Abuja from September 2014 to December 2016. Results A total of 133 patients with TSCI were studied. Most of these patients were young men with a mean age of 36 years. Most injury (72.2%) occurred following motor vehicular crash affecting mainly the cervical spinal cord (62.0%). None of the patients received standard prehospital care. Only 41.4% of the patients were transported to the hospital in an ambulance. About half (52.6%) of the patients suffered complete spinal cord injury (the American Spinal Injury Association [ASIA] A), and pressure ulcer was the most common complication (23.3%). Only 42% of the patients that needed surgical intervention were operated, mainly due to the inability to pay for the service. The ASIA grade on admission was the most significant determinant factor of morbidity and mortality. Conclusion Optimal care of patients with TSCI was hindered by inadequate facilities and economic constraints.

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