Epidemiology of Spinal Cord Injury: Changes to Its Cause Amid Aging Population, a Single Center Study

Objective To investigate the epidemiologic and demographic characteristics of patients with spinal cord injury (SCI) who were admitted to a department of rehabilitation of a university hospital.Methods This was a descriptive cross-sectional study. Medical records including sex, age at injury, type of disability, traumatic or non-traumatic etiology and presence of ossification of posterior longitudinal ligament (OPLL) of patients with SCI who were admitted to the department of rehabilitation between 2012 and 2018 were reviewed.Results Of the 221 cases of SCI, 161 were traumatic and 60 were non-traumatic. The mean age at injury was 52.8 years. People aged 40–49 years showed highest proportion among overall SCI patients (19.0%). The proportion of male patients was higher in traumatic SCI at 4.96:1 than in non-traumatic SCI at 1.30:1. The most common cause of traumatic SCI was falling off (37.3%), followed by motor vehicle crash (35.4%) and tripping over (19.3%). Meanwhile, the most common cause of non-traumatic SCI was neoplasm (35.0%). Tripping over was the leading cause of traumatic SCI in patients aged ≥60 years (42.6%). A high proportion of traumatic SCI patients were found to have underlying OPLL (26.1%), particularly those who were injured by tripping over (64.5%).Conclusion The mean age of SCI patients was higher than that of previous studies. Falls was the single most common cause of traumatic SCI, and tripping over was the most common cause of injury in the elderly patients. OPLL was prevalent in patients who were injured from tripping over.

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Maximum Movement and Cumulative Movement (Travel) to Inform our Understanding of Secondary Spinal Cord Injury and its Application to Collar use in Self-extrication

10.21203/rs.3.rs-1074763/v1 ◽

2021 ◽

Author(s):

Tim Nutbeam ◽

Rob Fenwick ◽

Barbara May ◽

Willem Stassen ◽

Jason Smith ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Healthy Volunteers ◽

Motor Vehicle ◽

Cervical Collar ◽

Spinal Movement ◽

Cord Injury ◽

Total Movement ◽

The Mean ◽

Secondary Spinal Cord Injury

Abstract Background:Motor vehicle collisions remain a common cause of spinal cord injury. Biomechanical studies of spinal movement often lack “real world” context and applicability. Additional data may enhance our understanding of the potential for secondary spinal cord injury. We propose the metric ‘travel’ (total movement) and suggest that our understanding of movement related risk of injury could be improved if travel was routinely reported. We report maximal movement and travel for collar application in vehicle and subsequent self-extrication.Methods:Biomechanical data on application of cervical collar with the volunteer sat in a vehicle were collected using Inertial Measurement Units on 6 healthy volunteers. Maximal movement and travel are reported. These data and a re-analysis of previously published work is used to demonstrate the utility of travel and maximal movement in the context of self-extrication.Results:Data from a total of 60 in-vehicle collar applications across three female and three male volunteers was successfully collected for analysis. The mean age across participants was 50.3 years (range 28–68) and the BMI was 27.7 (range 21.5–34.6). The mean maximal anterior-posterior movement associated with collar application was 2.3mm with a total AP travel of 4.9mm. Travel (total movement) for in-car application of collar and self-extrication was 9.5mm compared to 9.4mm travel for self-extrication without a collar. Conclusion:We have demonstrated the application of ‘travel’ in the context of self-extrication. Total travel is similar across self-extricating healthy volunteers with and without a collar.We suggest that where possible ‘travel’ is collected and reported in future biomechanical studies in this and related areas of research. It remains appropriate to apply a cervical collar to self-extricating casualties when the clinical target is that of movement minimisation.

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Maximum movement and cumulative movement (travel) to inform our understanding of secondary spinal cord injury and its application to collar use in self-extrication

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-022-00992-9 ◽

2022 ◽

Vol 30 (1) ◽

Author(s):

Tim Nutbeam ◽

Rob Fenwick ◽

Barbara May ◽

Willem Stassen ◽

Jason Smith ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Healthy Volunteers ◽

Motor Vehicle ◽

Cervical Collar ◽

Spinal Movement ◽

Cord Injury ◽

Total Movement ◽

The Mean ◽

Secondary Spinal Cord Injury

Abstract Background Motor vehicle collisions remain a common cause of spinal cord injury. Biomechanical studies of spinal movement often lack “real world” context and applicability. Additional data may enhance our understanding of the potential for secondary spinal cord injury. We propose the metric ‘travel’ (total movement) and suggest that our understanding of movement related risk of injury could be improved if travel was routinely reported. We report maximal movement and travel for collar application in vehicle and subsequent self-extrication. Methods Biomechanical data on application of cervical collar with the volunteer sat in a vehicle were collected using Inertial Measurement Units on 6 healthy volunteers. Maximal movement and travel are reported. These data and a re-analysis of previously published work is used to demonstrate the utility of travel and maximal movement in the context of self-extrication. Results Data from a total of 60 in-vehicle collar applications across three female and three male volunteers was successfully collected for analysis. The mean age across participants was 50.3 years (range 28–68) and the BMI was 27.7 (range 21.5–34.6). The mean maximal anterior–posterior movement associated with collar application was 2.3 mm with a total AP travel of 4.9 mm. Travel (total movement) for in-car application of collar and self-extrication was 9.5 mm compared to 9.4 mm travel for self-extrication without a collar. Conclusion We have demonstrated the application of ‘travel’ in the context of self-extrication. Total travel is similar across self-extricating healthy volunteers with and without a collar. We suggest that where possible ‘travel’ is collected and reported in future biomechanical studies in this and related areas of research. It remains appropriate to apply a cervical collar to self-extricating casualties when the clinical target is that of movement minimisation.

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Spine Trauma

Oxford Textbook of Neuroscience and Anaesthesiology ◽

10.1093/med/9780198746645.003.0021 ◽

2019 ◽

pp. 255-262

Author(s):

Timur M. Urakov ◽

Michael Y. Wang

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Vehicle ◽

Fluid Management ◽

The Elderly ◽

Autonomic Dysreflexia ◽

Spine Trauma ◽

Vehicle Accidents ◽

Cord Injury ◽

Anaesthesia Care

The estimated global incidence of spinal cord injury (SCI) is 250,000 to 500,000 people a year. North America tends to have higher rates of incidence of SCI than Europe. Statistically, young adults and the elderly are more likely to be injured. Motor vehicle accidents are the leading cause of SCI in the world, followed by falls, violence, sports, recreational activities, and iatrogenic sources. This chapter on spine trauma includes elements of anatomy and anaesthesia care for acute cervical spine cord injury (including airway management, blood pressure management, fluid management, hypothermia, monitoring, and steroids). It also covers anaesthesia care for chronic spinal cord injury (including autonomic dysreflexia, physiological changes in chronic SCI patients, and obstetrics).

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The Risk of Acute Spinal Cord Injury After Minor Trauma in Patients With Preexisting Cervical Stenosis

Neurosurgery ◽

10.1227/neu.0000000000000888 ◽

2015 ◽

Vol 77 (4) ◽

pp. 561-565 ◽

Cited By ~ 11

Author(s):

Victor Chang ◽

Benjamin M. Ellingson ◽

Noriko Salamon ◽

Langston T. Holly

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Vehicle ◽

Traumatic Event ◽

Minor Trauma ◽

Cervical Stenosis ◽

Canal Diameter ◽

Cord Injury ◽

The Mean

Abstract BACKGROUND: Cervical stenosis patients are commonly advised to undergo surgery due to the risk of spinal cord injury (SCI) after a traumatic event. However, the actual risk of SCI in this scenario is unknown. OBJECTIVE: To evaluate the risk of SCI after minor trauma in a cohort of prospectively followed cervical stenosis patients. METHODS: Clinical and radiographical analysis was performed in 55 nonoperatively treated patients evaluated between 2009 and 2014. Each patient was asked standardized questions including: 1) whether a previous physician recommended neck surgery, 2) whether a physician indicated that they would become paralyzed after a traumatic event, and 3) whether they experienced a traumatic event during the follow-up period. RESULTS: The mean age was 65, with a mean modified Japanese Orthopedic Association score of 16.6. The mean canal diameter was 6.1 mm. Nineteen patients (35%) had evidence of intramedullary T2 signal abnormality. Thirty-one patients (56%) were previously recommended for surgery. Twenty-six patients (47%) were told that they would be paralyzed after a motor vehicle accident or fall unless surgery was performed. Ten patients (18%) experienced a traumatic event during the follow-up, with none sustaining an SCI. CONCLUSION: Asymptomatic and mildly symptomatic cervical stenosis patients are commonly recommended to undergo surgery due to risk of paralysis after a traumatic event. SCI was not observed after minor trauma in our cohort of prospectively followed patients. It seems that occurrence of SCI in this patient population after minor trauma is likely smaller than many physicians surmise, yet will require future prospective study in a large cohort of patients.

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Bifocal Spinal Cord Injury without Radiographic Abnormalities in a 5-Year Old Boy: A Case Report

Case Reports in Pediatrics ◽

10.1155/2012/351319 ◽

2012 ◽

Vol 2012 ◽

pp. 1-2

Author(s):

K. G. Snoek ◽

M. Jacobsohn ◽

A. B. van As

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Unusual Case ◽

Motor Vehicle ◽

Motor Vehicle Crash ◽

Lumbar Spinal Cord ◽

Lumbar Region ◽

Cord Injury ◽

Thoracic And Lumbar Spine ◽

Lumbar Spinal

We present the extremely unusual case of a 5-year-old boy with a bifocal (cervical as well as lumbar) spinal cord injury without radiographic abnormalities (SCIWORAs). The MRI showed cord oedema at the level of C2 and T10. We propose that during the motor vehicle crash severe propulsion of the head with a flexed lumbar region resulted in a traction injury to the lower thoracic and lumbar spine and maximum flexion caused SCIWORA in C2.

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Postrehabilitation outcomes after spinal cord injury caused by firearms and motor vehicle crash among ethnically diverse groups

Archives of Physical Medicine and Rehabilitation ◽

10.1016/s0003-9993(98)90268-4 ◽

1998 ◽

Vol 79 (10) ◽

pp. 1237-1243 ◽

Cited By ~ 16

Author(s):

Robert L. Waters ◽

Rodney H. Adkins ◽

Ien Sie ◽

Jeffrey Cressy

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Motor Vehicle ◽

Ethnically Diverse ◽

Motor Vehicle Crash ◽

Vehicle Crash ◽

Cord Injury ◽

Diverse Groups

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Occupational Therapy Treatment Time During Spinal Cord Injury Rehabilitation: A Retrospective Study in Riyadh

Journal of Spine Practice (JSP) ◽

10.18502/jsp.v1i1.9786 ◽

2021 ◽

pp. 26

Author(s):

Teif Almohimeed

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Occupational Therapy ◽

Motor Vehicle ◽

Treatment Plan ◽

Inpatient Rehabilitation ◽

Therapeutic Activity ◽

Cord Injury ◽

Study Population ◽

The Mean

Introduction: Occupational therapy (OT) is a part of rehabilitation that facilitates and enables individuals with traumatic spinal cord injuries (TSCI) to engage in daily occupations independently. Little is known about the type of OT treatment plan and the amount of time spent selecting the treatment intervention during TSCI rehabilitation. This study aimed to describe the overall time spent by patients with TSCI throughout their inpatient rehabilitation stay. Methodology: A chart review was conducted of patients attending inpatient rehabilitation for TSCI at King Abdulaziz Medical City between 2016 and 2020. For each patient, an electronic medical file, the documented rehabilitation session, including the time spent and type of therapeutic activity, were extracted. Demographic, clinical data related to the type of injury and the level of spinal cord injury (SCI) involved were also collected. We estimated the time that each patient had among all sessions and examined it with clinical factors. Result: A total of 50 eligible patients were included in this analysis. The mean age of the study population was 28 (interquartile range [IQR], 22–41) years, and the majority were male patients (82%). The most common reason for the SCI was a motor vehicle accident (94%), in which 56% required ICU admission. Among the study population, 58% had paraplegia and 42% had quadriplegia. The most common specific therapeutic activity was education (100%), equipment prescription (96%), transfer training 86%, and toilet training (70%). The mean total time spent over the patients’ entire stay was 1785 min (IQR 660–3300 min), with approximately 43.7 hr (SD 52 hr) of occupational rehabilitation. After categorizing the spinal cord injury, a mean total of 33 (IQR, 20–110) hr of session was received for patients who had an SCI level between C1 and C4 over the course of rehabilitation, and this was 25 (IQR, 15–32) hr of session for patients with an SCI level between C5 and C8, 36 (IQR, 5–8) hr of session for patients with an SCI level of <T1–T6, and 29 (IQR, 5–53) hr of session for patients with an SCI level of <T6. Conclusion: Almost all patients with TSCI participated in strengthening/Range of Motion (ROM) exercises and Activities of Daily Living (ADLs) training during OT treatment; these two were the most time-consuming interventions. When examining therapy, we found that lower body dressing training was the most time-consuming ADL. Significant variation were seen in time spent among TSCI for all OT interventions when examining both the total time spent and a calculated number of minutes per session. Some of this variation could be explained by patient and injury characteristics.

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Breastfeeding Before and After Spinal Cord Injury: A Case Report of a Mother With C6 Tetraplegia

Journal of Human Lactation ◽

10.1177/0890334419844234 ◽

2019 ◽

Vol 35 (4) ◽

pp. 742-747 ◽

Cited By ~ 1

Author(s):

Amanda H. X. Lee ◽

Betty Wen ◽

Shea Hocaloski ◽

Nora Sandholdt ◽

Claes Hultling ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Milk Production ◽

Motor Vehicle ◽

Motor Vehicle Crash ◽

Sensory Function ◽

Second Child ◽

First Child ◽

Cord Injury ◽

Before And After

Introduction: Although lactation dysfunction and breastfeeding difficulties after spinal cord injury have been previously reported, there is still a lack of research on the specific challenges and aspects that require more support. This unique case of a mother with C6 tetraplegia details her breastfeeding experience before and after spinal cord injury. Main Issue: A 23-year-old woman with a 20-month-old daughter sustained a motor and sensory complete traumatic spinal cord injury in a motor-vehicle crash while she was 6 months pregnant with her second child. This resulted in complete absence of sensory function below the level of injury (including the breast) and limited hand function. In comparison with her breastfeeding experience before injury, after injury she experienced decreased milk production, absence of the milk ejection reflex, and impaired ability to pick up, hold, and position her infant. Management: Care aides and family members assisted this mother with picking up, positioning, and latching her infant. She also utilized alternative breastfeeding positions, nursing pillows, and wedges. Domperidone was suggested by her physiatrist to increase milk production but ultimately was not used as there were no concerns with her infant’s growth or development. Conclusion: Breastfeeding as a recently injured mother while undergoing intensive post-injury rehabilitation was challenging. Her second child developed well and was breastfed for 3 months compared to her first child (9 months). Breastfeeding was possible for this mother after spinal cord injury, in part due to previous experience successfully breastfeeding her first child, assistance from care personnel, and nursing aids.

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