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Mokbul MI, Biswas S, Beniwal SS, Sharma S, Cummings KRS, Karim R, Rana MS. Point-of-care ultrasound (POCUS) in the surgery of a paraplegic pregnant female: A case of "do no harm". Radiol Case Rep 2024; 19:3782-3787. [PMID: 38993517 PMCID: PMC11238703 DOI: 10.1016/j.radcr.2024.04.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 07/13/2024] Open
Abstract
We present here a case of multidisciplinary management of a 20-year-old pregnant woman who presented with sudden paraplegia attributed to a large paraspinal tumor. Magnetic resonance imaging (MRI) revealed compressive dorsal myelopathy due to an extramedullary tumor. Given the urgency of her symptoms and pregnancy status, a multidisciplinary team decided to proceed with surgery while avoiding radiation exposure (eg, O/C-arm). Intraoperative point-of-care ultrasound (POCUS) was utilized for tumor localization and surgical guidance, facilitating successful gross total excision with minimal risk to the fetus. Postoperative recovery was uneventful, with improvement in muscle strength and preservation of the pregnancy. Beyond tumor localization, POCUS offers additional benefits in assessing maternal hemodynamics and detecting potential complications. This case highlights the utility of POCUS as a radiation-free theranostic imaging modality in pregnant patients with spinal tumors, enhancing safety in surgery and optimizing outcomes for both mother and fetus.
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Affiliation(s)
| | - Shahnawas Biswas
- Dhaka Medical College Hospital, Dhaka, Bangladesh
- Department of Neurosurgery, BRB Hospital, Dhaka, Bangladesh
| | | | | | | | - Robiul Karim
- Dhaka Medical College Hospital, Dhaka, Bangladesh
- Department of Neurosurgery, BRB Hospital, Dhaka, Bangladesh
| | - Md Sumon Rana
- Dhaka Medical College Hospital, Dhaka, Bangladesh
- Department of Neurosurgery, BRB Hospital, Dhaka, Bangladesh
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Li L, Zheng ZZ, Jiang JJ, Chen JL, Jiang B, Li YW, Dai YL, Wang B. CTSD upregulation as a key driver of spinal ligament abnormalities in spinal stenosis. Bone 2024; 186:117174. [PMID: 38917962 DOI: 10.1016/j.bone.2024.117174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 05/25/2024] [Accepted: 06/18/2024] [Indexed: 06/27/2024]
Abstract
Spinal stenosis (SS) is frequently caused by spinal ligament abnormalities, such as ossification and hypertrophy, which narrow the spinal canal and compress the spinal cord or nerve roots, leading to myelopathy or sciatic symptoms; however, the underlying pathological mechanism is poorly understood, hampering the development of effective nonsurgical treatments. Our study aims to investigate the role of co-expression hub genes in patients with spinal ligament ossification and hypertrophy. To achieve this, we conducted an integrated analysis by combining RNA-seq data of ossification of the posterior longitudinal ligament (OPLL) and microarray profiles of hypertrophy of the ligamentum flavum (HLF), consistently pinpointing CTSD as an upregulated hub gene in both OPLL and HLF. Subsequent RT-qPCR and IHC assessments confirmed the heightened expression of CTSD in human OPLL, ossification of the ligamentum flavum (OLF), and HLF samples. We observed an increase in CTSD expression in human PLL and LF primary cells during osteogenic differentiation, as indicated by western blotting (WB). To assess CTSD's impact on osteogenic differentiation, we manipulated its expression levels in human PLL and LF primary cells using siRNAs and lentivirus, as demonstrated by WB, ALP staining, and ARS. Our findings showed that suppressing CTSD hindered the osteogenic differentiation potential of PLL and LF cells, while overexpressing CTSD activated osteogenic differentiation. These findings identify CTSD as a potential therapeutic target for treating spinal stenosis associated with spinal ligament abnormalities.
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Affiliation(s)
- Lei Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; Hunan Digital Spine Research Institute, Central South University, Changsha, China
| | - Zhen-Zhong Zheng
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; Hunan Digital Spine Research Institute, Central South University, Changsha, China
| | - Jia-Jiong Jiang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; Hunan Digital Spine Research Institute, Central South University, Changsha, China
| | - Jia-Lin Chen
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; Hunan Digital Spine Research Institute, Central South University, Changsha, China
| | - Bin Jiang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; Hunan Digital Spine Research Institute, Central South University, Changsha, China
| | - Ya-Wei Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; Hunan Digital Spine Research Institute, Central South University, Changsha, China
| | - Yu-Liang Dai
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; Hunan Digital Spine Research Institute, Central South University, Changsha, China
| | - Bing Wang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; Hunan Digital Spine Research Institute, Central South University, Changsha, China.
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Zhao F, Zhang L, Chen X, Lei M, Sun L, Ma L, Wang C. Construction and Verification of Urinary Tract Infection Prediction Model for Hospitalized Rehabilitation Patients with Spinal Cord Injury. World Neurosurg 2024; 188:e396-e404. [PMID: 38810877 DOI: 10.1016/j.wneu.2024.05.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To explore the influencing factors of urinary tract infection (UTI) in hospitalized patients with spinal cord injury and to construct and verify the nomogram prediction model. METHODS This study is a retrospective cohort study. From January 2017 to March 2022, 558 patients with spinal cord injury admitted to the Department of Rehabilitation Medicine of a tertiary hospital in Anhui Province, China, were selected as the research objects, and they were randomly divided into training group (n = 390) and verification group (n = 168) according to the ratio of 7:3, and clinical data including socio-demographic characteristics, disease-related data, and laboratory examination data were collected. Univariate analysis and multivariate logistic regression were used to analyze the influencing factors of UTI in hospitalized patients with spinal cord injuries. Based on this, a nomogram prediction model was constructed with the use of R software, and the risk prediction efficiency of the nomogram model was verified by the receiver operating characteristic curve and calibration curve. RESULTS Logistic regression analysis showed that the American Spinal Cord Injury Association (ASIA)-E grade (compared with ASIA-A grade) was an independent protective factor for UTI in hospitalized patients with spinal cord injury (odds ratio < 1, P < 0.05), while white blood cell count and indwelling catheter were independent risk factors for UTI in hospitalized patients with spinal cord injury (odds ratio > 1, P < 0.05). Based on this, a nomogram risk predictive model for predicting UTI in hospitalized rehabilitation patients with spinal cord injury was constructed, which proved to have good predictive efficiency. In the training group and the verification group, the area under the receiver operating characteristic curve of the nomogram model is 0.808 and 0.767, and the 95% confidence interval of the area under the receiver operating characteristic curve of the nomogram in the training group and the verification group is 0.760∼0.856 and 0.688∼0.845, respectively, indicating the nomogram model has good discrimination. According to the calibration curve, the prediction probability of the nomogram model and the actual frequency of UTI in the training group and the verification group are in good consistency, and the results of the Hosmer-Lemeshow bias test also suggest that the nomogram model has a good calibration degree in both the training group and the verification group (P = 0.329, 0.067). CONCLUSIONS ASIA classification level, white blood cell count, and indwelling catheter are independent influencing factors of UTI in hospitalized patients with spinal cord injury. The nomogram prediction model based on the above factors can simply and effectively predict the risk of UTI in hospitalized patients with spinal cord injury, which is helpful for clinical medical staff to identify high-risk groups early and implement prevention, treatment, and nursing strategies in time.
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Affiliation(s)
- Fangfang Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lixiang Zhang
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xia Chen
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Mengling Lei
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The Graduate School, Bengbu Medical University, Bengbu, Anhui, China
| | - Liai Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lina Ma
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Cheng Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
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Böthig R, Schöps W, Kowald B, Golka K. [Oncological relevance of neuro-urological diseases]. Aktuelle Urol 2024; 55:326-336. [PMID: 38599592 DOI: 10.1055/a-2269-1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Apart from a few exceptions, there is currently little scientific evidence on the oncological relevance of neuro-urological diseases. Most research has been conducted into the association between long-term spinal cord injury with its consequences for the lower urinary tract and the occurrence of bladder cancer. These cancers differ in many ways from bladder cancers in patients without spinal cord injury: patients are 20 years younger on average, tumours are very often already muscle-invasive and poorly differentiated with a high proportion of squamous cell carcinomas, and the prognosis is poor. These characteristics also occur in spinal cord injury patients without permanent catheter drainage of the urinary bladder. Although the pathophysiological association has not been clarified in detail, the presence of a neurogenic bladder appears to be the decisive link between spinal cord injury and the occurrence of bladder cancer. Pathological pressure conditions in the urinary bladder and frequent urinary tract infections or asymptomatic bacteriuria resulting from neurogenic lower urinary tract dysfunction could be the decisive pathophysiological factors. In this respect, urinary bladder cancer in persons with a chronic spinal cord injury represents a model tumour after denervation. The clinically important question of screening requires future interdisciplinary research approaches.
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Affiliation(s)
- Ralf Böthig
- Abt. Neuro-Urologie, Querschnittgelähmten-Zentrum, BG Klinikum Hamburg, Hamburg, Germany
| | | | - Birgitt Kowald
- Zentrum für Klinische Forschung, BG Klinikum Hamburg, Hamburg, Germany
| | - Klaus Golka
- Leibniz-Institut für Arbeitsforschung an der TU Dortmund (IfADo), Dortmund, Germany
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Ali F, Arshad K, Latif R, Farooq A, Nanjundappa A. Spontaneous spinal epidural hematoma following IV heparin and catheter-directed thrombolysis for deep vein thrombosis. J Vasc Surg Cases Innov Tech 2024; 10:101541. [PMID: 38994220 PMCID: PMC11238116 DOI: 10.1016/j.jvscit.2024.101541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/10/2024] [Indexed: 07/13/2024] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) is a rare condition, and it usually presents with acute onset neck or back pain, progressive weakness, and other symptoms of spinal cord compression. Catheter-directed thrombolysis is one option for limbs threatened by iliofemoral venous thrombosis; other options, such as venous thrombectomy (either open or percutaneous), are also available. There are few reported cases of SSEH owing to catheter-directed thrombolysis for deep venous thrombosis (DVT). We present a case of a 65-year-old man who presented with left lower limb extensive iliofemoral DVT and received catheter-directed thrombolysis. The patient initially had rapid improvement in his symptoms with restoration of limb perfusion. However, within 6 hours of starting catheter-directed thrombolysis, the patient developed extensive SSEH and underwent emergent spinal decompression surgery with laminectomy of T11 to T12 with complete resolution of the neurological deficit. Clinicians should consider SSEH in differential diagnosis if the patient develops acute onset neck or back pain after catheter-guided thrombolysis for DVT.
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Affiliation(s)
- Farman Ali
- Internal Medicine, Corewell Health Dearborn Hospital, Dearborn, MI
| | - Khurram Arshad
- Internal Medicine, Corewell Health Dearborn Hospital, Dearborn, MI
| | - Rabia Latif
- Internal Medicine, Mclaren Flint Hospital, Flint, MI
| | - Ali Farooq
- Internal Medicine, Charleston Area Medical Center, Charleston, SC
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Moreau N, Korai SA, Sepe G, Panetsos F, Papa M, Cirillo G. Peripheral and central neurobiological effects of botulinum toxin A (BoNT/A) in neuropathic pain: a systematic review. Pain 2024; 165:1674-1688. [PMID: 38452215 DOI: 10.1097/j.pain.0000000000003204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/07/2023] [Indexed: 03/09/2024]
Abstract
ABSTRACT Botulinum toxin (BoNT), a presynaptic inhibitor of acetylcholine (Ach) release at the neuromuscular junction (NMJ), is a successful and safe drug for the treatment of several neurological disorders. However, a wide and recent literature review has demonstrated that BoNT exerts its effects not only at the "periphery" but also within the central nervous system (CNS). Studies from animal models, in fact, have shown a retrograde transport to the CNS, thus modulating synaptic function. The increasing number of articles reporting efficacy of BoNT on chronic neuropathic pain (CNP), a complex disease of the CNS, demonstrates that the central mechanisms of BoNT are far from being completely elucidated. In this new light, BoNT might interfere with the activity of spinal, brain stem, and cortical circuitry, modulating excitability and the functional organization of CNS in healthy conditions. Botulinum toxins efficacy on CNP is the result of a wide and complex action on many and diverse mechanisms at the basis of the maladaptive plasticity, the core of the pathogenesis of CNP. This systematic review aims to discuss in detail the BoNT's mechanisms and effects on peripheral and central neuroplasticity, at the basis for the clinical efficacy in CNP syndromes.
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Affiliation(s)
- Nathan Moreau
- Laboratoire de Neurobiologie oro-faciale, EA 7543, Université Paris Cité, Paris, France
| | - Sohaib Ali Korai
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanna Sepe
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fivos Panetsos
- Neurocomputing & Neurorobotics Research Group, Universidad Complutense de Madrid, Instituto de Investigaciones Sanitarias (IdISSC), Hospital Clinico San Carlos de Madrid, Silk Biomed SL, Madrid, Spain
| | - Michele Papa
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giovanni Cirillo
- Division of Human Anatomy, Laboratory of Morphology of Neuronal Networks & Systems Biology, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Xie Y, Zhang J, Jin X, Liu S, Song W. Development and validation of a nomogram for predicting heterotopic ossification following spinal cord injury. Clin Neurol Neurosurg 2024; 243:108348. [PMID: 38833809 DOI: 10.1016/j.clineuro.2024.108348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Heterotopic ossification (HO) following spinal cord injury (SCI) can severely compromise patient mobility and quality of life. Precise identification of SCI patients at an elevated risk for HO is crucial for implementing early clinical interventions. While the literature presents diverse correlations between HO onset and purported risk factors, the development of a predictive model to quantify these risks is likely to bolster preventive approaches. This study is designed to develop and validate a nomogram-based predictive model that estimates the likelihood of HO in SCI patients, utilizing recognized risk factors to expedite clinical decision-making processes. METHODS We recruited a total of 145 patients with SCI and presenting with HO who were hospitalized at the China Rehabilitation Research Center, Beijing Boai Hospital, from June 2016 to December 2022. Additionally, 337 patients with SCI without HO were included as controls. Comprehensive data were collected for all study participants, and subsequently, the dataset was randomly partitioned into training and validation groups. Using Least Absolute Shrinkage and Selection Operator regression, variables were meticulously screened during the pretreatment phase to formulate the predictive model. The efficacy of the model was then assessed using metrics including receiver-operating characteristic (ROC) analysis, calibration assessment, and decision curve analysis. RESULTS The final prediction model incorporated age, sex, complete spinal cord injury status, spasm occurrence, and presence of deep vein thrombosis (DVT). Notably, the model exhibited commendable performance in both the training and validation groups, as evidenced by areas under the ROC curve (AUCs) of 0.756 and 0.738, respectively. These values surpassed the AUCs obtained for single variables, namely age (0.636), sex (0.589), complete spinal cord injury (0.681), spasm occurrence (0.563), and DVT presence (0.590). Furthermore, the calibration curve illustrated a congruence between the predicted and actual outcomes, indicating the high accuracy of the model. The decision curve analysis indicated substantial net benefits associated with the application of the model, thereby underscoring its practical utility. CONCLUSIONS HO following SCI correlates with several identifiable risk factors, including male gender, youthful age, complete SCI, spasm occurrence and DVT. Our predictive model effectively estimates the likelihood of HO development by leveraging these factors, assisting physicians in identifying patients at high risk. Subsequently, correct positioning to prevent spasm-related deformities and educating healthcare providers on safe lower limb mobilization techniques are crucial to minimize muscle injury risks from rapid iliopsoas muscle extension. Additionally, the importance of early DVT prevention through routine screening and anticoagulation is emphasized to further reduce the incidence of HO.
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Affiliation(s)
- Yulei Xie
- School of Rehabilitation, Capital Medical University, Beijing, China
| | - Junwei Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China; Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, China; Department of Orthopedics Surgery, Capital Medical University, Beijing, China.
| | - Xiaoqin Jin
- School of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shujia Liu
- School of Rehabilitation, Capital Medical University, Beijing, China; Spine and Spinal Cord Surgery, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing, China; Department of Orthopedics Surgery, Capital Medical University, Beijing, China
| | - Wei Song
- Department of Rehabilitation Engineering, China Rehabilitation Science Institute, Beijing, China.
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Noma M, Sato Y, Hara N, Yu J, Fukuhara H, Fukushima M, Nishizawa M, Komatsu N, Oshima Y. Treatment Outcomes of Lower Urinary Tract Symptoms due to Fragility Sacral Fractures: A Review of Eight Patients and Literature. World Neurosurg 2024; 188:e278-e287. [PMID: 38777323 DOI: 10.1016/j.wneu.2024.05.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Sacral fractures can cause lower urinary tract symptoms (LUTS) due to damage to the cauda equina. While several studies have reported on sacral fractures due to high-energy trauma, those due to fragility fractures have only been reported in case reports and their clinical differences are not well known. This study aimed to investigate the clinical characteristics of LUTS caused by fragility sacral fractures and propose a novel treatment strategy. METHODS This study is retrospective, uncontrolled, clinical case series. The inclusion criteria were sole sacral fractures due to low-energy trauma and appearance of LUTS after injury. Patients with additional spinal fractures or combined abdominal or pelvic organ injuries that could cause LUTS were excluded. Improvement in LUTS, period from onset to improvement, and imaging findings were recorded. RESULTS Eight patients met the inclusion criteria (4 surgical and 4 conservative treatment cases). Six patients showed improvement in LUTS. In surgical cases, the mean period from onset of LUTS to surgery and from onset of LUTS to improvement was 14.5 and 21.5 days, respectively. Intraoperative rupture or laceration of the dural sac was not observed. In 2 conservatively improved cases, the period from onset to improvement of LUTS was 14 and 17 days. CONCLUSIONS LUTS can improve even with conservative treatment and should be utilized as the primary choice. LUTS caused by severe sacral canal deformity and stenosis can be reversible, and the decision to perform surgical treatment is still timely if LUTS do not improve with conservative treatment for several weeks.
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Affiliation(s)
- Michita Noma
- Department of Orthopedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan; Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yusuke Sato
- Department of Orthopedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan; Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.
| | - Nobuhiro Hara
- Department of Orthopedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Jim Yu
- Department of Orthopedic Surgery, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hiroki Fukuhara
- Faculty of Medicine, Department of Urology, Yamagata University, Yamagata, Japan
| | | | - Mitsuhiro Nishizawa
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naoto Komatsu
- Department of Orthopedic and Spine Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Yasushi Oshima
- Department of Orthopedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Tsai SE, Yang SF, Wang YH, Yeh CB. Association between gabapentin use and risk of dementia in adults with chronic pain: A nested case-control study. J Affect Disord 2024; 358:205-210. [PMID: 38729220 DOI: 10.1016/j.jad.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
STUDY OBJECTIVE To explore the association between gabapentin use and the risk of dementia in patients with chronic pain, considering the rising concerns of dementia in an aging population and the potential cognitive impacts of chronic pain management. DESIGN A nested case-control study utilizing data from a longitudinal health insurance database. SETTING The study is based on a longitudinal health insurance database spanning 2000-2019 in Taiwan. PATIENTS A total of 201,492 patients aged 50 years and older diagnosed with chronic pain between 2001 and 2017 were included. The study focused on individuals with chronic pain, excluding those diagnosed with dementia a year before or after their chronic pain diagnosis. INTERVENTION Analysis of gabapentin prescription history was conducted, considering the cumulative dose from the chronic pain diagnosis date to the dementia diagnosis date or equivalent period for controls. MEASUREMENT Data included demographics, gabapentin prescription history, and comorbidities. Logistic regression was used to estimate odds ratios for dementia risk. MAIN RESULTS No significant difference in the risk of dementia was found between low and high cumulative doses of gabapentin. The adjusted odds ratio for dementia risk associated with gabapentin use was 0.91 (95 % C.I. 0.83-1.01), indicating no substantial increase in risk. CONCLUSION Long-term Gabapentin therapy for chronic pain is not associated with a differential risk of dementia across dosage levels, irrespective of age or gender. Further study into its potential cognitive impacts is essential.
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Affiliation(s)
- Sheng-En Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Anesthesiology, Changhua Christian Hospital, Changhua, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chao-Bin Yeh
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Mae De Sagun Maala J, Sih IMY. Clinical Characteristics and Outcomes of Patients with Traumatic Spinal Cord Injury at a Tertiary Care Center in the Philippines. World Neurosurg 2024; 188:e390-e395. [PMID: 38802058 DOI: 10.1016/j.wneu.2024.05.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Traumatic spinal cord injury (TSCI) is a devastating condition that may result to lifelong complications that affect patient outcome and quality of life. Because of the increasing incidence of TSCI, it is important to comprehend the extent of this condition in terms of demographics, mechanism, and degree of disability to raise awareness and develop strategies in approaching care for these patients. There is a lack of information regarding data on TSCI in Southeast Asia, especially in the Philippines. This study aims to describe the clinical characteristics and outcomes of patients with TSCI in a tertiary care hospital in the Philippines. METHODS This is a retrospective descriptive cohort study in individuals aged 18 years older who were admitted for TSCI in a Philippine tertiary care hospital between 2022 and 2023. Of 118 admitted patients, 100 patients were included in the study. The data were obtained from the review of patients' medical records. Demographics of TSCI, mechanism, presenting clinical characteristics, American Spinal Injury Association Impairment Scale (AIS) grade, radiographic findings, outcomes, and complications were analyzed. RESULTS A total of 100 patients with TSCI were included in the study. The mean age of the patients was 43.4 ± 15.8 in years, with male patients being predominant, at 92%. The most common mechanism of injury was motor vehicular crash, at 68%, followed by fall, at 22%. Most patients, 38%, were graded AIS C, on admission. The most common level of injury was cervical, at 70%. The usual complications recorded were sacral ulcer 28%, and hospital-acquired pneumonia, 20%. CONCLUSIONS TSCI is common in young adult male patients with motor vehicular crash as the mechanism of injury. Most patients in the study had incomplete spinal cord injury (AIS C), with the cervical region as the most common level. The recorded mean length of hospital stay was 1-2 weeks. The most common co-occurring extra spinal injury was traumatic brain injury. At discharge, most developed sacral ulcer and hospital-acquired pneumonia, with stable neurologic status. A multicenter prospective data collection with a larger population and inclusion of more variables are necessary to formulate a regression model and establish the factors that improve the outcomes of TSCI.
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Affiliation(s)
| | - Ibet Marie Y Sih
- Section of Neurosurgery, St. Luke's Medical Center, Manila, Philippines; Division of Neurosurgery, University of the Philippines-Philippine General Hospital, Manila, Philippines
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Shekouhi R, Chen X, Taylor J, Marji FP, Chim H. The Safety and Efficacy of Dorsal Root Entry Zone Lesioning for Pain Management in Patients With Brachial Plexus Avulsion: A Systematic Review and Meta-Analysis. Neurosurgery 2024; 95:259-274. [PMID: 38465954 DOI: 10.1227/neu.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/12/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Persistent neuropathic pain after brachial plexus avulsion (BPA) is common and generally nonresponsive to medical management. Dorsal root entry zone (DREZ) lesioning is the last resort for pain management in patients with BPA. This study aims to investigate and compare the outcomes and complications of DREZ procedures. METHODS A systematic literature search was conducted to identify all related studies. Comparisons were based on the number of patients with preoperative pain vs postoperative pain, with the effect size calculated using the risk ratio. Mean visual analog scale (VAS) scores were extracted and analyzed between interventions. A meta-regression analysis was performed to identify risk factors for final outcomes. The rates of complications were also assessed and analyzed between interventions. RESULTS A total of 30 studies with 917 patients (90.0% male and 10.0% female, mean age: 42.9 ± 16.6) were included in this systematic review. Of the 917 patients who underwent surgery, 655 (71.4%) patients had significant pain reduction at the last follow-up ( P < .05). The weighted mean preoperative VAS score was 8.3 ± 1.3, compared with postoperative VAS scores (1.9 ± 2.2); a significant improvement was observed ( P < .05). The subgroup analysis showed that microsurgical DREZotomy (MDT) is associated with better outcomes in terms of VAS score improvements compared with radiofrequency (RF)-assisted DREZ lesioning ( P < .05). Meta-analysis showed that the relative risk of motor deficits was significantly lower in the MDT group, compared with the RF-assisted group ( P < .05). Meta-regression showed that older age is correlated with an elevated risk of postoperative motor deficits compared with the incidence of sensory loss. CONCLUSION DREZ lesioning is effective for intractable pain alleviation after BPA. Compared with RF-assisted DREZ lesioning, MDT is associated with better VAS score improvements and a lower rate of postoperative motor weakness.
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Affiliation(s)
- Ramin Shekouhi
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville , Florida , USA
| | - Xizhao Chen
- Department of Surgery, University of Florida, Gainesville , Florida , USA
| | - Justin Taylor
- College of Medicine, University of Central Florida, Orlando , Florida , USA
| | - Fady P Marji
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville , Florida , USA
| | - Harvey Chim
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville , Florida , USA
- Lilian S. Wells Department of Neurosurgery, University of Florida, Gainesville , Florida , USA
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12
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Chan KN, Myers J, Huberman D, Ota D, Jaramillo J, Kiratli BJ. An exploratory analysis of the metabolic syndrome and cardiovascular disease risk calculations in veterans with spinal cord injury and disorders. J Spinal Cord Med 2024:1-9. [PMID: 39051857 DOI: 10.1080/10790268.2024.2375888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES (1) To describe and compare cardiovascular and cardiometabolic disease risk scores using three existing risk calculators: Framingham Risk Score (FRS), American Heart Association (AHA) and Metabolic Syndrome Severity Score (MSSS) in Veterans with spinal cord injury and disorders (SCI/D); (2) To examine level of agreement between risk scores derived from three different risk scoring systems; and (3) To investigate whether the agreement among these methods is different for Veterans with Tetraplegia versus Paraplegia. DESIGN Retrospective chart review. METHODS Electronic medical records of 194 Veterans with SCI/D who were seen at the VAPAHCS SCI/D Center between August 2004 and June 2022 were reviewed. Cardiovascular disease (CVD) risk scores (FRS and AHA) along with a Metabolic Syndrome Severity Score (MSSS) were computed using web-based calculators. RESULTS Moderate agreement between CVD risk scores (FRS and AHA) was observed; however, the agreement was poor between MSSS and both AHA and FRS. No differences were observed between the paraplegia and tetraplegia cohorts. From the AHA risk score, more than half the study population was found to be at high risk while less than half was considered high risk from the FRS and MSSS scores. CONCLUSIONS Given the moderate association between AHA and FRS scores along with considerable variation in risk predictors, CVD risk prediction assessment tools should be interpreted cautiously in the SCI population. SCI-related clinical biomarkers and other clinically relevant risk factors should be taken into consideration to optimize risk estimation in persons with SCI/D.
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Affiliation(s)
- Khin N Chan
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- Cardiology Division, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Jonathan Myers
- Cardiology Division, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - David Huberman
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Doug Ota
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | - Jeffrey Jaramillo
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - B Jenny Kiratli
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
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13
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Chen Y, Yu P, Li Z, Xu H, Li S, Wang Q, Ji F, Lan Q. Outcomes and adverse events for spinal synovial cysts surgical treatment: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05460-w. [PMID: 39039314 DOI: 10.1007/s00402-024-05460-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/07/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Spinal synovial cysts (SSCs) are a rare cause of nerve root and spinal cord compression. Surgical excision of SSCs remains the mainstay of treatment in the presence of unremitting symptoms or neurological deficits, but the choice of the surgical approach remains controversial. The goal of this study was to compare clinical outcomes and adverse events associated with traditional approaches (interlaminar or laminectomy/hemilaminectomy) and minimally invasive approaches (microsurgical tubular approaches or endoscopic approaches) for SSCs. METHODS Studies reporting surgical management of SSCs were searched in three online databases (PubMed, the Cochrane Library, and Web of Science). This meta-analysis was reported following the PRISMA Statement. It was registered at the International Prospective Register of Systematic Reviews (CRD42021288992). The Cochrane Collaboration's Risk of Bias in Nonrandomised Studies-of Interventions (ROBINS-I) was used to evaluate bias. Extracted research data were statistically analyzed using Stata 16 and SPSS statistics 25. RESULTS A total of 22 related relevant studies were included. Meta-analysis revealed no statistically significant difference in dural tear, residual cyst, recurrence, reoperation, and operation time between minimally invasive approaches and traditional approaches (p > 0.05), but minimally invasive approaches had a good functional improvement (p = 0.004). Postoperative length of hospital stays and intraoperative bleeding in traditional approaches were also higher than in minimally invasive approaches (p < 0.05). CONCLUSION Based on the available evidence, minimally invasive approaches may be better than traditional approaches in the treatment of SSCs. Minimally invasive approaches had the advantages of improving clinical satisfaction, with a similar complication rate to traditional approaches. Moreover, endoscopic and microsurgical tubular approaches had similar outcomes.
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Affiliation(s)
- Ying Chen
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Pei Yu
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Zhaoliang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Hui Xu
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Shenggang Li
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Qing Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Fufu Ji
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China
| | - Qing Lan
- Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, P.R. China.
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Dietz N, Alkin V, Agarwal N, Bjurström MF, Ugiliweneza B, Wang D, Sharma M, Drazin D, Boakye M. Polypharmacy in spinal cord injury: Matched cohort analysis comparing drug classes, medical complications, and healthcare utilization metrics with 24-month follow-up. J Spinal Cord Med 2024:1-10. [PMID: 39037335 DOI: 10.1080/10790268.2024.2375892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE Polypharmacy in spinal cord injury (SCI) is common and predisposes patients to increased risk of adverse events. Evaluation of long-term health consequences and economic burden of polypharmacy in patients with SCI is explored. DESIGN Retrospective cohort. METHODS The IBM Marketscan Research Databases claims-based dataset was queried to search for adult patients with SCI with a 2-year follow-up. PARTICIPANTS Two matched cohorts were analyzed: those with and without polypharmacy, analyzing index hospitalization, readmissions, payments, and health outcomes. RESULTS A total of 11 569 individuals with SCI were included, of which 7235 (63%) were in the polypharmacy group who took a median of 11 separate drugs over two years. Opioid analgesics were the most common medication, present in 57% of patients with SCI meeting the criteria of polypharmacy, followed by antidepressant medications (46%) and muscle relaxants (40%). Risk of pneumonia was increased for the polypharmacy group (58%) compared to the non-polypharmacy group (45%), as were urinary tract infection (79% versus 63%), wound infection (30% versus 21%), depression (76% versus 57%), and adverse drug events (24% versus 15%) at 2 years. Combined median healthcare payments were higher in polypharmacy at 2 years ($44 333 vs. $10 937, P < .0001). CONCLUSION Majority of individuals with SCI met the criteria for polypharmacy with nearly 60% of those prescribed opioids and taking drugs from high-risk side effect profiles. Polypharmacy in SCI was associated with a greater risk of pneumonia, depression, urinary tract infections, adverse drug events, and emergency room visits over two years with four times higher overall healthcare payments at 1-year post-injury.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Victoria Alkin
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Nitin Agarwal
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | - Dengzhi Wang
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Mayur Sharma
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Doniel Drazin
- Department of Neurosurgery, Pacific Northwest University of Health Sciences, Yakima, Washington, USA
| | - Maxwell Boakye
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
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15
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Schnipper J, Azawi N, Størling Z, Simonsen KS, Andersen K. Switching from intermittent catheterization with single-use catheter to a reusable catheter has a negative impact on quality of life. Neurourol Urodyn 2024. [PMID: 39032094 DOI: 10.1002/nau.25556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/06/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE It has been proposed that reusable catheters are more cost effective and environmentally sustainable than single-use catheters intended for intermittent catheterization (IC). However, the aspect of individuals' well-being and preference for catheter type is not considered. In this study, we investigated the impact on individuals' health-related quality of life (HR-QoL) when testing a reusable catheter. MATERIALS AND METHODS The study was an open-labeled, single-arm, multicenter investigation with a treatment period of 28 days. Forty subjects using single-use hydrophilic catheters were accustomed to a reusable catheter for managing IC. HR-QoL was evaluated by the Intermittent-Self Catheterization Questionnaire (ISC-Q). Additionally, satisfaction was evaluated by the Intermittent Catheterization Satisfaction Questionnaire (InCaSa-Q). The difference in total score was analyzed using a mixed linear model. Furthermore, preference for IC (single-use vs. reusable) was assessed and microbial evaluation of the catheters was performed. RESULTS The total ISC-Q score measuring HR-QoL decreased significantly by 28% (p < 0.001). Two of the four subdomains (ease-of-use and discreetness) also decreased significantly (p < 0.001). The total InCaSa-score and all four subdomains evaluating satisfaction decreased significantly (p < 0.005). The primary study results were supported by the fact that 90.9% of subjects preferred to use a single-use catheter for IC. Furthermore, 50% of reusable catheters were contaminated with bacteria. CONCLUSION Switching from single-use to reusable IC resulted in a significant decrease in HR-QoL and satisfaction. Moreover, the vast majority preferred the single-use catheter due to handling and convenience. The users' rights to their preferred bladder management method should be acknowledged.
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Affiliation(s)
| | - Nessn Azawi
- Department of Urology, Sjællands Universitetshospital, Roskilde, Denmark
| | | | | | - Karin Andersen
- Department of Urology, Odense Universitetshospital, Odense, Denmark
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16
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Kueper N, Kim SK, Kirchner EA. Avoidance of specific calibration sessions in motor intention recognition for exoskeleton-supported rehabilitation through transfer learning on EEG data. Sci Rep 2024; 14:16690. [PMID: 39030206 DOI: 10.1038/s41598-024-65910-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/25/2024] [Indexed: 07/21/2024] Open
Abstract
Exoskeleton-based support for patients requires the learning of individual machine-learning models to recognize movement intentions of patients based on the electroencephalogram (EEG). A major issue in EEG-based movement intention recognition is the long calibration time required to train a model. In this paper, we propose a transfer learning approach that eliminates the need for a calibration session. This approach is validated on healthy subjects in this study. We will use the proposed approach in our future rehabilitation application, where the movement intention of the affected arm of a patient can be inferred from the EEG data recorded during bilateral arm movements enabled by the exoskeleton mirroring arm movements from the unaffected to the affected arm. For the initial evaluation, we compared two trained models for predicting unilateral and bilateral movement intentions without applying a classifier transfer. For the main evaluation, we predicted unilateral movement intentions without a calibration session by transferring the classifier trained on data from bilateral movement intentions. Our results showed that the classification performance for the transfer case was comparable to that in the non-transfer case, even with only 4 or 8 EEG channels. Our results contribute to robotic rehabilitation by eliminating the need for a calibration session, since EEG data for training is recorded during the rehabilitation session, and only a small number of EEG channels are required for model training.
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Affiliation(s)
- Niklas Kueper
- Robotics Innovation Center, German Research Center for Artificial Intelligence (DFKI), 28359, Bremen, Germany
| | - Su Kyoung Kim
- Robotics Innovation Center, German Research Center for Artificial Intelligence (DFKI), 28359, Bremen, Germany
| | - Elsa Andrea Kirchner
- Robotics Innovation Center, German Research Center for Artificial Intelligence (DFKI), 28359, Bremen, Germany.
- Institute of Medical Technology Systems, University of Duisburg-Essen, 47057, Duisburg, Germany.
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Ikwuegbuenyi CA, Woodfield J, Waterkeyn F, Zuckerman SL, Cheserem B, Leidinger A, Lazaro A, Shabani HK, Härtl R, Mangat HS. Is mechanism of injury associated with outcome in spinal trauma? An observational cohort study from Tanzania. PLoS One 2024; 19:e0306577. [PMID: 39024312 PMCID: PMC11257230 DOI: 10.1371/journal.pone.0306577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Traumatic spinal injury (TSI) is a disease of significant global health burden, particularly in low and middle-income countries where road traffic-related trauma is increasing. This study compared the demographics, injury patterns, and outcomes of TSI caused by road traffic accidents (RTAs) to non-traffic related TSI. METHODS A retrospective analysis was conducted using a neurotrauma registry from the Muhimbili Orthopaedic Institute (MOI) in Tanzania, a national referral center for spinal injuries. Patient sociodemographic characteristics, injury level, and severity were compared across mechanisms of injury. Neurological improvement, neurological deterioration, and mortality were compared between those sustaining TSI through an RTA versus non-RTA, using univariable and multivariable analyses. RESULTS A total of 626 patients were included, of which 302 (48%) were RTA-related. The median age was 34 years, and 532 (85%) were male. RTAs had a lower male preponderance compared to non-RTA causes (238/302, 79% vs. 294/324, 91%, p<0.001) and a higher proportion of cervical injuries (144/302, 48% vs. 122/324, 38%, p<0.001). No significant differences between RTA and non-RTA mechanisms were found in injury severity, time to admission, length of hospital stay, surgical intervention, neurological outcomes, or in-hospital mortality. Improved neurological outcomes were associated with incomplete injuries (AIS B-D), while higher mortality rates were linked to cervical injuries and complete (AIS A) injuries. CONCLUSION Our study in urban Tanzania finds no significant differences in outcomes between spinal injuries from road traffic accidents (RTAs) and non-RTA causes, suggesting the need for equitable resource allocation in spine trauma programs. Highlighting the critical link between cervical injuries and increased mortality, our findings call for targeted interventions across all causes of traumatic spinal injuries (TSI). We advocate for a comprehensive trauma care system that merges efficient pre-hospital care, specialized treatment, and prevention measures, aiming to enhance outcomes and ensure equity in trauma care in low- and middle-income countries.
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Affiliation(s)
- Chibuikem Anthony Ikwuegbuenyi
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York, United States of America
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Julie Woodfield
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York, United States of America
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - François Waterkeyn
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York, United States of America
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
- Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Scott L. Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | | | - Andreas Leidinger
- Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Albert Lazaro
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Hamisi K. Shabani
- Division of Neurosurgery, Muhimbili Orthopedic and Neurosurgery Institute, Dar es Salaam, Tanzania
| | - Roger Härtl
- Department of Neurological Surgery, New York Presbyterian Hospital/Och Spine, Weill Cornell Medicine, New York, New York, United States of America
| | - Halinder S. Mangat
- Department of Neurology, Kansas University Medical Center, Kansas City, Kansas, United States of America
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Glista D, O'Hagan R, Servais M, Jalilian N. Adolescent-Centered mHealth Applications in a Collaborative Care Model: A Virtual Focus Group Study With Audiologists. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024:1-17. [PMID: 39018271 DOI: 10.1044/2024_jslhr-23-00679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
PURPOSE Technology-enabled care, including the use of mobile health (mHealth), is emerging as a viable hearing health care delivery method. While the integration of mHealth with adult populations currently supports a wide array of hearing services, a better understanding of the implementation across the lifespan is needed. Literature surrounding the unique population of adolescent hearing aid users is currently lacking. Research is needed to highlight factors important to the use and clinical integration of mHealth hearing aid applications (apps) with adolescents. This study explored two primary objectives: (a) audiologists' perceptions around the use of mHealth apps to enable collaborative, child-inclusive hearing aid personalization, and (b) person-centered ideation around potential app design components to benefit users aged 12 to 17 years. METHOD Twelve audiologists participated in virtual synchronous focus groups, across three group sessions using Cisco Webex. Sessions were recorded, transcribed, and analyzed using an inductive, codebook thematic analysis approach. RESULTS Six main themes resulted from group discussion analyses: (a) client candidacy: characteristics impacting suitability for mHealth use; (b) clinical implementation: organizational, professional, or patient-level strategies for mHealth adoption; (c) collaboration: the use of two or more individuals working together; (d) empowerment: process of acquiring and using knowledge, skills, and strategies; (e) remote technology: technologies enabling remote hearing aid personalization; and (f) application functionality and design: features and characteristics important to an adolescent-focused app. CONCLUSIONS Findings identified the potential for clinical integration of hearing aid apps with adolescents in a collaborative care model, including consideration of child-specific use patterns, outcomes, and key design and technology components to support real-world implementation and use. Results may guide development and tailoring efforts around existing and future hearing aid apps for use with adolescent populations.
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Affiliation(s)
- Danielle Glista
- National Centre for Audiology, The University of Western Ontario, London, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, The University of Western Ontario, London, Canada
| | - Robin O'Hagan
- National Centre for Audiology, The University of Western Ontario, London, Canada
| | - Michelle Servais
- National Centre for Audiology, The University of Western Ontario, London, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders, The University of Western Ontario, London, Canada
- Thames Valley Children's Centre, London, Ontario, Canada
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Warner E, Azizoddin D, Frank-Pearce SG, Ford L, Bradley D, Cohn A, Businelle M, Spicer P, Appleseth H, McQuoid J. "It frees your body from that pain thought": A mixed methods exploration of patterns, contexts, and experiences of cannabis use for pain in rural communities. THE JOURNAL OF PAIN 2024:104636. [PMID: 39025284 DOI: 10.1016/j.jpain.2024.104636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/02/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
U.S. adults increasingly report using cannabis to manage chronic pain and rural areas have inadequate comprehensive pain management. Using mixed methods, we aimed to understand how and why some rural adults use cannabis for pain, including within the context of co-use with opioids. Participants (N=14; Oklahoma) were rural-dwelling adults who used tobacco and ≥ 1 other substance, including cannabis and opioids, ≥ 3 days per week. Participants completed 14-days of ecological momentary assessment (EMA) regarding substance use and subsequent in-depth interviews discussing maps of their substance use reports. Half (7/14) described cannabis use for chronic pain, and most of these (85%) reported use on ≥75% of EMA days. The most frequently reported cannabis use motive was therapeutic/medicinal (90% of use reports). Most reports were of combusted cannabis (88% of use reports) at home (99% of use reports). Same-day use of cannabis and opioids was relatively common (45% of daily surveys), but seemingly not within close temporal proximity. Interview narratives characterized cannabis as modifying pain-adjacent factors (e.g., thoughts); not eliminating pain itself. They recounted using a repertoire of substances to manage different pain dimensions (e.g., intensity, quality) and balance perceived trade-offs of different substances. Participants described high medical cannabis access, low pain specialist access, and most physicians as unwilling to discuss cannabis for pain. Findings suggest that rural-dwelling patients could benefit from increased access to comprehensive pain management, having cannabis addressed within pain management provider discussions, and that risks and benefits of cannabis use for pain must be better established. PERSPECTIVE: This study used a geographically-explicit ecological momentary assessment mixed method to gather rich, intensive pilot data on cannabis use and co-use for chronic pain in rural Oklahoma. It provides unique insights to inform future research on cannabis use among a vulnerable and understudied sub-group of adults with pain - rural residents.
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Affiliation(s)
- Emily Warner
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA; TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Desiree Azizoddin
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Summer G Frank-Pearce
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lance Ford
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - David Bradley
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amy Cohn
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Paul Spicer
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma, USA
| | - Hannah Appleseth
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA; TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Julia McQuoid
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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20
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Benzon HT, Elmofty D, Shankar H, Rana M, Chadwick AL, Shah S, Souza D, Nagpal AS, Abdi S, Rafla C, Abd-Elsayed A, Doshi TL, Eckmann MS, Hoang TD, Hunt C, Pino CA, Rivera J, Schneider BJ, Stout A, Stengel A, Mina M, FitzGerald JD, Hirsch JA, Wasan AD, Manchikanti L, Provenzano DA, Narouze S, Cohen SP, Maus TP, Nelson AM, Shanthanna H. Use of corticosteroids for adult chronic pain interventions: sympathetic and peripheral nerve blocks, trigger point injections - guidelines from the American Society of Regional Anesthesia and Pain Medicine, the American Academy of Pain Medicine, the American Society of Interventional Pain Physicians, the International Pain and Spine Intervention Society, and the North American Spine Society. Reg Anesth Pain Med 2024:rapm-2024-105593. [PMID: 39019502 DOI: 10.1136/rapm-2024-105593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/14/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND There is potential for adverse events from corticosteroid injections, including increase in blood glucose, decrease in bone mineral density and suppression of the hypothalamic-pituitary axis. Published studies note that doses lower than those commonly injected provide similar benefit. METHODS Development of the practice guideline was approved by the Board of Directors of American Society of Regional Anesthesia and Pain Medicine with several other societies agreeing to participate. The scope of guidelines was agreed on to include safety of the injection technique (landmark-guided, ultrasound or radiology-aided injections); effect of the addition of the corticosteroid on the efficacy of the injectate (local anesthetic or saline); and adverse events related to the injection. Based on preliminary discussions, it was decided to structure the topics into three separate guidelines as follows: (1) sympathetic, peripheral nerve blocks and trigger point injections; (2) joints; and (3) neuraxial, facet, sacroiliac joints and related topics (vaccine and anticoagulants). Experts were assigned topics to perform a comprehensive review of the literature and to draft statements and recommendations, which were refined and voted for consensus (≥75% agreement) using a modified Delphi process. The United States Preventive Services Task Force grading of evidence and strength of recommendation was followed. RESULTS This guideline deals with the use and safety of corticosteroid injections for sympathetic, peripheral nerve blocks and trigger point injections for adult chronic pain conditions. All the statements and recommendations were approved by all participants after four rounds of discussion. The Practice Guidelines Committees and Board of Directors of the participating societies also approved all the statements and recommendations. The safety of some procedures, including stellate blocks, lower extremity peripheral nerve blocks and some sites of trigger point injections, is improved by imaging guidance. The addition of non-particulate corticosteroid to the local anesthetic is beneficial in cluster headaches but not in other types of headaches. Corticosteroid may provide additional benefit in transverse abdominal plane blocks and ilioinguinal/iliohypogastric nerve blocks in postherniorrhaphy pain but there is no evidence for pudendal nerve blocks. There is minimal benefit for the use of corticosteroids in trigger point injections. CONCLUSIONS In this practice guideline, we provided recommendations on the use of corticosteroids in sympathetic blocks, peripheral nerve blocks, and trigger point injections to assist clinicians in making informed decisions.
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Affiliation(s)
- Honorio T Benzon
- Anesthesiology, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Dalia Elmofty
- Department of Anesthesia, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Hariharan Shankar
- Anesthesiology, Clement Zablocki VA Medical Center/Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Maunak Rana
- Department of Anesthesia, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Andrea L Chadwick
- Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Shalini Shah
- University of California Irvine, Orange, California, USA
| | - Dmitri Souza
- Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | - Ameet S Nagpal
- Orthopaedics and PM&R, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Salahadin Abdi
- Pain Medicine, MD Anderson Cancer Center, Houston, Texas, USA
| | - Christian Rafla
- Anesthesiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | - Alaa Abd-Elsayed
- University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tina L Doshi
- Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Maxim S Eckmann
- Anesthesiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Thanh D Hoang
- Endocrinology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Carlos A Pino
- Anesthesiology, Naval Medical Center San Diego, San Diego, California, USA
| | | | - Byron J Schneider
- PM&R, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Angela Stengel
- American Society of Regional Anesthesia and Pain Medicine, Pittsburgh, Pennsylvania, USA
| | - Maged Mina
- Anesthesiology, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ajay D Wasan
- University of Pittsburgh Health Sciences, Pittsburgh, Pennsylvania, USA
| | | | | | - Samer Narouze
- Anesthesia, Division of Pain Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Steven P Cohen
- Anesthesiology, Feinberg School of Medicine, Chicago, Illinois, USA
- Anesthesiology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Ariana M Nelson
- Department of Anesthesiology and Perioperative Medicine, University of California Irvine, Irvine, California, USA
- Department of Aerospace Medicine, Exploration Medical Capability, Johnson Space Center
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21
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Zeller SL, Stein A, Frid I, Carpenter AB, Soldozy S, Rawanduzy C, Rosenberg J, Bauerschmidt A, Al-Mufti F, Mayer SA, Kinon MD, Wainwright JV. Critical Care of Spinal Cord Injury. Curr Neurol Neurosci Rep 2024:10.1007/s11910-024-01357-8. [PMID: 39008022 DOI: 10.1007/s11910-024-01357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE OF REVIEW Spinal cord injury (SCI) is a major cause of morbidity and mortality, posing a significant financial burden on patients and the healthcare system. While little can be done to reverse the primary mechanical insult, minimizing secondary injury due to ischemia and inflammation and avoiding complications that adversely affect neurologic outcome represent major goals of management. This article reviews important considerations in the acute critical care management of SCI to improve outcomes. RECENT FINDINGS Neuroprotective agents, such as riluzole, may allow for improved neurologic recovery but require further investigation at this time. Various forms of neuromodulation, such as transcranial magnetic stimulation, are currently under investigation. Early decompression and stabilization of SCI is recommended within 24 h of injury when indicated. Spinal cord perfusion may be optimized with a mean arterial pressure goal from a lower limit of 75-80 to an upper limit of 90-95 mmHg for 3-7 days after injury. The use of corticosteroids remains controversial; however, initiation of a 24-h infusion of methylprednisolone 5.4 mg/kg/hour within 8 h of injury has been found to improve motor scores. Attentive pulmonary and urologic care along with early mobilization can reduce in-hospital complications.
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Affiliation(s)
- Sabrina L Zeller
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Alan Stein
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Ilya Frid
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Austin B Carpenter
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Sauson Soldozy
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Cameron Rawanduzy
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Jon Rosenberg
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Andrew Bauerschmidt
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Stephan A Mayer
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
| | - Merritt D Kinon
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA
- Department of Orthopedic Surgery, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA
| | - John V Wainwright
- Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
- Department of Neurosurgery, New York Medical College, Valhalla, NY, USA.
- Department of Orthopedic Surgery, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA.
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Guntin J, Ricciardelli A, Flores A, Chen J, Treiber J, Fuentes A. Pure epidural extraosseous cavernous hemangioma with thoracic myelopathy: case report and review of literature. Spinal Cord Ser Cases 2024; 10:48. [PMID: 39009566 PMCID: PMC11251031 DOI: 10.1038/s41394-024-00655-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/07/2024] [Accepted: 06/07/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Pure epidural spinal cavernous hemangiomas are rare, benign vascular tumors that account for approximately 4% of all spinal epidural tumors. Due to their dumbbell shape and propensity for foraminal invasion, they are often misdiagnosed and inadequately treated. We present a case of a 58-year-old male with extra-osseous cavernous hemangioma to better aid in diagnosis and management of these lesions. CASE PRESENTATION A 58-year-old male presented with chronic lower back pain, progressive lower extremity weakness, T10 sensory level, absent lower extremity proprioception, hyperreflexia, and an episode of bowel incontinence. Imaging demonstrated T7-T10 homogenous dorsal epidural mass causing cord signal change. He underwent resection with histopathologic exam revealing a pure epidural cavernous hemangioma. CONCLUSION Spinal epidural cavernous hemangiomas are exceedingly rare lesions that are often misdiagnosed as nerve sheath tumors and meningiomas. Common features include chronic pain and myelopathy as well as T1 isodensity, T2 hyperintensity, and homogenous enhancement. Uniquely, they present as a lobulated, spindled shape with tapered ends in the dorsal epidural space. Both gross and subtotal resection result in favorable neurologic outcomes.
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Affiliation(s)
- Jordan Guntin
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Alex Flores
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Chen
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Treiber
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Alfonso Fuentes
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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23
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Bhattarai M, Shigemoto Y, Huang YC, Islam MT, Sorenson M. Mindfulness for health and wellbeing in adults with spinal cord injury: A scoping review. J Spinal Cord Med 2024:1-15. [PMID: 39007686 DOI: 10.1080/10790268.2024.2374130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
CONTEXT Individuals with spinal cord injury (SCI) require resources to prevent or self-manage complications in order to maintain optimum functioning and well-being. Rehabilitation literature suggests that mindfulness as an internal psychological resource can play a crucial role in promoting self-management and improving health and well-being. OBJECTIVES We sought to identify and synthesize existing evidence on the role of mindfulness and mindfulness-based interventions in health and well-being outcomes among adults with SCI. METHODS We conducted a scoping review, searching evidence across four electronic databases, CINAHL, PubMed, PsycINFO, and Web of Science, for articles published between 2000 and 2023. Additional articles were searched from the reference list of identified articles. RESULTS Of 354 articles identified in the search, 20 were included in the scoping review. Thirteen studies were interventional in design, while the other seven included cross-sectional and qualitative designs. Some interventional studies examined mindfulness as the major component of the interventions, whereas other studies integrated mindfulness as one component of the intervention program. Overall, mindfulness and mindfulness-based interventions were associated with a range of health and well-being outcomes among individuals with SCI. CONCLUSIONS Mindfulness and mindfulness-based interventions appear to positively impact health and well-being in adults with SCI. However, mindfulness interventions were inconsistent in terms of content, delivery frequency, and duration. It is essential to develop multifaceted, tailored mindfulness interventions utilizing a consumer-based approach and established theories of mindfulness and mindfulness-based practices for adults with SCI.
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Affiliation(s)
- Muna Bhattarai
- College of Nursing, Texas A&M University, College Station, TX, USA
| | - Yuki Shigemoto
- Department of Psychology, Prairie View A&M University, Prairie View, TX, USA
| | - Ya-Ching Huang
- College of Nursing, Texas A&M University, College Station, TX, USA
| | | | - Matthew Sorenson
- College of Nursing, Texas A&M University, College Station, TX, USA
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24
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Shaker K, Alomar K, Wahoob M, Altabaa K, Omran M, Marwa G. A rare case of Ewing's sarcoma primary of the cervical spine in a 1-year-old child: A case report and literature review. Int J Surg Case Rep 2024; 122:110020. [PMID: 39043091 DOI: 10.1016/j.ijscr.2024.110020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 07/03/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024] Open
Abstract
INTRODUCTION AND SIGNIFICANCE Ewing sarcoma is a rare and malignant bone tumor that can primarily affect the cervical spine. Symptoms may not always be present, but muscle weakness is a critical indicator of disease progression and necessitates urgent surgical intervention to relieve pressure on the spinal cord. CASE PRESENTATION We present a case of a child who experienced sudden muscle weakness in the left upper limb. An MRI of the spine revealed a tumor in the cervical spine compressing the spinal cord. Urgent surgical intervention was performed, successfully removing most of the tumor. This was followed by complementary chemotherapy. CLINICAL DISCUSSION Tumors located in the cervical spine are challenging to treat due to their location. Urgent surgery may be crucial when muscle weakness is present. This case demonstrates a novel surgical approach through the spinous processes of the vertebrae, avoiding laminectomy and the need for spinal fixation, which can be difficult in children. CONCLUSION Our case highlights a rare presentation of Ewing sarcoma in the cervical spine, infrequently reported in medical literature. It also demonstrates the success of a novel surgical approach that avoids spinal fixation in children.
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Affiliation(s)
- Kamar Shaker
- Damascus University, University Pediatric Hospital, Syria.
| | - Khaled Alomar
- Damascus University, University Pediatric Hospital, Syria.
| | - Mohammed Wahoob
- Faculty of Medicine, Damascus University, Al Assad University Hospital, Syria
| | - Kasem Altabaa
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria
| | - Mohammad Omran
- Faculty of Medicine, Al-Sham Private University, Damascus, Syria
| | - Ghassan Marwa
- Damascus University, University Pediatrics' Hospital, Syria
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Negosanti L, Balloni M, Landi S, Mercante E, Villa D, Sgarzani R. Complications in spinal cord injury persons with "traditional" colostomy: a case series. Spinal Cord Ser Cases 2024; 10:46. [PMID: 38997269 PMCID: PMC11245491 DOI: 10.1038/s41394-024-00660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
INTRODUCTION Neurogenic bowel dysfunction is a frequent consequence of spinal cord injury/disease (SCI/D). A colostomy is considered when conservative treatments fail [1, 2]. In the last year we observed several SCI/D persons with colostomy, admitted to our institution with multiple complications. CASE PRESENTATION We present four cases of SCI/D persons treated with Hartmann's procedure and admitted to our institution for pressure ulcer (PU) treatment. All patients underwent PU surgery with good results. All patients reported a subjective good evacuation setting. No one assumed laxative therapies at home. At admission, all patients underwent abdominal radiography that showed an important constipation, with cases of sub-occlusion or complete occlusion with gastroparesis. One person presented a parastomal, strangulated hernia and underwent hernia reduction and patch positioning around the stoma. During hospital stay, bowel management required an important administration of laxatives and frequent, almost daily, stoma washes. DISCUSSION Some considerations must be made regarding the use of traditional techniques in SCI/D people, such as Hartmann's, leaving a large part of the colon and the anatomical position of the stoma itself represent limitations to fecal progression and may cause constipation. A specific approach, tailored on the SCI/D patients' characteristics, such as the one described by our group, should be considered. Even if colostomy has been performed, appropriate therapies and health education on how to manage the stoma are fundamental to prevent complications.
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Affiliation(s)
| | | | | | | | - Davide Villa
- Montecatone Rehabilitation Institue, Imola, Italy
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26
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Yassin MM, Saad MN, Khalifa AM, Said AM. Advancing clinical understanding of surface electromyography biofeedback: bridging research, teaching, and commercial applications. Expert Rev Med Devices 2024:1-18. [PMID: 38967375 DOI: 10.1080/17434440.2024.2376699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/02/2024] [Indexed: 07/06/2024]
Abstract
INTRODUCTION Expanding the use of surface electromyography-biofeedback (EMG-BF) devices in different therapeutic settings highlights the gradually evolving role of visualizing muscle activity in the rehabilitation process. This review evaluates their concepts, uses, and trends, combining evidence-based research. AREAS COVERED This review dissects the anatomy of EMG-BF systems, emphasizing their transformative integration with machine-learning (ML) and deep-learning (DL) paradigms. Advances such as the application of sophisticated DL architectures for high-density EMG data interpretation, optimization techniques for heightened DL model performance, and the fusion of EMG with electroencephalogram (EEG) signals have been spotlighted for enhancing biomechanical analyses in rehabilitation. The literature survey also categorizes EMG-BF devices based on functionality and clinical usage, supported by insights from commercial sectors. EXPERT OPINION The current landscape of EMG-BF is rapidly evolving, chiefly propelled by innovations in artificial intelligence (AI). The incorporation of ML and DL into EMG-BF systems augments their accuracy, reliability, and scope, marking a leap in patient care. Despite challenges in model interpretability and signal noise, ongoing research promises to address these complexities, refining biofeedback modalities. The integration of AI not only predicts patient-specific recovery timelines but also tailors therapeutic interventions, heralding a new era of personalized medicine in rehabilitation and emotional detection.
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Affiliation(s)
- Mazen M Yassin
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, China
- Biomedical Engineering Department, Faculty of Engineering, Minia University, Minia, Egypt
- Department of Biomedical Engineering, Helwan University, Cairo, Egypt
| | - Mohamed N Saad
- Biomedical Engineering Department, Faculty of Engineering, Minia University, Minia, Egypt
| | - Ayman M Khalifa
- Department of Biomedical Engineering, Helwan University, Cairo, Egypt
| | - Ashraf M Said
- Biomedical Engineering Program, Electrical Engineering Department, Benha Faculty of Engineering, Benha University, Al Qalyubiyah, Egypt
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27
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Yao H, Li X, Leng S, Zhang H. Good outcome with conservative treatment of delayed spinal epidural hematoma following combined spinal-epidural anesthesia: a rare case report. BMC Anesthesiol 2024; 24:235. [PMID: 38997652 PMCID: PMC11241848 DOI: 10.1186/s12871-024-02619-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Delayed spinal epidural hematoma (SEH) following central neuraxial block (CNB) is a rare but serious complication. The underlying causes of SEH associated with neuraxial anesthesia are still unclear. Furthermore, the decision between surgical intervention and conservative management for SEH remains a complex and unresolved issue. CASE PRESENTATION We report a case of delayed SEH in a 73-year-old woman who underwent vaginal hysterectomy under combined spinal-epidural anesthesia, with the administration of postoperative anticoagulants to prevent deep vein thrombosis on the 1st postoperative day (POD). She experienced symptoms 56 h after CNB. Magnetic resonance imaging (MRI) revealed a dorsal SEH at the L1-L4 level with compression of the thecal sac. On conservative treatment, full recovery was achieved after six months. CONCLUSIONS This case reminds anesthesiologists should be alert to the possible occurrence of a delayed SEH following CNB, particularly with the administration of anticoagulants. Immediate neurological evaluation of neurological deficit and MRI are advised. Conservative treatment combined with close and dynamic neurological function monitoring may be feasible for patients with mild or nonprogressive symptoms even spontaneous recovery.
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Affiliation(s)
- Hui Yao
- Department of Anesthesiology, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, No. 466, Shi liugang road, Hai zhu District, Guangzhou, Guangdong Province, China
| | - Xuejie Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Shize Leng
- Department of Anesthesiology, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, No. 466, Shi liugang road, Hai zhu District, Guangzhou, Guangdong Province, China
| | - Hui Zhang
- Department of Anesthesiology, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, No. 466, Shi liugang road, Hai zhu District, Guangzhou, Guangdong Province, China.
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28
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Scheffler MS, Martin CA, Dietz V, Faraji AH, Sayenko DG. Synergistic implications of combinatorial rehabilitation approaches using spinal stimulation on therapeutic outcomes in spinal cord injury. Clin Neurophysiol 2024; 165:166-179. [PMID: 39033698 DOI: 10.1016/j.clinph.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/07/2024] [Accepted: 06/26/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE The objective of this narrative review was to locate and assess recent articles employing a combinatorial approach of transcutaneous spinal cord stimulation or epidural spinal cord stimulation with additional modalities. We sought to provide relevant knowledge of recent literature and advance understanding on outcomes reported, to better equip those working in neurorehabilitation and neuromodulation. METHODS Articles were selected and analyzed based on study approach, stimulation parameters, outcome measures, and presence of neurophysiological data to support findings. RESULTS This narrative review analyzed 44 recent articles employing a combinatorial approach of transcutaneous spinal cord stimulation or epidural spinal cord stimulation with additional modalities. Our findings showed that limited research exists regarding such combinatorial approaches, particularly when considering modalities beyond activity-based training. There is also limited consistency in neurophysiological and quality of life outcomes. CONCLUSION Articles involving transcutaneous spinal cord stimulation or epidural spinal cord stimulation with other modalities are limited in the current body of literature. Authors noted variety in approach, sample size, and use of participant perspective. Opportunities are present to add high quality research to this body of literature. SIGNIFICANCE Transcutaneous spinal cord stimulation and epidural spinal cord stimulation are emerging in research as viable avenues for targeting improvement of function after traumatic spinal cord injury, particularly when combined with activity-based training. This body of literature demonstrates viable areas for growth from both neurophysiological and functional perspectives. Further, exploration of novel combinatorial approaches holds potential to offer enhanced contributions to clinical and neurophysiological rehabilitation and research.
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Affiliation(s)
- Michelle S Scheffler
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Catherine A Martin
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Valerie Dietz
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Amir H Faraji
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA
| | - Dimitry G Sayenko
- Department of Neurosurgery, Houston Methodist Research Institute, 6670 Bertner Ave, Houston, TX, 77030, USA.
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Sahu S, Venkataraman S, Chanu AR, Singh U. Transcutaneous neuromodulation versus oxybutynin for neurogenic detrusor overactivity in persons with spinal cord injury: A randomized, investigator blinded, parallel group, non-inferiority controlled trial. J Spinal Cord Med 2024:1-8. [PMID: 38958641 DOI: 10.1080/10790268.2024.2370099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
STUDY DESIGN This study is a randomized, investigator-blinded, controlled trial with a non-inferiority design. OBJECTIVE To investigate the effectiveness of neuromodulation by transcutaneous electrical stimulation of the somatic afferent nerves of the foot in neurogenic detrusor overactivity (NDO) in persons with spinal cord injury (SCI) and compare its effectiveness with oral oxybutynin. SETTING The study was conducted in a rehabilitation in-patient ward of a tertiary care hospital. METHODS Twenty-nine persons with SCI with NDO, either sex, aged 18 years and above were randomized into two groups, one group receiving oral oxybutynin (5 mg thrice a day for two weeks) and the other transcutaneous electrical stimulation (5 Hz, 200 µs pulse, biphasic, amplitude up to 60 mA, 30 min/day for two weeks). Bladder capacity was evaluated by clinical bladder evaluation (i.e. bladder capacity measured by adding leak volume, voiding volume if any, and post-void residue using a catheter) and cystometric bladder capacity by one-channel cystometry. Maximum cystometric pressure was evaluated by one-channel water cystometry. Data were analyzed with Fisher's Exact, t-test, and Wilcoxon rank sum tests. RESULTS Bladder capacity improved significantly in the oxybutynin and neuromodulation groups as measured by one-channel water cystometry (136 ml vs. 120.57 ml) and clinical evaluation (138.93 ml vs. 112 ml). The increase in the neuromodulation group achieved the pre-decided non-inferiority margin of 30 ml over the oxybutynin group when measured by one-channel water cystometry but not by clinical evaluation. Maximum cystometric pressure did not significantly improve in either group when compared with the baseline. CONCLUSION Transcutaneous neuromodulation and oxybutynin effectively increased bladder capacity in persons with SCI with NDO. Neuromodulation by once-a-day transcutaneous electrical stimulation was non-inferior to thrice-a-day oxybutynin when evaluated by one-channel water cystometry.Trial registration: Clinical Trials Registry India identifier: CTRI/2018/05/013735.
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Affiliation(s)
- Samantak Sahu
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Srikumar Venkataraman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Asem Rangita Chanu
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - U Singh
- Department of Physical Medicine and Rehabilitation, Mahatma Gandhi Medical College and Hospitals, Jaipur, Rajasthan, India
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McKenzie K, Veit N, Aalla S, Yang C, Giffhorn M, Lynott A, Buchler K, Kishta A, Barry A, Sandhu M, Moon Y, Rymer WZ, Jayaraman A. Combining Neuromodulation Strategies in Spinal Cord Injury Gait Rehabilitation: A Proof Of Concept, Randomized, Crossover Trial. Arch Phys Med Rehabil 2024:S0003-9993(24)01073-6. [PMID: 38969255 DOI: 10.1016/j.apmr.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 06/17/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVES To evaluate if acute intermittent hypoxia (AIH) coupled with transcutaneous spinal cord stimulation (tSCS) enhances task-specific training and leads to superior and more sustained gait improvements as compared with each of these strategies used in isolation in persons with chronic, incomplete spinal cord injury. DESIGN Proof of concept, randomized crossover trial. SETTING Outpatient, rehabilitation hospital. INTERVENTIONS Ten participants completed 3 intervention arms: (1) AIH, tSCS, and gait training (AIH + tSCS); (2) tSCS plus gait training (SHAM AIH + tSCS); and (3) gait training alone (SHAM + SHAM). Each arm consisted of 5 consecutive days of intervention with a minimum of a 4-week washout between arms. The order of arms was randomized. The study took place from December 3, 2020, to January 4, 2023. MAIN OUTCOME MEASURES 10-meter walk test at self-selected velocity (SSV) and fast velocity, 6-minute walk test, timed Up and Go (TUG) and secondary outcome measures included isometric ankle plantarflexion and dorsiflexion torque RESULTS: TUG improvements were 3.44 seconds (95% CI: 1.24-5.65) significantly greater in the AIH + tSCS arm than the SHAM AIH + tSCS arm at post-intervention (POST), and 3.31 seconds (95% CI: 1.03-5.58) greater than the SHAM + SHAM arm at 1-week follow up (1WK). SSV was 0.08 m/s (95% CI: 0.02-0.14) significantly greater following the AIH + tSCS arm than the SHAM AIH + tSCS at POST. Although not significant, the AIH + tSCS arm also demonstrated the greatest average improvements compared with the other 2 arms at POST and 1WK for the 6-minute walk test, fast velocity, and ankle plantarflexion torque. CONCLUSIONS This pilot study is the first to demonstrate that combining these 3 neuromodulation strategies leads to superior improvements in the TUG and SSV for individuals with chronic incomplete spinal cord injury and warrants further investigation.
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Affiliation(s)
| | - Nicole Veit
- Shirley Ryan AbilityLab, Chicago; Department of Biomedical Engineering, Northwestern University, Evanston
| | | | - Chen Yang
- Shirley Ryan AbilityLab, Chicago; Feinberg School of Medicine, Northwestern University, Chicago
| | | | | | | | | | | | - Milap Sandhu
- Shirley Ryan AbilityLab, Chicago; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago
| | - Yaejin Moon
- Shirley Ryan AbilityLab, Chicago; Feinberg School of Medicine, Northwestern University, Chicago
| | - William Zev Rymer
- Shirley Ryan AbilityLab, Chicago; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago; Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago; Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago.
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Thornton WA, Smulligan K, Weber KA, Tefertiller C, Mañago M, Sevigny M, Wiley L, Stevens-Lapsley J, Smith AC. Lesion characteristics are associated with bowel, bladder, and overall independence following cervical spinal cord injury. J Spinal Cord Med 2024:1-9. [PMID: 38958637 DOI: 10.1080/10790268.2024.2363005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
CONTEXT/OBJECTIVE There is a growing global interest in quantifying spinal cord lesions and spared neural tissue using magnetic resonance imaging (MRI) in individuals with spinal cord injury (SCI). The primary objective of this study was to assess the relationships between spinal cord lesion characteristics assessed on MRI and bowel, bladder, and overall independence following SCI. DESIGN Retrospective, exploratory study. PARTICIPANTS 93 individuals with cervical SCI who were enrolled in a local United States Model Systems SCI database from 2010 to 2017. METHODS Clinical and MRI data were obtained for potential participants, and MRIs of eligible participants were analyzed. Explanatory variables, captured on MRIs, included intramedullary lesion length (IMLL), midsagittal ventral tissue bridge width (VTBW), midsagittal dorsal tissue bridge width (DTBW), and axial damage ratio (ADR). OUTCOME MEASURES Bowel and bladder management scale of the Functional Independence Measure (FIM) and FIM total motor score. RESULTS When accounting for all four variables, only ADR was significantly associated with bowel independence (OR = 0.970, 95% CI: 0.942-0.997, P = 0.030), and both ADR and IMLL were strongly associated with bladder independence (OR = 0.967, 95% CI: 0.936-0.999, P = 0.046 and OR = 0.948, 95% CI: 0.919-0.978, P = 0.0007, respectively). 32% of the variation in overall independence scores were explained by all four predictive variables, but only ADR was significantly associated with overall independence after accounting for all other predictive variables (β = -0.469, 95% CI: -0.719, -0.218, P = 0.0004). CONCLUSIONS Our results suggest that the MRI-measured extent of spinal cord lesion may be predictive of bowel, bladder, and overall independence following cervical SCI.
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Affiliation(s)
- Wesley A Thornton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
- Craig Hospital, Englewood, Colorado, USA
| | - Katherine Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Mark Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Laura Wiley
- Department of Biostatistics & Informatics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrew C Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
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Milicevic S, Sekulic A, Nikolic D, Tomasevic-Todorovic S, Lazarevic K, Pelemis S, Petrovic M, Mitrovic SZ. Urinary Tract Infections in Relation to Bladder Emptying in Patients with Spinal Cord Injury. J Clin Med 2024; 13:3898. [PMID: 38999463 PMCID: PMC11242679 DOI: 10.3390/jcm13133898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/22/2024] [Accepted: 06/28/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Spinal cord injuries are debilitating conditions with significant impacts on physical function and patient quality of life. The high incidence of urinary tract infections in these patients can be attributed to neurogenic bladder-a major complication of spinal cord injuries. The aim of this study is to investigate the incidence of urinary tract infections in patients with spinal cord injuries and their relation to the method of bladder emptying. Methods: A retrospective analysis on 560 patients admitted for rehabilitation at the Clinic for Rehabilitation "Dr Miroslav Zotovic" from December 2009 to January 2023 was conducted. Patients over 18 years old who were inpatients for longer than 30 days without any symptoms of urinary tract infection on admission were included. Patient demographics, injury details, and bladder emptying methods were recorded. Results: In our study, 402 (71.8%) participants developed a urinary tract infection during their rehabilitation. Urinary tract infections were significantly more common in patients with traumatic spinal cord injuries, lower ASIA scores, and thoracic-level injuries. The highest incidence of urinary tract infections was observed in intermittent self-catheterization patients (62.7%), with Escherichia coli and Proteus mirabilis being the most frequently isolated pathogens. Conclusions: The method of bladder emptying significantly impacted the incidence of urinary tract infection in patients with spinal cord injuries. Despite guidelines favoring intermittent catheterization, this study found it to be associated with the highest infection rates. These findings suggest a need for personalized bladder management strategies to reduce the risk of urinary tract infections and improve outcomes for spinal cord injury patients.
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Affiliation(s)
- Sasa Milicevic
- Faculty of Medicine, University of Pristina, 38220 Kosovska Mitrovica, Serbia
| | | | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
| | - Snezana Tomasevic-Todorovic
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Clinic for Medical Rehabilitation, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
| | - Konstansa Lazarevic
- Department for Biomedical Science, State University of Novi Pazar, 36300 Novi Pazar, Serbia
| | - Svetislav Pelemis
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Masa Petrovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Cardiovascular Diseases “Dedinje”, 11000 Belgrade, Serbia
| | - Sindi Z. Mitrovic
- Clinic for Rehabilitation “Dr Miroslav Zotovic”, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Zhou J. An unusual case of ventral spontaneous thoracic epidural hematoma. Clin Case Rep 2024; 12:e9144. [PMID: 38962460 PMCID: PMC11220456 DOI: 10.1002/ccr3.9144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024] Open
Abstract
Spontaneous spinal epidural hematoma (SSEH) rarely occurs. Without early diagnosis, SSEH can lead to the acute onset of neurologic deficits. We report the case of a 65-year-old male with diabetes mellitus who was admitted to our emergency department with a chief complaint of sharp and severe pain in the left scapula and behind the sternum. He was misdiagnosed with cardiovascular disease until the onset of progressive bilateral paraplegia and lower limb numbness. Magnetic resonance imaging revealed a ventral thoracic SSEH. Surgical treatment to remove epidural hematoma and laminectomy for decompression were performed. Except for urine retention, bilateral lower limb paraplegia and numbness were alleviated postoperatively. Due to the high risk of poor neurological outcomes without treatment or with delayed intervention, timely surgical evacuation of the hematoma and hemostasis are recommended to ensure favorable neurological outcomes.
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Affiliation(s)
- Junge Zhou
- Department of NeurosurgeryWuhan Brain HospitalWuhanHubeiChina
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Wesley SR, Vates GE, Thornburg LL. Neurologic Emergencies in Pregnancy. Obstet Gynecol 2024; 144:25-39. [PMID: 38626451 DOI: 10.1097/aog.0000000000005575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 02/29/2024] [Indexed: 04/18/2024]
Abstract
Neurologic emergencies in pregnancy require prompt evaluation and early, focused intervention to improve neurologic outcomes for the affected person and to avoid further injury. Neurologic events in pregnancy, although rare, present a time of extreme risk of permanent injury for the person who is pregnant. Therefore, obstetric clinicians should be well versed in the risk factors for potential neurologic events and understand the symptoms and events that should prompt evaluation for a neurologic event. In addition, they should support other specialties in aggressive and early neurologic care for the patient to improve outcomes while assessing fetal well-being and care optimization for the dyad. Obstetric clinicians can uniquely provide knowledge of changes in pregnancy physiology that can increase the risk of neurologic events, as well as change the treatment of these events. For all patients with neurologic events, "time is brain." Therefore, it is important to be aware of changes in common presenting pregnancy concerns that should prompt evaluation for other pathogeneses. Finally, pregnancy care teams should be prepared to begin the initial stabilization and management of acute neurologic emergencies, including seizure, stroke, and meningitis, while seeking aid from other medical and neurologic specialists who can support their care and interventions. Early and aggressive interventions for individuals with neurologic events during pregnancy and postpartum are critical to the overall well-being of the dyad.
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Affiliation(s)
- Shaun R Wesley
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Division of Neuroendocrine Disorders, Department of Neurosurgery, University of Rochester, Rochester, New York
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35
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Lijodi B, Titus A, Louw Q, Joseph C. Activity limitations, participation restrictions, and environmental barriers among persons with traumatic spinal cord injury in Kenya. Disabil Rehabil 2024:1-7. [PMID: 38950895 DOI: 10.1080/09638288.2024.2365413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/02/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE Spinal cord injury (SCI) is a life-changing condition, almost always leading to disability. The aim was to determine the period-prevalence of activity limitations, participation restrictions, and environmental barriers in community-dwelling persons with traumatic spinal cord injury (TSCI) in Kenya. METHODS A cross-sectional survey of 90 community-dwelling adult persons living with TSCI for more than 1 year, recruited from the database of the only specialised rehabilitation, in-patient, facility in Kenya. Modules of the International Spinal Cord Injury community survey (InSCI) used were demographic and injury characteristics; activity and participation; and environmental factors. RESULTS Most prevalent activity limitations and participation restrictions in the total sample were using public transportation (90%), standing unsupported (83%), getting to destination (76%), and toileting (76%). The top environmental barriers were inadequate finances (96%), inaccessibility of public places (92%), and problems with long distance transportation (90%). Participants with tetraplegia were more affected with activity limitations and participation restrictions than those with paraplegia. CONCLUSION Functioning problems and environmental barriers are prevalent among adults living with TSCI in Kenya. Although this is the best-case scenario with respect to healthcare services, where individuals received inpatient rehabilitation previously, a need exists to examine the principles and models of rehabilitation and explore the value proposition of primary care/community level rehabilitation to further optimise independence and functioning.
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Affiliation(s)
- Brenda Lijodi
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adnil Titus
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Quinette Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Conran Joseph
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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36
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Senthinathan A, Tadrous M, Hussain S, McKay S, Moineddin R, Chu C, Jaglal SB, Shepherd J, Cadel L, Noonan VK, Craven BC, Tu K, Guilcher SJT. Examining the impact of the COVID-19 pandemic on homecare services among individuals with traumatic and non-traumatic spinal cord injuries. Spinal Cord 2024; 62:406-413. [PMID: 38811768 DOI: 10.1038/s41393-024-00999-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Abstract
STUDY DESIGN Descriptive repeated-cross sectional retrospective longitudinal cohort study. OBJECTIVE To investigate the impact of the COVID-19 pandemic on homecare services in individuals with traumatic or non-traumatic Spinal Cord Injury (SCI). SETTING Health administrative database in Ontario, Canada. METHODS A repeated cross-sectional study using linked health administrative databases from March 2015 to June 2022. Monthly homecare utilization was assessed in 3381 adults with SCI using Autoregressive Integrated Moving Average (ARIMA) models. RESULTS Compared to pre-pandemic levels, between March 2020 to June 2022, the traumatic group experienced a decrease in personal and/or homemaking services, as well as an increase in nursing visits from April 2020-March 2022 and June 2022. Case management increased at various times for the traumatic group, however therapies decreased in May 2020 only. The non-traumatic group experienced a decrease in personal and/or homemaking services in July 2020, as well as an increase in nursing visits from March 2020 to February 2021 and sporadically throughout 2020. Case management also increased at certain points for the non-traumatic group, but therapies decreased in April 2020, July 2020, and September 2021. CONCLUSION The traumatic group had decreases in personal and/or homemaking services. Both groups had increases in nursing services, increases in case management, and minimal decreases in therapies at varying times during the pandemic. Investigation is warranted to understand the root cause of these changes, and if they resulted in adverse outcomes.
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Affiliation(s)
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Swaleh Hussain
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Sandra McKay
- VHA Home HealthCare, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
| | - Rahim Moineddin
- ICES, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Cherry Chu
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Susan B Jaglal
- ICES, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - B Catharine Craven
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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37
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Field-Fote EC, Anderson KD, Capron M, Rupp R, Jones L, Schmidt-Read M, Noonan VK, Bryden A, Mulroy S, Weiss W, Widmer M, Hagen Poder H, Jørgensen V, Smith E, Purcell M, Biering-Sørensen F. Reliability of the International Spinal Cord Injury Physical Therapy-Occupational Therapy Basic Data Set. Neurotrauma Rep 2024; 5:584-591. [PMID: 39036428 PMCID: PMC11257129 DOI: 10.1089/neur.2024.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
In interventional clinical trials for persons with spinal cord injury (SCI), the influence of experimental biological, pharmacological, or device-related interventions must be differentiated from that of physical and occupational therapy interventions, as rehabilitation influences motor-related outcomes. The International Spinal Cord Injury (ISCI) Physical Therapy-Occupational Therapy Basic Data Set (PT-OT BDS) was developed with the intent to track the content and time of rehabilitation interventions that are delivered concurrently with experimental interventions. We assessed the reliability of the PT-OT BDS based on agreement between users. Following an online training session, physical therapists (PTs) and occupational therapists (OTs) from 10 SCI clinical centers across 7 countries participated. At each center, pairs of therapists (a treating therapist and an observing therapist; PT/PT, OT/OT, or PT/OT) used the PT-OT BDS to record the content and time of therapy sessions for 20 patients. Data were analyzed to determine agreement between therapist pairs regarding the content of the therapy session. The influence of therapist characteristics (professional discipline [PT/OT], years of experience working with individuals with SCI), patient characteristics (level [tetraplegia/paraplegia] and severity [complete/incomplete] of injury), setting (inpatient/outpatient), and whether the center was U.S.- versus non-U.S.-based were also analyzed. There was high agreement for five of seven categories and medium agreement for the remaining two categories. For six of the seven intervention categories, there were no significant differences between the treating and the observing therapists in the percentage of instances that a specific category was selected. Characteristics of the therapists, characteristics of the patient, therapy setting, and global location of the center had no meaningful influence on level of agreement between therapist pairs. The BDS is reliable for use across settings, countries, and with patients of various impairment levels. The study also helped identify additional areas where refinement of the syllabus would be of value.
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Affiliation(s)
- Edelle C. Field-Fote
- Crawford Research Institute, Shepherd Center, Atlanta, Georgia, USA
- Division of Physical Therapy, Emory University School of Medicine, Atlanta, Georgia, USA
- Program in Applied Physiology, School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Kim D. Anderson
- MetroHealth Rehabilitation Institute, MetroHealth System, Cleveland, Ohio, USA
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA
| | - Maclain Capron
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ruediger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Linda Jones
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mary Schmidt-Read
- Magee Rehabilitation Hospital, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
| | - Anne Bryden
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sara Mulroy
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Walter Weiss
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Mario Widmer
- Department of Therapy, Swiss Paraplegic Centre, Nottwil, Switzerland
- Neuro-Musculoskeletal Functioning and Mobility, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Henrik Hagen Poder
- Department for Brain and Spinal Cord Injuries, Bodil Eskesen Centre, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Eimear Smith
- National Rehabilitation Hospital, Dublin, Ireland
| | - Mariel Purcell
- National Spinal Injuries Unit, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Fin Biering-Sørensen
- Department for Brain and Spinal Cord Injuries, Bodil Eskesen Centre, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Nikjou DA, Taggart CM, Lettieri SC, Collins MR, McCabe OT, Rousseau LA, Feiz-Erfan I. Laminectomy for acute transverse sacral fractures with compression of the cauda equina: A neurosurgical perspective. World Neurosurg X 2024; 23:100374. [PMID: 38584879 PMCID: PMC10997834 DOI: 10.1016/j.wnsx.2024.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/28/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Optimal management of transverse sacral fractures (TSF) remains inconclusive. These injuries may present with neurological deficits including cauda equina syndrome. We present our series of laminectomy for acute TSF with cauda equina compression. Methods This was a retrospective chart review of all patients that underwent sacral laminectomy for treatment of cauda equina compression in acute TSF at our institution between 2007 through 2023. Results A total of 9 patients (5 male and 4 female) underwent sacral laminectomy to decompress the cauda equina in the setting of acute high impact trauma. Surgeries were done early within a mean time of 5.9 days. All but one patient had symptomatic cauda equina syndrome. In one instance surgery was applied due to significant canal stenosis present on imaging in a patient with diminished mental status not allowing proper neurological examination. Torn sacral nerve roots were repaired directly when possible. All patients regained their neurological function related to the sacral cauda equina on follow up. The rate of surgical site infection (SSI) was 33%. Conclusion Acute early sacral laminectomy and nerve root repair as needed was effective in recovering bowel and bladder function in patients after high impact trauma and TSF with cauda equina compression. A high SSI rate may be reduced by delaying surgery past 1 week from trauma, but little data exists at this time for clear recommendations.
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Affiliation(s)
- Devin A. Nikjou
- Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Department of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Arizona State University, School of Biological and Health Systems Engineering, Tempe, AZ, USA
| | - Chani M. Taggart
- Department of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Division of Trauma, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Salvatore C. Lettieri
- Department of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Division of Plastic Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Division of Plastic Surgery, Mayo Clinic, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Michael R. Collins
- Department of Radiology, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Owen T. McCabe
- Department of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Division of Trauma, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Layne A. Rousseau
- Department of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Division of Urology, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
| | - Iman Feiz-Erfan
- Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Department of Surgery, Valleywise Health Medical Center, Phoenix, AZ, USA
- Creighton University, School of Medicine Phoenix, Phoenix, AZ, USA
- University of Arizona, College of Medicine Phoenix, Phoenix, AZ, USA
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Kulkarni AM, Gayam PKR, Aranjani JM. Advances in Understanding and Management of Erdheim-Chester Disease. Life Sci 2024; 348:122692. [PMID: 38710283 DOI: 10.1016/j.lfs.2024.122692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/13/2024] [Accepted: 05/03/2024] [Indexed: 05/08/2024]
Abstract
Erdheim Chester Disease (ECD) is a rare histiocytic disorder marked by infiltration of organs with CD68+ histiocytes. ECD stems from mutations of BRAF and MAP2K1 in hematopoietic stem and progenitor cells (HSPCs), which further differentiate into monocytes and histiocytes. Histopathology reveals lipid-containing histiocytes, which test positive for CD68 and CD133 in immunohistochemistry. Signs and symptoms vary and depend on the organ/s of manifestation. Definitive radiological results associated with ECD include hairy kidney, coated aorta, and cardiac pseudotumor. Treatment options primarily include anti-cytokine therapy and inhibitors of BRAF and MEK signaling.
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Affiliation(s)
- Aniruddha Murahar Kulkarni
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prasanna Kumar Reddy Gayam
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jesil Mathew Aranjani
- Department of Pharmaceutical Biotechnology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Gomes Costa RR, Dorneles JR, Veloso JHCL, Gonçalves CWP, Neto FR. Feasibility and validity of the push-up test for synchronous and asynchronous strength tele-assessment in spinal cord injury individuals with paraplegia. J Spinal Cord Med 2024; 47:530-539. [PMID: 36149347 PMCID: PMC11218583 DOI: 10.1080/10790268.2022.2124651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVES This study aimed to determine whether the synchronous and asynchronous push-up tele-assessment in individuals with spinal cord injury (SCI) is feasible and valid and to identify the relationship between the participants' self-reported asynchronous strength tele-assessment and asynchronous push-up tele-assessment. STUDY DESIGN Cross-sectional study. METHODS Thirty-three men and women with SCI were included in this study. The participants were assessed using the one-maximum repetition test (1RM), the maximum repetitions with 60% of 1RM (MRT) of the bench press exercise, and synchronous and asynchronous push-up tele-assessment. The videos and the total repetitions performed were recorded. The primary outcomes were 1RM, MRT, synchronous push-up tele-assessment and asynchronous volume loads, and the participants' self-reported asynchronous strength tele-assessment volume load. RESULTS The synchronous push-up tele-assessment and asynchronous volume loads presented significant correlations with 1RM (0.73 and 0.45, p < 0.001, respectively) and MRT volume loads (0.87 and 0.66, p < 0.001, respectively). The asynchronous push-up tele-assessment presented significant correlations with the synchronous version (intraclass correlation coefficient, ICC = 0.86; 95% CI: 0.72-0.93, p < 0.001) and participants' self-reported asynchronous strength tele-assessment volume loads (ICC = 0.88; 95% CI: 0.75-0.94, p < 0.001). The difference between the synchronous push-up tele-assessment and asynchronous volume load means was 254.9 kg, and the interval around the differences was 1856.1 kg. The difference between asynchronous push-up tele-assessment and participants' self-reported asynchronous strength tele-assessment means was -239.4 kg, and the interval around these was 1884.1 kg. CONCLUSION The synchronous push-up tele-assessment is a feasible and valid way to assess the maximum resistance strength of individuals with SCI. Although the asynchronous push-up tele-assessment demonstrated excellent and significant correlations with the synchronous push-up tele-assessment and participants' self-reported asynchronous strength tele-assessment, the test repetitions and the volume loads were underestimated by 15.5% (synchronous push-up tele-assessment vs. asynchronous) and overestimated by 17.3% (asynchronous push-up tele-assessment vs. participants' self-reported asynchronous strength tele-assessment), and the effect sizes ranged from 0.19-0.38. The authors suggest emphasizing the criteria of repetition validity to reduce test error.
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Borau A, Amaya E, Delía P, Alves MJ, Morcillo M, Ustrell A, Opisso E. Single-center, double-blind, randomized, placebo-controlled pilot study of Canoxidin® for prevention of catheter encrustation in patients with indwelling catheters. Actas Urol Esp 2024:S2173-5786(24)00082-9. [PMID: 38960062 DOI: 10.1016/j.acuroe.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/26/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION AND OBJECTIVES Long-term use of an indwelling catheter is associated with complications such as catheter encrustation and infection. Canoxidin® is a novel oral treatment that can potentially prevent catheter encrustation, as it contains a urine acidifier and a combination of two crystallization inhibitors. This study aimed to evaluate the effects of Canoxidin® on catheter encrustation in patients with indwelling Foley catheters. PATIENTS AND METHODS This was a single-center, double-blind, randomized, placebo-controlled study. Neuro-urology patients aged ≥18 years with an indwelling catheter (urethral or suprapubic) were randomized to treatment consisting of either Canoxidin® or placebo for one month. Foley catheters (two per patient, one before treatment and one after treatment) were removed for analysis of the presence and degree of encrustation. RESULTS A total of 40 patients were enrolled and randomized, 28 of whom had analyzable catheters (13 assigned to Canoxidin® and 15 assigned to placebo). The patients had a mean age of 51.8 years, and eight (28.6%) were female. Two patients (13.3%) in the placebo group and eight patients (61.5%) in the Canoxidin® group experienced an improvement (less encrustation). There was a significant association between Canoxidin® and improvement (odds ratio: 10.4, 95% confidence interval: 1.6 to 66.9, P = 0.016). No adverse effects attributable to the treatment were reported. CONCLUSIONS The overall rate of catheter encrustation was high among those with indwelling Foley catheters. One-month treatment with Canoxidin® reduced the formation of these encrustations, with an excellent short-term safety profile.
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Affiliation(s)
- A Borau
- Servicio de Neurourología, Institut Guttmann, Badalona, Barcelona, Spain.
| | - E Amaya
- Servicio de Neurourología, Institut Guttmann, Badalona, Barcelona, Spain
| | - P Delía
- Servicio de Neurourología, Institut Guttmann, Badalona, Barcelona, Spain
| | - M J Alves
- Servicio de Urología, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - M Morcillo
- Área de Enfermería, Institut Guttmann, Badalona, Barcelona, Spain
| | - A Ustrell
- Área de Enfermería, Institut Guttmann, Badalona, Barcelona, Spain
| | - E Opisso
- Oficina de Innovación e Investigación, Institut Guttmann, Badalona, Barcelona, Spain
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Anderson E, Baker A, Borisoff J, Mattie J, Sawatzky B, Sparrey C, Mortenson WB. Accessible exercise for wheelchair users: comparing the usability of two adapted exercise machines. Disabil Rehabil Assist Technol 2024; 19:2065-2075. [PMID: 37695264 DOI: 10.1080/17483107.2023.2256380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/16/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023]
Abstract
INTRODUCTION Exercise is an important occupation for wheelchair users. Limited access to adapted aerobic exercise equipment in the community and lack of knowledge on how to exercise are barriers to exercise participation among wheelchair users. To address these barriers, the adapted rower (aROW) and adapted skier (aSKI) exercise machines and educational materials were created. PURPOSE 1) To compare wheelchair users' perspectives of the effectiveness and usability of the aROW and aSKI. 2) To explore perceptions of educational materials to support use of the machines. MATERIALS AND METHODS A sequential, mixed-methods study design was used. Six wheelchair users trialled the machines, and completed an interview and two usability questionnaires. Qualitative data were analysed using thematic and conventional content analysis. Usability scores of both machines were compared using the Wilcoxon Signed Ranks Test. RESULTS Data show high usability of the aROW and aSKI. More set up challenges were reported for the aROW than the aSKI. Participants perceived both machines provided effective cardiovascular workouts, and each met their exercise goals differently. Participants preferred the instructional videos over instructional sheets and provided suggestions for improving both. The Wilcoxon Signed Ranks Test showed no statistically significant difference in usability between the aROW and aSKI. CONCLUSION Implementing the aROW and aSKI in the community may address some equity issues that wheelchair users face by providing more aerobic exercise options. Results will inform educational material revisions to support use of the machines.
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Affiliation(s)
- Elisabeth Anderson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Abigail Baker
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
| | - Jaimie Borisoff
- International Collaboration on Repair Discoveries (iCORD), Vancouver, Canada
- Rehabilitation Engineering Design Lab, British Columbia Institute of Technology, Burnaby, Canada
| | - Johanne Mattie
- Rehabilitation Engineering Design Lab, British Columbia Institute of Technology, Burnaby, Canada
| | - Bonita Sawatzky
- International Collaboration on Repair Discoveries (iCORD), Vancouver, Canada
- Faculty of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Carolyn Sparrey
- International Collaboration on Repair Discoveries (iCORD), Vancouver, Canada
- Mechatronic Systems Engineering, Simon Fraser University, Burnaby, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries (iCORD), Vancouver, Canada
- Rehabilitation Research Program, Vancouver, Canada
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Lim Y, Dahapute A, Clarke A, Hutton M, Selbi W. Delayed tension pneumocephalus and pneumorrhacis after routine cervical spine surgery treated successfully without burr holes. Ann R Coll Surg Engl 2024; 106:555-560. [PMID: 37381753 PMCID: PMC11214862 DOI: 10.1308/rcsann.2023.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 06/30/2023] Open
Abstract
Tension pneumocephalus (TP) after spinal surgery is very rare with only a few cases reported in the English literature. Most cases of TP occur rapidly after spinal surgery. Traditionally, TP is managed using burr holes to relieve intracranial pressure. However, our case highlights a rare delayed presentation of TP and pneumorrhacis 1 month after routine cervical spine surgery. It is to our knowledge the first case of TP after spinal surgery to be treated using dural repair and supportive care. A 75-year-old woman presented with TP after having routine cervical decompression and stabilisation for cervical myelopathy. She re-presented 1 month after her initial operation with a leaking wound and altered mental status, which deteriorated rapidly shortly after admission. This, in combination with her radiographic features, influenced the decision to explore her surgical wound emergently. She made a full recovery and was discharged after 2 weeks in hospital. We hope to emphasise the need for a high index of suspicion for cerebrospinal fluid leaks and the low threshold to return to theatre to repair a potential dural defect, as well as illustrate that TP after spinal surgery can be treated successfully without burr holes.
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Affiliation(s)
- Y Lim
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - A Dahapute
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - A Clarke
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - M Hutton
- Royal Devon and Exeter NHS Foundation Trust, UK
| | - W Selbi
- Royal Devon and Exeter NHS Foundation Trust, UK
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de Groot S, Adriaansen JJE, Stolwijk-Swüste JM, Osterthun R, van den Berg-Emons RJG, Post MWM. Obesity in wheelchair users with long-standing spinal cord injury: prevalence and associations with time since injury and physical activity. Spinal Cord 2024; 62:378-386. [PMID: 38649757 DOI: 10.1038/s41393-024-00995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
STUDY DESIGN Secondary analysis of cross-sectional data from the ALLRISC cohort study. OBJECTIVES To investigate the prevalence of obesity and its association with time since injury (TSI) and physical activity (PA) in wheelchair users with long-standing (TSI > 10 years) spinal cord injury (SCI). SETTING Community, The Netherlands. METHODS Wheelchair users with SCI (N = 282) in TSI strata (10-19, 20-29, and ≥30 years) and divided in meeting SCI-specific exercise guidelines or not. Waist circumference (WC) and body mass index (BMI) were assessed. Participants were classified as being obese (WC > 102 cm for men, WC > 88 cm for women; BMI ≥ 25 kg/m2) or not. Logistic regression analyses were performed to investigate the associations between obesity and TSI and PA. RESULTS Almost half of the participants (45-47%) were classified as obese. TSI was significantly associated with obesity, the odds of being obese were 1.4 higher when having a 10 years longer TSI. Furthermore, the odds of being obese were 2.0 lower for participants who were meeting the exercise guidelines. CONCLUSIONS The prevalence of obesity is high in people with long-standing SCI. Those with a longer TSI and individuals who do not meet the exercise guidelines are more likely to be obese and need to be targeted for weight management interventions.
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Affiliation(s)
- Sonja de Groot
- Amsterdam Rehabilitation Research Center | Reade, Amsterdam, The Netherlands.
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
| | | | - Janneke M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Spinal Cord Injury and Orthopedics, De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Rutger Osterthun
- Rijndam Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marcel W M Post
- De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Centre for Rehabilitation, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands
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Oh GY, Moga DC, Fardo DW, Harp JP, Abner EL. The Association of Gabapentin Initiation with Cognitive and Behavioral Changes in Older Adults with Cognitive Impairment: A Retrospective Cohort Study. Drugs Aging 2024; 41:623-632. [PMID: 38980643 DOI: 10.1007/s40266-024-01130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Although gabapentin has been increasingly prescribed to older adults, the relation between gabapentin initiation and longer-term neurocognitive changes is not well understood. Thus, this study aimed to examine the association of gabapentin initiation with cognitive and motor function decline in older adult participants with cognitive impairment. METHODS A retrospective cohort study was conducted using the National Alzheimer's Coordinating Center Uniform Data Set (2005-March 2023). Participants with cognitive impairment at the visit of gabapentin initiation (i.e., index visit) were included. Using the incidence density sampling method, up to nine non-users were randomly selected for each initiator. Cognitive decline over 1 year was defined as any increase in Clinical Dementia Rating global score (CDR®GLOB) or a 1-point increase in CDR® sum of boxes (CDR®SB). Functional status decline over 1 year was defined as at least a 3-point increase in the Functional Activities Questionnaire (FAQ) sum or a 0.3-point increase of mean of FAQ. Motoric decline over 1 year was defined as new clinician reports of gait disorder, falls, and slowness. To mitigate confounding and selection bias, joint stabilized inverse probability of treatment weights and censoring weights were used. Analyses compared index with index + 1 and index + 2 visits. RESULTS For the study of cognitive and functional status decline, we included 505 initiators (mean age [SD] 78.8 [7.4]; male = 45%) and 4545 non-users (79.2 [7.6]; 50.1%). For the study of motor decline, we included 353 initiators (78.3 [7.2]; 42.8%) and 3177 non-users (78.5 [7.4]; 48.1%). Gabapentin initiation was not statistically associated with decline on CDR®GLOB, CDR®SB, FAQ sum, or mean FAQ at the index + 1 or index + 2 visits. However, gabapentin initiation was significantly associated with increased odds of new falls at the index + 2 visit (odds ratio [95% confidence interval] 2.5 [1.3, 4.6]). CONCLUSIONS Over 1 or 2 years of follow-up, gabapentin initiation was not associated with decline in cognitive or functional status but was associated with increased odds of falling among research participants with cognitive impairment.
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Affiliation(s)
- GYeon Oh
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40506, USA.
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, KY, USA.
| | - Daniela C Moga
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40506, USA
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, KY, USA
- Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY, USA
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky, Lexington, KY, USA
| | - David W Fardo
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40506, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
| | - Jordan P Harp
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40506, USA
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Erin L Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, 40506, USA
- Department of Epidemiology and Environmental Health, University of Kentucky, Lexington, KY, USA
- Department of Biostatistics, University of Kentucky, Lexington, KY, USA
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Fleurette J, Solignac N, Werthel JD. Post-traumatic Coracoclavicular Ligament Ossification: A Case Report and Surgical Technique. JBJS Case Connect 2024; 14:01709767-202409000-00014. [PMID: 39028830 DOI: 10.2106/jbjs.cc.24.00136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
CASE A patient presented with complete coracoclavicular ligament ossification after an unnoticed acromioclavicular joint Rockwood Type IV dislocation. He had full passive range of motion in the glenohumeral joint but was disabled by a loss of both active (80°) and passive (90°) abduction due to insufficient passive scapulo-thoracic motion. He was treated with an arthroscopic osteotomy of the coracoclavicular ligament ossification. CONCLUSION One year after the surgery, active abduction was improved by 45° (80°-125°) with no recurrence of the ossification on the radiographs. Arthroscopic osteotomy of complete coracoclavicular ligament ossification seems effective in restoring abduction in these patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Justine Fleurette
- Department of Orthopedic surgery, Hôpital Ambroise Paré, AP-HP, UVSQ University, Boulogne-Billancourt, France
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Marshall K, Patterson F, Fleming J, Gustafsson L, Atresh S. "Be ready to learn": a qualitative study of the patient perspective of falls and fall prevention following discharge from a spinal injuries unit. Disabil Rehabil 2024; 46:3108-3115. [PMID: 37559389 DOI: 10.1080/09638288.2023.2245755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE Falls following a spinal cord injury (SCI) can have physical and psychological consequences, although some risk of falls may be acceptable to enable participation in meaningful activity. The study aimed to explore the patients' perspective of falls and fall prevention after discharge from a inpatient spinal injuries unit. METHODS An interpretive descriptive approach guided the study. Semi structured interviews were conducted in the 6-12 months post discharge period. Thematic analysis was used to analyze the data and identify themes. RESULTS Fifteen individuals with SCI, with a mean age of 57 years and varied fall experiences were included. Three themes were identified including: 1. Expectation of falling; 2. Learning from my own experience and the experience of others' and 3. How to prevent falls. Learning from their own experience and the experience of others was highly valued by persons with SCI and influenced expectations of falls. A variety of strategies were used to prevent falls. CONCLUSIONS Strategies that include learning from others, include activities that are individual and provide skills in self-reflection may aid to make fall prevention meaningful.
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Affiliation(s)
- Kathryn Marshall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane, Australia
| | - Freyr Patterson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Louise Gustafsson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Sridhar Atresh
- Queensland Spinal Cord Injuries Service, Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
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Ellis J, Garner E, Webster KE, Darzins S, Galea MP, Scheinberg A. Establishing an Australian pediatric spinal cord disorder register using consumer, health professional, and researcher perspectives. J Spinal Cord Med 2024; 47:495-503. [PMID: 36066465 PMCID: PMC11218586 DOI: 10.1080/10790268.2022.2115513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT/OBJECTIVE Pediatric spinal cord disorders (SCD) are rare, and epidemiological data available to support treatment are lacking. The implementation of a national data register tailored to this population would greatly assist clinicians and therapists in guiding clinical practice. This study gathered perspectives surrounding a prospective national pediatric spinal cord disorder register. DESIGN Survey and modified Delphi technique. SETTING Australia. PARTICIPANTS SCD consumers, health professionals, and researchers. INTERVENTIONS None. OUTCOME MEASURES None. RESULTS Purposive sampling recruited 6 consumers and 52 health professionals and researchers working in the field of SCD to participate. The consumer survey contained items including demographic information, general and pediatric-specific SCD health issues, and questions regarding activity and participation. The modified Delphi survey required health professionals and researchers to identify which "collection items" and "administrative features" should be included in a national SCD register for both clinical and research purposes. Seventeen essential and nine optional items, two outcome measures, data collection methods, consumer access, definition of "pediatric," and use of International Data Standards were included in the consensus for a minimum dataset. CONCLUSION This study developed a minimum dataset that could inform an Australian register for pediatric SCD. A register linking to an adult database is recommended to ensure coverage across the lifespan. While items for a minimum dataset have been recommended, this dataset is large. Review and refinement of this list are recommended to ensure the register is not overly time-consuming for practical use.
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Affiliation(s)
- Jamie Ellis
- Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Erin Garner
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kate E. Webster
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Susan Darzins
- School of Allied Health, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Mary P. Galea
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Adam Scheinberg
- Neurodisability and Rehabilitation, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Paediatric Rehabilitation Service, The Royal Children’s Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
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Fratt EM, McDonald A, Hargrave H, Sallis R. The Perfect Step is the first one: Improving the quality of life for patients with spinal cord injuries through structured exercise. J Spinal Cord Med 2024; 47:477-485. [PMID: 38588028 PMCID: PMC11218577 DOI: 10.1080/10790268.2024.2336276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
CONTEXT More than 1 million people live with spinal cord injuries (SCI) in the United States alone. Despite research suggesting improvement in functional activities in patients who participate in regular physical activity, there is limited data on the specific impact of exercise as it pertains to patient-reported quality-of-life (QoL) measures of mood, pain, independence, or medical complications. Patients with SCI participating in a longitudinal exercise program at a community-based fitness facility (The Perfect Step) in Pomona, California were invited to participate in this study. This program consisted of at least two hours a week of exercise-based therapy, loadbearing, and neuroplasticity retraining for two years. Participants were asked to retrospectively rate patient-reported quality-of-life outcomes at the start of participation in the program, and at 6, 12, and 24 months after the program start as measured by an 89-item SCI QoL questionnaire covering domains including mood (39 items), pain (16 items), independence (7 items), bladder function (14 items), and pressure ulcers (13 items). 24 patients with SCI (16 cervical, 4 thoracic, 3 lumbar, 1 unspecified) were included in the final analysis. FINDINGS Wilcoxon rank sum tests were used to compare patient-reported outcome measures over time. Patients reported statistically significantly improved outcomes across all domains at all timepoints to varying degrees, with improvement in 73/89 items at 6 months, 57/89 at 12 months, and 65/89 at 24 months after participation start (P < 0.05, all). CONCLUSION/CLINICAL RELEVANCE Patients with SCI engaging in a structured exercise program demonstrated sustainable, longitudinal improvements in mood, pain control, independence, and fewer impairments related to bladder function and pressure ulcers. Physicians should consider the integration of structured exercise into the rehabilitation program alongside traditional medical care to optimize the quality of life for those with SCI. Future research should involve a direct comparison of QoL in patients with SCI participating in structured exercise versus those who are not.
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Affiliation(s)
- Ellie M. Fratt
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
| | - Alex McDonald
- Southern California Permanente Medical Group, Pasadena, California, USA
| | | | - Robert Sallis
- Southern California Permanente Medical Group, Pasadena, California, USA
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Lv H, Zhang Z, Yang A, Zhou J, Guo Y, Luo F, Zhang Z, Zhang Z, Xu J. Delayed postoperative neurological deficits from scoliosis correction: a case series and systematic review on clinical characteristics, treatment, prognosis, and recovery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2721-2733. [PMID: 38809439 DOI: 10.1007/s00586-024-08296-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/02/2024] [Accepted: 05/01/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE This study was designed to investigate the clinical features, treatment modalities, and risk factors influencing neurological recovery in patients who underwent scoliosis correction with delayed postoperative neurological deficit (DPND). METHODS Three patients with DPND were identified from 2 central databases for descriptive analysis. Furthermore, all DPND cases were retrieved from the PubMed and Embase databases. Neurological function recovery was categorized into complete and incomplete recovery groups based on the American Spinal Injury Association (ASIA) impairment scale. RESULTS Two patients were classified as type 3, and one was classified as type 2 based on the MRI spinal cord classification. Intraoperative neurophysiological monitoring (IONM) was consistently negative throughout the corrective procedure, and intraoperative wake-up tests were normal. The average time to DPND development was 11.8 h (range, 4-18 h), and all three patients achieved complete recovery of neurological function after undergoing revision surgery. A total of 14 articles involving 31 patients were included in the literature review. The mean time to onset of DPND was found to be 25.2 h, and 85.3% (29/34) of patients experienced DPND within the first 48 h postoperatively, with the most common initial symptoms being decreased muscle strength and sensation (26 patients, 83.9%). Regarding neurological function recovery, 14 patients were able to reach ASIA grade E, while 14 patients were not able to reach ASIA grade E. Univariate analysis revealed that preoperative diagnosis (p = 0.004), operative duration (p = 0.017), intraoperative osteotomy method (p = 0.033), level of neurological deficit (p = 0.037) and deficit source (p = 0.0358) were significantly associated with neurological outcomes. Furthermore, multivariate regression analysis indicated a strong correlation between preoperative diagnosis (p = 0.003, OR, 68.633; 95% CI 4.299-1095.657) and neurological prognosis. CONCLUSION Our findings indicate that spinal cord ischemic injury was a significant factor for patients experiencing DPND and distraction after corrective surgery may be a predisposing factor for spinal cord ischemia. Additionally, it is important to consider the possibility of DPND when limb numbness and decreased muscle strength occur within 48 h after corrective scoliosis surgery. Moreover, emergency surgical intervention is highly recommended for DPND caused by mechanical compression factors with a promising prognosis for neurological function, emphasizing the importance of taking into account preoperative orthopedic diagnoses when evaluating the potential for neurological recovery.
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Affiliation(s)
- Hui Lv
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - ZhongRong Zhang
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - AiJun Yang
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - JianHong Zhou
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - Yuan Guo
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - Fei Luo
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China
| | - ZhengFeng Zhang
- Department of Orthopedics, Xinqiao Hospital, 183 Xinqiao Main Street, Shapingba District, Chongqing, 400037, China
| | - ZeHua Zhang
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China.
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China.
| | - JianZhong Xu
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, No. 30 Gaotanyan Zhengjie, Shapingba District, Chongqing, 400038, China.
- Department of Orthopaedic, Jiangbei Branch of Southwest Hospital, 958th, Hospital of the PLA Army, No. 29 Jianxin East Road, Jiangbei District, Chongqing, 400023, China.
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