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Zhong H, Zhang K, Zhou M, Xing C, An Y, Zhang Q, Guo J, Liu S, Qu Z, Feng S, Ning G. An Implantable Self-Driven Diaphragm Pacing System Based on a Microvibration Triboelectric Nanogenerator for Phrenic Nerve Stimulation. ACS APPLIED MATERIALS & INTERFACES 2024; 16:43199-43211. [PMID: 39120580 PMCID: PMC11346467 DOI: 10.1021/acsami.4c03715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/10/2024]
Abstract
Spinal cord injury poses considerable challenges, particularly in diaphragm paralysis. To address limitations in existing diaphragm pacing technologies, we report an implantable, self-driven diaphragm pacing system based on a microvibration triboelectric nanogenerator (MV-TENG). Leveraging the efficient MV-TENG, the system harvests micromechanical energy and converts this energy into pulses for phrenic nerve stimulation. In vitro tests confirm a stable MV-TENG output, while subcutaneous implantation of the device in rats results in a constant amplitude over 4 weeks with remarkable energy-harvesting efficacy. The system effectively induces diaphragmatic motor-evoked potentials, triggering contractions of the diaphragm. This proof-of-concept system has potential clinical applications in implantable phrenic nerve stimulation, presenting a novel strategy for advancing next-generation diaphragm pacing devices.
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Affiliation(s)
- Hao Zhong
- Department
of Orthopedics, Tianjin Medical University
General Hospital, Tianjin 300052, People’s
Republic of China
- International
Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin 300052, People’s Republic of China
- Tianjin
Key Laboratory of Spine and Spinal Cord Injury, Tianjin 300052, People’s Republic of China
| | - Ke Zhang
- College
of Electronic Information and Automation, Advanced Structural Integrity
International Joint Research Center, Tianjin
University of Science and Technology, Tianjin 300222, People’s Republic of China
| | - Mi Zhou
- Department
of Orthopedics, Tianjin Medical University
General Hospital, Tianjin 300052, People’s
Republic of China
- International
Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin 300052, People’s Republic of China
- Tianjin
Key Laboratory of Spine and Spinal Cord Injury, Tianjin 300052, People’s Republic of China
| | - Cong Xing
- Department
of Orthopedics, Tianjin Medical University
General Hospital, Tianjin 300052, People’s
Republic of China
- International
Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin 300052, People’s Republic of China
- Tianjin
Key Laboratory of Spine and Spinal Cord Injury, Tianjin 300052, People’s Republic of China
| | - Yang An
- College
of Electronic Information and Automation, Advanced Structural Integrity
International Joint Research Center, Tianjin
University of Science and Technology, Tianjin 300222, People’s Republic of China
| | - Qi Zhang
- Department
of Orthopedics, Tianjin Medical University
General Hospital, Tianjin 300052, People’s
Republic of China
- International
Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin 300052, People’s Republic of China
- Tianjin
Key Laboratory of Spine and Spinal Cord Injury, Tianjin 300052, People’s Republic of China
| | - Junrui Guo
- Department
of Orthopedics, Tianjin Medical University
General Hospital, Tianjin 300052, People’s
Republic of China
- International
Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin 300052, People’s Republic of China
- Tianjin
Key Laboratory of Spine and Spinal Cord Injury, Tianjin 300052, People’s Republic of China
| | - Song Liu
- Department
of Orthopedics, Tianjin Medical University
General Hospital, Tianjin 300052, People’s
Republic of China
- International
Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin 300052, People’s Republic of China
- Tianjin
Key Laboratory of Spine and Spinal Cord Injury, Tianjin 300052, People’s Republic of China
| | - Zhigang Qu
- College
of Electronic Information and Automation, Advanced Structural Integrity
International Joint Research Center, Tianjin
University of Science and Technology, Tianjin 300222, People’s Republic of China
| | - Shiqing Feng
- Department
of Orthopedics, Tianjin Medical University
General Hospital, Tianjin 300052, People’s
Republic of China
- International
Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin 300052, People’s Republic of China
- Tianjin
Key Laboratory of Spine and Spinal Cord Injury, Tianjin 300052, People’s Republic of China
| | - Guangzhi Ning
- Department
of Orthopedics, Tianjin Medical University
General Hospital, Tianjin 300052, People’s
Republic of China
- International
Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin 300052, People’s Republic of China
- Tianjin
Key Laboratory of Spine and Spinal Cord Injury, Tianjin 300052, People’s Republic of China
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Kanna RM, Shafeeq GM, Shetty AP, Rajasekaran S. The incidence and risk factors for unplanned readmission within 90 days after surgical treatment of spinal fractures. 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 2024:10.1007/s00586-024-08420-5. [PMID: 39048842 DOI: 10.1007/s00586-024-08420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Unplanned readmissions after spine surgery are undesired, and cause significant functional, and financial distress to the patients and healthcare system. Though critical, knowledge about readmissions after surgery for traumatic spinal injuries (TSI) is scarce and under-evaluated. METHODS Consecutive patients surgically treated for TSI and who had unplanned readmission within 90 days post-discharge were studied. Peri-operative demographic and surgical variables, surgical treatment, level of injury, delay in surgery, ASIA score, other organ injuries, peri-operative complications, smoking, ICU stay, co-morbidity, and the length of hospital stay were studied and correlated with the causes for readmission. RESULTS Among 884 patients, 4.98% (n = 44) had unplanned readmissions within 90 days of discharge. Notably, 50% (n = 22) patients were readmitted within the first 30 days. The common causes of readmissions were urinary tract related problems (27%, n = 12), pressure ulcers (20.4%, n = 9), respiratory problems (13.6%, n = 6), surgical wound related problems (14%, n = 7,) limb injuries (11.4%, n = 5), and others (11%, n = 5). The total beds lost secondary to readmissions was 314 days, and the mean bed-days lost per patient was 7.2 ± 5.1. Thirteen peri-operative risk factors were associated with unplanned readmissions, among which, smoking (OR 2.2), diabetes (OR 2.4), and pressure sore during index admission (OR 16.7) were strong independent predictors. CONCLUSION The incidence of unplanned readmissions after TSI was 5%, which was similar to elective spine surgeries but the causes and risk factors are different. Non-surgical complications related to urinary tract, respiratory care and pressure sores were the most common causes. Pre-operative smoking status, diabetes mellitus and pressure sores noted in the index admission were important independent risk factors.
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Affiliation(s)
- Rishi M Kanna
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
| | - Gulam Muhammed Shafeeq
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Ajoy P Shetty
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Rajasekaran
- Department of Orthopaedics and Spine Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Li P, Zhang Z, Yu HF, Yao R, Wei W, Nie H. Development and validation of a model to predict the need for artificial airways for acute trauma patients in the emergency department: a retrospective case-control study. BMJ Open 2024; 14:e081638. [PMID: 38889944 PMCID: PMC11191793 DOI: 10.1136/bmjopen-2023-081638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE To develop scores for predicting the need for artificial airway procedures for acute trauma patients in the emergency department (ED). DESIGN Retrospective case-control. SETTING A tertiary comprehensive hospital in China. PARTICIPANTS 8288 trauma patients admitted to the ED within 24 hours of injury and who were admitted from 1 August 2012 to 31 July 2020. PRIMARY AND SECONDARY OUTCOME MEASURES The study outcome was the establishment of an artificial airway within 24 hours of admission to the ED. Based on the different feature compositions, two scores were developed in the development cohort by multivariable logistic regression. The predictive performance was assessed in the validation cohort. RESULTS The O-SPACER (Oxygen saturation, Systolic blood pressure, Pulse rate, Age, Coma Scale, Eye response, Respiratory rate) score was developed based on the patient's basic information with an area under the curve (AUC) of 0.85 (95% CI 0.80 to 0.89) in the validation group. Based on the basic information and trauma scores, the IO-SPACER (Injury Severity Score, Oxygen saturation, Systolic blood pressure, Pulse rate, Age, Coma Scale, Eye response, Respiratory rate) score was developed, with an AUC of 0.88 (95% CI 0.84 to 0.92). According to the O-SPACER and IO-SPACER scores, the patients were stratified into low, medium and high-risk groups. According to these two scores, the high-risk patients were associated with an increased demand for artificial airways, with an OR of 40.16-40.67 compared with the low-risk patients. CONCLUSIONS The O-SPACER score provides risk stratification for injured patients requiring urgent airway intervention in the ED and may be useful in guiding initial management. The IO-SPACER score may assist in further determining whether the patient needs planned intubation or tracheotomy early after trauma.
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Affiliation(s)
- Ping Li
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuo Zhang
- Emergency Department, West China Hospital, Sichuan University, Chengdu, China
| | - Hai Fang Yu
- Emergency Department, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Yao
- Emergency Department, West China Hospital, Sichuan University, Chengdu, China
| | - Wei Wei
- Emergency Department, West China Hospital, Sichuan University, Chengdu, China
| | - Hu Nie
- Emergency Department, West China Hospital, Sichuan University, Chengdu, China
- West China Xiamen Hospital of Sichuan University, Xiamen, China
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Meregildo-Rodríguez ED, Vásquez-Tirado GA, Quispe-Castañeda CV, del Carmen Cuadra-Campos M, Contreras-Cabrera JM, Pinedo-Portilla JL. High vs. low tidal volume and pulmonary complications in patients with cervical spinal cord injury on mechanical ventilation: systematic review. Front Med (Lausanne) 2024; 11:1362318. [PMID: 38495112 PMCID: PMC10940362 DOI: 10.3389/fmed.2024.1362318] [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: 12/28/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Cervical spinal cord injury (CSCI) patients on mechanical ventilation often lack standardized guidelines for optimal ventilatory support. This study reviews existing literature to compare outcomes between high tidal volume (HTV) and low tidal volume (LTV) strategies in this unique patient population. Methods We searched for studies published up to August 30, 2023, in five databases, following a PECO/PICO strategy. We found six studies for quantitative analysis and meta-analyzed five studies. Results This meta-analysis included 396 patients with CSCI and mechanical ventilation (MV), 119 patients treated with high tidal volume (HTV), and 277 with low tidal volume (LTV). This first meta-analysis incorporates the few studies that show contradictory findings. Our meta-analysis shows that there is no significant statistical difference in developing VAP between both comparison groups (HTV vs. LTV) (OR 0.46; 95% CI 0.13 to 1.66; p > 0.05; I2: 0%), nor are there differences between the presence of other pulmonary complications when treating with HTV such as acute respiratory distress syndrome (ARDS), atelectasis, onset of weaning. Conclusion In patients with CSCI in MV, the use of HTV does not carry a greater risk of pneumonia compared to LTV; in turn, it is shown as a safe ventilatory strategy as it does not establish an increase in other pulmonary complications such as ARDS, atelectasis, the onset of weaning nor others associated with volutrauma. It is necessary to evaluate the role of HTV ventilation in this group of patients in primary RCT-type studies.
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Esmorís-Arijón I, Galeiras R, Ferreiro Velasco ME, Pértega Díaz S. Predictors of Intensive Care Unit Stay in Patients with Acute Traumatic Spinal Cord Injury Above T6. World Neurosurg 2022; 166:e681-e691. [PMID: 35872126 DOI: 10.1016/j.wneu.2022.07.072] [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: 05/16/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to identify factors associated with the intensive care unit (ICU) length of stay (LOS) of patients with an acute traumatic spinal cord injury above T6. METHODS We performed a retrospective, observational study of patients admitted to an ICU between 1998 and 2017 (n = 241). The LOS was calculated using a cumulative incidence function, with events of death being considered a competing event. Factors associated with the LOS were analyzed using both a cause-specific Cox proportional hazards regression model and a competing risk model. A multistate approach was also used to analyze the impact of nosocomial infections on the LOS. RESULTS A total of 211 patients (87.5%) were discharged alive from the ICU (median LOS = 23 days), and 30 (12.4%) died (median LOS = 11 days). In the multivariate analysis after adjusting for variables collected 4 days after the ICU admission, a higher American Spinal Injury Association motor score (subdistribution hazards ratio [sHR] = 1.01), neurological level C5-C8 (HR = 0,64), and lower Sequential Organ Failure Assessment score (sHR = 0.82) and fluid balance (sHR = 0.95) on day 4 were linked to a lower LOS in this unit. In the multivariate analysis, the onset of an infection was significantly associated with a longer LOS when adjusting for variables collected both at ICU admission (adjusted sHR = 0.62; 95% confidence interval = 0.50-0.77) and on day 4 (adjusted hazards ratio = 0.65; 95% confidence interval = 0.52-0.80). CONCLUSIONS After adjusting the data for conventional variables, we identified a lower American Spinal Injury Association motor score, injury level C5-C8, a higher Sequential Organ Failure Assessment score on day 4, a more positive fluid balance on day 4, and the onset of an infection as factors independently associated with a longer ICU LOS.
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Affiliation(s)
| | - Rita Galeiras
- Critical Care Unit, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | - María Elena Ferreiro Velasco
- Spinal Cord Injury Unit (SCIU), Complexo Hospitalario Universitario A Coruña, Sergas, Universidade de A Coruña, A Coruña, Spain
| | - Sonia Pértega Díaz
- Research Support Unit, Nursing and Healthcare Research Group, Rheumatology and Health Research Group, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña, A Coruña, Spain
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Korupolu R, Uhlig-Reche H, Achilike EC, Reeh C, Pedroza C, Stampas A. Factors Associated With Ventilator Weaning Success and Failure in People With Spinal Cord Injury in an Acute Inpatient Rehabilitation Setting: A Retrospective Study. Top Spinal Cord Inj Rehabil 2022; 28:129-138. [PMID: 35521063 PMCID: PMC9009196 DOI: 10.46292/sci21-00062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To evaluate baseline characteristics, describe pulmonary outcomes, and identify weaning predictors for people with acute traumatic spinal cord injury (SCI) who are dependent on mechanical ventilation at admission to acute inpatient rehabilitation (AIR). Methods The retrospective study was conducted at an AIR facility in the United States. It included 91 adults with acute traumatic SCI from 2015 to 2019 who were dependent on mechanical ventilation. Results People who successfully weaned (85%) had fewer days from time of SCI to AIR admission (22 vs. 30, p = .04), higher vital capacity at admission to AIR (12 vs. 3 mL/kg predicted body weight [PBW]; p < .001), and lower (caudal) neurological injury level (p < .001) compared to those who failed weaning. The risk of pneumonia was higher in people who failed weaning compared to those who were weaned successfully (risk ratio, 5.5; 95% confidence interval [95% CI], 2.3-13). Receiver operating characteristics (ROC) curves suggest a vital capacity cutoff of 5.8 mL/kg PBW could predict weaning. The vital capacity of ≥ 5.8 mL/kg PBW is associated with 109 times higher odds (95% CI, 11-1041; p < .001) of weaning than vital capacity below that threshold. Conclusion In this retrospective study, there was an increased risk of pneumonia in people with SCI who failed weaning at discharge from AIR. Vital capacity was a better predictor of weaning from mechanical ventilation compared to the neurological level of injury, with a cutoff of 5.8 mL/kg PBW predictive of weaning success. Further research is needed on this critical topic.
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Affiliation(s)
- Radha Korupolu
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
,TIRR Memorial Hermann Hospital, Houston, Texas
| | - Hannah Uhlig-Reche
- Department of Rehabilitation Medicine, Long School of Medicine, University of Texas Health Science Center at San Antonio
| | | | - Colton Reeh
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
| | - Claudia Pedroza
- Center for Clinical Research and Evidence Based Medicine, The University of Texas Health Science Center, Houston, Texas
| | - Argyrios Stampas
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas
,TIRR Memorial Hermann Hospital, Houston, Texas
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Mora-Boga R, Canosa-Hermida E, Toral-Guisasola I, Balboa-Barreiro V, Salvador-de la Barrera S, Ferreiro-Velasco ME, Rodríguez-Sotillo A, Montoto-Marqués A. Clinical characteristics and prognosis of spinal cord injury in individuals over 75 years old. NEUROCIRUGÍA (ENGLISH EDITION) 2021; 32:209-216. [PMID: 34493401 DOI: 10.1016/j.neucie.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze the incidence and characteristics of traumatic spinal cord injury (SCI) in geriatric population of Galicia (Spain), hospital management and functional prognosis METHODS: Comparative retrospective study. Patients admitted with acute traumatic SCI during the time period between January 2010 and December 2016 were included. Two groups established: The elderly over and under 75 years of age, with the latter acting as a control group. RESULTS 379 patients were studied (27.2% ≥75 years). The main etiology in the >75 years group were falls: 80.6%. There were 65.7% who presented incomplete spinal cord injuries with mean motor index (MI) of 44.9/100. Upon discharge, 90.8% were dependent. Hospital mortality was 34.9%. Those >75 years suffered from more cervical injuries (74.8 vs. 51.2%, p < 0.001), longer delay in diagnosis (31.1% vs. 9.2%, p < 0.001) and higher hospital mortality (34.9% vs. 3.2%, p < 0.001). Fewer surgical interventions were performed, with a longer delay. Percentages for admission into ICU, mechanical ventilation and performing a tracheostomy proved to be similar. There were no significant differences found in the evolution according to the ASIA scale or the MI. CONCLUSIONS 1) The frequency of traumatic SCI in the elderly in Galicia is high. 2) Neurological evolution is similar to younger patients but the level of dependence is higher. 3) The level of care provided is similar in both groups, except for the surgical indication. 4) Hospital mortality is high.
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Affiliation(s)
- Rubén Mora-Boga
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
| | - Eva Canosa-Hermida
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Iris Toral-Guisasola
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Vanessa Balboa-Barreiro
- Unidad de Estadística y Epidemiología Clínica, Spanish Clinical Research Network (SCReN), Complexo Hospitalario Universitario, A Coruña (CHUAC), A Coruña, Spain
| | - Sebastián Salvador-de la Barrera
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - María Elena Ferreiro-Velasco
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Antonio Rodríguez-Sotillo
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, Spain
| | - Antonio Montoto-Marqués
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, Spain
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Ji C, Rong Y, Jia H, Yan N, Hou T, Li Y, Cai W, Yu S. Surgical outcome and risk factors for cervical spinal cord injury patients in chronic stage: a 2-year follow-up study. 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 2021; 30:1495-1500. [PMID: 33387050 DOI: 10.1007/s00586-020-06703-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/03/2020] [Accepted: 12/12/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aims to assess the nerve function deficient recovery in surgically treated patients with cervical trauma with spinal cord injury (SCI) in chronic stage and figure out prognostic predictors of improvement in impairment and function. METHODS We reviewed the clinical and radiological data of 143 cervical SCI patients in chronic stage and divided into non-operative group (n = 61) and operative group (n = 82). The severity of neurological involvement was assessed using the ASIA motor score (AMS) and Functional Independence Measure Motor Score (FIM MS). The health-related quality of life was measured using the SF-36 questionnaire. Correspondence between the clinical and radiological findings and the neurological outcome was investigated. RESULTS At 2-year follow-up, surgery resulted in greater improvement in AMS and FIM MS than non-operative group. Regression analysis revealed that lower initial AMS (P = 0.000), longer duration after injury (P = 0.022) and injury above C4 level (P = 0.022) were factors predictive of lower final AMS. Longer duration (P = 0.020) and injury above C4 level (P = 0.010) were associated with a lower FIM MS. SF-36 scores were significantly lower in higher age (P = 0.015), female patients (P = 0.009) and patients with longer duration (P = 0.001). CONCLUSION It is reasonable to consider surgical decompression in patients with cervical SCI in chronic stage and persistent spinal cord compression and/or gross cervical instability. Initial AMS, longer duration, injury above C4 level, higher age and female patients are the five major relevant factors of functional recovery.
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Affiliation(s)
- Chengyue Ji
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, China
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China
| | - Yuluo Rong
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China
| | - Hongyu Jia
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, China
| | - Ning Yan
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, China
| | - Tiesheng Hou
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, China
| | - Yao Li
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, China
| | - Weihua Cai
- Department of Orthopedics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, China.
| | - Shunzhi Yu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Yanchang Road, Shanghai, China.
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Mora-Boga R, Canosa-Hermida E, Toral-Guisasola I, Balboa-Barreiro V, Salvador-de la Barrera S, Ferreiro-Velasco ME, Rodríguez-Sotillo A, Montoto-Marqués A. Clinical characteristics and prognosis of spinal cord injury in individuals over 75 years old. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30084-1. [PMID: 32800694 DOI: 10.1016/j.neucir.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 06/16/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyze the incidence and characteristics of traumatic spinal cord injury (SCI) in geriatric population of Galicia (Spain), hospital management and functional prognosis. METHODS Comparative retrospective study. Patients admitted with acute traumatic SCI during the time period between January 2010 and December 2016 were included. Two groups established: The elderly over and under 75 years of age, with the latter acting as a control group. RESULTS Three hundred seventy-nine patients were studied (27.2% ≥75 years). The main etiology in the >75 years group were falls: 80.6%. There were 65.7% who presented incomplete spinal cord injuries with mean motor index (MI) of 44.9/100. Upon discharge, 90.8% were dependent. Hospital mortality was 34.9%. Those >75 years suffered from more cervical injuries (74.8 vs. 51.2%; p<0.001), longer delay in diagnosis (31.1 vs. 9.2%; p<0.001) and higher hospital mortality (34.9 vs. 3.2%; p<0.001). Fewer surgical interventions were performed, with a longer delay. Percentages for admission into ICU, mechanical ventilation and performing a tracheostomy proved to be similar. There were no significant differences found in the evolution according to the ASIA scale or the MI. CONCLUSIONS 1) The frequency of traumatic SCI in the elderly in Galicia is high; 2) Neurological evolution is similar to younger patients but the level of dependence is higher; 3) The level of care provided is similar in both groups, except for the surgical indication, and 4) Hospital mortality is high.
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Affiliation(s)
- Rubén Mora-Boga
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España.
| | - Eva Canosa-Hermida
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Iris Toral-Guisasola
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Vanessa Balboa-Barreiro
- Unidad de Estadística y Epidemiología Clínica, Spanish Clinical Research Network (SCReN), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Sebastián Salvador-de la Barrera
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - María Elena Ferreiro-Velasco
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España
| | - Antonio Rodríguez-Sotillo
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, España
| | - Antonio Montoto-Marqués
- Unidad de Lesionados Medulares, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, España; Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Universidad de A Coruña, A Coruña, España
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Furlan JC, Craven BC, Fehlings MG. Sex-related discrepancies in the epidemiology, injury characteristics and outcomes after acute spine trauma: A retrospective cohort study. J Spinal Cord Med 2019; 42:10-20. [PMID: 31573442 PMCID: PMC6781464 DOI: 10.1080/10790268.2019.1607055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context/Objective: The potential effects of sex on injury severity and outcomes after acute spine trauma (AST) have been reported in pre-clinical and clinical studies, even though the data are conflicting. This study compared females and males regarding the epidemiology, injury characteristics, and clinical outcomes of AST. Design: Retrospective cohort study. Setting: Acute spine care quaternary center. Participants: All consecutive cases of AST admitted from January/1996 to December/2007 were included. Interventions: None. Outcome Measures: The potential effects of sex on the epidemiology, injury characteristics, and clinical outcomes of AST were studied. Results: There were 504 individuals with AST (161 females, 343 males; mean age of 49.44 ± 0.92 years). Sex was not associated with age or pre-existing co-morbidities as assessed using the Charlson Co-morbidity Index, however, females had a greater number of International Classifications of Diseases (ICD) codes at admission and higher Cumulative Illness Rating Scale (CIRS) than males. Over the 12-year period, the male-to-female ratio has not significantly changed. Although there were significant sex-related discrepancies regarding injury etiology, level and severity of AST, males and females had similar lengths of stay in the acute spine center, in-hospital survival post-AST, and need for mechanical ventilation and tracheostomy. Conclusion: This study suggests that females with AST present with a greater number of pre-existing co-morbidities, a higher frequency of thoraco-lumbar trauma, less severe neurological impairment and a greater proportion of MVA-related injuries. However, females and males have a similar length of stay in the acute spine center, and comparable in-hospital survival, need for mechanical ventilation, and tracheostomy after AST.
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Affiliation(s)
- Julio C. Furlan
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Correspondence to: Julio C. Furlan, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, 520 Sutherland Drive, Room 206J, Toronto, Ontario M4G 3V9, Canada; Ph: 416-597-4322 (Ext. 6129), 416-425-9923.
| | - B. Catharine Craven
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Michael G. Fehlings
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada,Spinal Program, Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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