Functional outcome of patients 12 and 48 weeks after acute traumatic tetraplegia and paraplegia: data analysis from 2004–2009

[Factors associated with functional improvement in patients with cervical spinal cord injuries]

OBJECTIVE

To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission.

MATERIAL AND METHODS

We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge.

RESULTS

Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge.

CONCLUSIONS

Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays.

Tuberculosis of the spine--Prospective neurological and patient reported outcome study

OBJECTIVE

To prospectively investigate the rate of neurological recovery and patient reported outcome of tuberculosis (TB) spine patients following surgery at a tertiary referral hospital. TB spine remains a major cause of neurological impairment in the developing world fuelled by poor socio-economic conditions and HIV co-infection. Although numerous retrospective studies are available, there is a paucity of prospective data regarding rate of neurological improvement and patient reported outcome.

METHODS

Twenty adult patients were prospectively recruited. The average age was 44.5 years. Half had co-existent HIV infection. All patients underwent decompressive surgery utilising a variety of anterior and posterior procedures. All received a minimum of 9 months TB medication. They were followed up at 4, 8, 12, 26 and 52 weeks post operatively. Neurological status was monitored by Nurick, mJOA and ASIA systems. Patient reported outcome was monitored by SF36 questionnaires at all-time points.

RESULTS

All patients improved neurologically including 4 ASIA A's. By last follow up, 17 could walk as opposed to 5 pre-op. The Nurick average score improved from 5.5 to 1.9 and the mJOA lower limb score 1.8-5.5. The SF36 improved from 31 to 62 over the year with the biggest gains occurring after 3 months. This was confirmed in all domains except pain and social, which improved earlier.

CONCLUSIONS

There is a positive prognosis for neurological outcome in TB spine following a variety of surgical decompressive procedures and medical therapy. The majority of the recovery occurs after the 3 months post-operative mark.

Management strategies for acute spinal cord injury: current options and future perspectives

PURPOSE OF REVIEW

Spinal cord injury is a devastating acute neurological condition with loss of function and poor long-term prognosis. This review summarizes current management strategies and innovative concepts on the horizon.

RECENT FINDINGS

The routine use of steroids in patients with spinal cord injuries has been largely abandoned and considered a 'harmful standard of care'. Prospective trials have shown that early spine stabilization within 24  h results in decreased secondary complication rates. Neuronal plasticity and axonal regeneration in the adult spinal cord are limited due to myelin-associated inhibitory molecules, such as Nogo-A. The experimental inhibition of Nogo-A ameliorates axonal sprouting and functional recovery in animal models.

SUMMARY

General management strategies for acute spinal cord injury consist of protection of airway, breathing, oxygenation and control of blood loss with maintenance of blood pressure. Unstable spine fractures should be stabilized early to allow unrestricted mobilization of patients with spinal cord injuries and to decrease preventable complications. Steroids are largely considered obsolete and have been abandoned in clinical guidelines. Nogo-A represents a promising new pharmacological target to promote sprouting of injured axons and restore function. Prospective clinical trials of Nogo-A inhibition in patients with spinal cord injuries are currently under way.