Association of acute pancreatitis or high level of serum pancreatic enzymes in patients with acute spinal cord injury: a prospective study

Consequences of spinal cord injury on the sympathetic nervous system

Spinal cord injury (SCI) damages multiple structures at the lesion site, including ascending, descending, and propriospinal axons; interrupting the conduction of information up and down the spinal cord. Additionally, axons associated with the autonomic nervous system that control involuntary physiological functions course through the spinal cord. Moreover, sympathetic, and parasympathetic preganglionic neurons reside in the spinal cord. Thus, depending on the level of an SCI, autonomic function can be greatly impacted by the trauma resulting in dysfunction of various organs. For example, SCI can lead to dysregulation of a variety of organs, such as the pineal gland, the heart and vasculature, lungs, spleen, kidneys, and bladder. Indeed, it is becoming more apparent that many disorders that negatively affect quality-of-life for SCI individuals have a basis in dysregulation of the sympathetic nervous system. Here, we will review how SCI impacts the sympathetic nervous system and how that negatively impacts target organs that receive sympathetic innervation. A deeper understanding of this may offer potential therapeutic insight into how to improve health and quality-of-life for those living with SCI.

Increased risk of acute pancreatitis in persons with spinal cord injury: a population-based, propensity score-matched longitudinal follow-up study

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

To evaluate the risk of acute pancreatitis (AP) in persons with spinal cord injury (SCI) based on a nationally representative sample.

SETTING

A retrospective cohort study using Taiwan's National Health Insurance Research Database.

METHODS

Drawing on Taiwan's Longitudinal Health Insurance Database 2005, the researchers created an SCI group consisting of 2280 persons with SCI aged 20-74 years. Propensity-score matching was then used to generate a non-SCI group of 9120 participants with similar baseline characteristics to the SCI group. These two groups' respective cumulative incidence of AP was compared, and the effect of SCI on AP risk was then assessed using stratified Cox proportional-hazards regression.

RESULTS

For the SCI and non-SCI groups, the respective incidence rates of AP were 1.34 per 1000 person-years (95% confidence interval [CI], 0.83-2.05) and 0.79 per 1000 person-years (95% CI, 0.61-1.01). Compared with the non-SCI group, the hazard ratio of AP for the SCI group was 1.96 (95% CI 1.19-3.25, p = 0.0088); and the SCI group's cumulative incidence of AP was significantly higher than that of the non-SCI group (p = 0.0227).

CONCLUSION

This population-based longitudinal follow-up study indicates that there is an increased long-term risk of AP in persons with SCI.

Update on traumatic acute spinal cord injury. Part 2

The aim of treatment in acute traumatic spinal cord injury is to preserve residual neurologic function, avoid secondary injury, and restore spinal alignment and stability. In this second part of the review, we describe the management of spinal cord injury focusing on issues related to short-term respiratory management, where the preservation of diaphragmatic function is a priority, with prediction of the duration of mechanical ventilation and the need for tracheostomy. Surgical assessment of spinal injuries based on updated criteria is discussed, taking into account that although the type of intervention depends on the surgical team, nowadays treatment should afford early spinal decompression and stabilization. Within a comprehensive strategy in spinal cord injury, it is essential to identify and properly treat patient anxiety and pain associated to spinal cord injury, as well as to prevent and ensure the early diagnosis of complications secondary to spinal cord injury (thromboembolic disease, gastrointestinal and urinary disorders, pressure ulcers).