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Incidence of traumatic spinal cord injury worldwide: A systematic review, data integration, and update. World Neurosurg X 2023; 18:100171. [PMID: 36910686 PMCID: PMC9996445 DOI: 10.1016/j.wnsx.2023.100171] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Objectives This review was designed to update our earlier systematic review which evaluated both published and unpublished evidence on the incidence of traumatic spinal cord injury (TSCI) worldwide. Methods We used various search methods including strategic searching, reference checking, searching for grey literature, contacting registries, authors, and organizations requesting unpublished data, browsing related websites, and hand searching key journals. The quality of included studies was evaluated by Joanna Briggs Institute Critical Appraisal Tools. Records published between April 2013 and May 2020 were added to the original systematic review. Results Overall, 58 resources including 45 papers, 10 SCI registry reports, 1 book, and 2 theses were retrieved. We found TSCI incidence data for eight new countries, which overall shapes our knowledge of TSCI incidence for 49 countries. The incidence of TSCI ranges from 3.3 to 195.4 cases per million (cpm) based on subnational studies and from 5.1 to 150.48 cpm based on national studies. Most of the studies were low quality, lacked consistent case selection due to unclear definition of TSCI and unclear ascertainment methods. Conclusions There is an increasing number of publications in the literature focusing on the epidemiologic data of TSCI. The absence of a standard form of reporting TSCI hinders the comparability of data across different data sources. Use of various definitions for TSCI may lead to heterogeneity in reports. Use of sensitivity analyses based on reasonable classification criteria can aid in offering a uniform set of case identification and ascertainment criteria for TSCI.
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Key Words
- AMR, American region
- ASCIR, Australian Spinal Cord Injury Register
- CPM, Cases Per Million
- CoCoPop, Condition, Context, and Population
- EMR, Eastern Mediterranean region
- EUR, European Region
- Epidemiology
- ICD, International Codes of Disease
- ISCoS, International Spinal Cord Society
- InSCI, The International Spinal Cord Injury
- Incidence
- JBI, Joanna Briggs Institute
- PHM, Prehospital mortality
- PICO, Population, Intervention, Comparator, and Outcome
- SEAR, South East Asia Region
- Spinal cord injury
- SwiSCI, Swiss Spinal Cord Injury
- TSCI, Traumatic Spinal Cord Injury
- TSI, Traumatic spinal injuries
- WPR, Western Pacific Region
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Temporal changes in demographic and injury characteristics of traumatic spinal cord injuries in Nordic countries - a systematic review with meta-analysis. Spinal Cord 2022; 60:765-773. [PMID: 35220414 DOI: 10.1038/s41393-022-00772-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 01/22/2023]
Abstract
STUDY DESIGN Systematic review with meta-analysis. OBJECTIVES To explore temporal changes in incidence rates, demographic and injury characteristics of incident traumatic spinal cord injury (TSCI) in Nordic countries. METHODS Peer-reviewed publications and periodic reports about epidemiology of TSCI in the Nordic countries (Denmark, Finland, Iceland, Norway, Sweden) are identified, reviewed and included in the meta-analysis. Data are stratified into 20-year intervals to allow for chronological comparisons. Pooled estimates are derived using random effects meta-analysis. RESULTS Twenty-three data sources are included presenting a total of 5416 cases. The pooled incidence rate for 2001-2020 is 15.4 cases/million/year compared to 17.6 and 18.3 cases/million/year during the two previous 20-year intervals. The proportion of cases with TSCI in the 15-29 age-group decreases from 50% (1961-1980) to 20% (2001-2020), while it increases from 9% to 35% in 60+ age-group. Transportation-related injuries decrease from 44% (1961-1980) to 27% (2001-2020). Conversely, fall-related injuries increase from 32% (1961-1980) to 46% (2001-2020). The proportion of individuals with incomplete tetraplegia increases from 31% (1961-1980) to 43% (2001-2020), while complete paraplegia decreases from 25% to 16%. CONCLUSION The characteristics of TSCI in the Nordic countries have changed drastically over the last six decades, in line with clinical experiences, and limited research evidence from other countries. These changes indicate the need for adapting research focus, prevention strategies, design and provision of care, rehabilitation and community services towards older individuals, fall-related injuries, and incomplete injuries in Nordic countries and other settings internationally where such changes occur.
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Oyediran OO, Ayandiran EO, Olanrewaju TD, Ojo IO, Ogunlade AA, Fajemilehin BR. Prevalence and outcome of care among patients with spinal cord injury in a Nigerian Tertiary Health Institution. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tien NLB, Thanh VV, Hanh KTH, Anh PG, Huyen LTM, Tu NT, Mai DTN, Toi PL. Quality of Life and Activities of Daily Living among Patients with Complete Cervical Spinal Cord Injury and Surgical Treatment in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189703. [PMID: 34574629 PMCID: PMC8465366 DOI: 10.3390/ijerph18189703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/10/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022]
Abstract
Spinal cord injury (SCI) is defined as temporary or permanent changes in spinal cord function and reflex activity. The objective of this study is to evaluate health-related quality of life (HRQoL) and activities of daily living (ADL) among postoperative surgery patients with complete cervical SCI in Vietnam and to explore the factors associated with these indices. A cross-sectional study was conducted on 88 adults in Vietnam from June 2018 to June 2019. The EQ-5D-5L, ADL, and instrumental activities of daily living (IADL) were applied. Multivariate Tobit regression was adopted to determine factors that were associated with HRQOL, ADL, and IADL. Results: Participants who were in American Spinal Cord Injury Association (ASIA) scale group A (ASIA-A) had the lowest ADL, IADL index, and HRQOL score (p < 0.001). HRQoL and ADL were affected by health insurance coverage, occupation, type of fracture, and IADL. Meanwhile, IADL was significantly associated with living areas and ASIA. Low HRQoL among patients suffering from SCI was observed. Attention should be given to outcomes related to a disability during clinical treatment and should be treated effectively in the recovery.
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Affiliation(s)
- Nguyen Le Bao Tien
- Institute of Orthopaedics and Trauma Surgery, Viet Duc Hospital, Hanoi 100000, Vietnam; (N.L.B.T.); (V.V.T.); (N.T.T.)
| | - Vo Van Thanh
- Institute of Orthopaedics and Trauma Surgery, Viet Duc Hospital, Hanoi 100000, Vietnam; (N.L.B.T.); (V.V.T.); (N.T.T.)
- Department of Surgery, Hanoi Medical University, Hanoi 100000, Vietnam
| | - Khuc Thi Hong Hanh
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.T.H.H.); (L.T.M.H.)
| | - Pham Gia Anh
- Oncology Department, Viet Duc Hospital, Hanoi 100000, Vietnam;
| | - Le Thi Minh Huyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam; (K.T.H.H.); (L.T.M.H.)
| | - Ngo Thanh Tu
- Institute of Orthopaedics and Trauma Surgery, Viet Duc Hospital, Hanoi 100000, Vietnam; (N.L.B.T.); (V.V.T.); (N.T.T.)
| | - Dang Thi Ngoc Mai
- Center of clinical pharmacology, Hanoi Medical University, Hanoi 100000, Vietnam;
| | - Phung Lam Toi
- Health Strategy and Policy Institute, Ministry of Health, Hanoi 100000, Vietnam
- Correspondence: ; Tel.: +84-963625068
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FINGER GUILHERME, CECCHINI TIAGOPACZKOBOZKO, GRIPA MARIAEDUARDACONTE, NASCIMENTO TOBIASLUDWIGDO, CECCHINI FELIPEMARTINSDELIMA, SFREDO ERICSON, CECCHINI ANDRÉMARTINSDELIMA, FALAVIGNA ASDRUBAL. SPINE TRAUMA EPIDEMIOLOGICAL PROFILE IN A TERTIARY NEUROSURGERY HOSPITAL IN SOUTH BRAZIL. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212003244177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective The aim of this paper is to analyze the epidemiological profile of a large series of spine trauma victims in the Southernmost state of Brazil. Methods A retrospective study including spine trauma patients was performed at a tertiary hospital from January 1st, 2013 to December 31st, 2018. The variables analyzed include demographic data, information related to the trauma (etiology, trauma mechanism, type of spine injury, number of vertebrae involved, vertebral segment involved), neurological status at hospital admission (Frankel scale), treatment performed and the outcome (number of days in hospital, neurological outcome, and mortality). Results A total of 808 patients were included. The mean age was 47.9 (±19.0), and the majority were male and Caucasian. The most frequent etiology was falls from height (N=508; 62.9%) followed by traffic accidents (N=185; 22.9%). The thoracolumbar segment was the spinal segment most frequently affected, occurring in 401 (52.1%) patients, followed by the cervical, thoracic and lumbar segments. The incidence of SCI was 16.7%. Non-operative treatment was indicated in 510 (63.1%) patients. Conclusion The authors presented the largest epidemiological profile regarding spine trauma in Latin America, analyzing a total of 808 patients, which represents an incidence of 134.6 cases/year. This paper fills a gap in the medical literature regarding the epidemiological profile of this disease in Latin America. Level of evidence II; Prognostic study.
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Epidemiological characteristics of traumatic spinal cord injury in Xi'an, China. Spinal Cord 2020; 59:804-813. [PMID: 33268825 DOI: 10.1038/s41393-020-00592-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A hospital-based retrospective epidemiological study. OBJECTIVE To describe the demographic and epidemiological characteristics of patients with traumatic spinal cord injury (TSCI) in Xi'an to help health-related institutions formulate corresponding measures. SETTING People with TSCI, all spine centres and orthopaedic centres in Xi'an, China. METHODS We retrospectively reviewed the medical records of the all spine centers or orthopedic centers in Xi'an according to the International Classification of Disease Version 10 (ICD-10) and diagnostic code of TSCI. Variables included gender, age, medical insurance, etiology, occupation, level of injury, and severity of injury, multiple injury, complication, treatment, and so on. RESULTS The study included the medical records of 1730 patients with TSCI from 2014 to 2018. The estimated annual incidence rate increased from 39.0 cases (95% CI, 34.7-43.3 cases) per 1 million persons in 2014 to 43.2 cases (95% CI, 39.0-47.5 cases) per 1 million persons in 2018. The leading cause of TSCI was high falls (35.5%, 614 cases). The most common injury site was the cervical spinal cord, accounting for 55.7% (963 cases). The degree of injury severity with the highest proportion was incomplete tetraplegia (47.2%, 816 cases). In addition, 71.4% (1236 cases) of TSCI cases had spinal fracture or dislocation. CONCLUSIONS There are specific epidemiological characteristics of TSCI patients in Xi'an, and preventive measures are suggested to be based on the characteristics of the different types of patients with TSCI and focused on high-risk groups.
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Johansson E, Luoto TM, Vainionpää A, Kauppila AM, Kallinen M, Väärälä E, Koskinen E. Epidemiology of traumatic spinal cord injury in Finland. Spinal Cord 2020; 59:761-768. [PMID: 33149235 PMCID: PMC7610166 DOI: 10.1038/s41393-020-00575-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/23/2020] [Accepted: 10/23/2020] [Indexed: 11/26/2022]
Abstract
Study design Prospective cohort study. Objectives To determine the incidence and evaluate the characteristics of newly injured patients admitted to two spinal cord injury (SCI) centers during a 4-year period. Setting Oulu and Tampere University Hospital, Finland. Methods A dedicated multidisciplinary team evaluated all of the patients with new traumatic SCI (TSCI). The data were recorded according to the International Spinal Cord Injury Core Data Sets. Results In a 4-year period, 346 new patients with TSCI were admitted to the study centers. In the Oulu and Tampere University Hospitals’ catchment areas, the mean annual incidence of TSCI was 36.6 per million. The leading causes of injury were low-level falls (36.2%), high-level falls (25.5%), and transport-related accidents (19.2%). In the patients >60 years, 72.6% were injured by falling and the proportion of low-level falls was 49.7%. In the patients ≤60 years old, 47.4% were alcohol-related. The proportion of cervical injuries in the patients >60 years was 77.1%, while in the patients ≤60 years the proportion was 59.6%. The incidence of TSCI was higher during the Summer and Autumn months. Conclusion The mean annual incidence of TSCI was 36.6 per million corresponding to 200 new annual cases in Finland. Incomplete tetraplegia due to falling among elderly was overrepresented in the study population. Alcohol-consumption preceded injury in nearly half of the cases in the younger population. The prevention should focus on alcohol-related injuries and falls in the elderly.
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Affiliation(s)
- Elina Johansson
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Aki Vainionpää
- Department of Rehabilitation, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Anna-Maija Kauppila
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Mauri Kallinen
- Department of Rehabilitation Medicine, Central Finland Central Hospital, Central Finland Health Care District, Jyväskylä, Finland.,Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Eija Väärälä
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Eerika Koskinen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
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Kotanen P, Kreivi HR, Vainionpää A, Laaksovirta H, Brander P, Siirala W. Home invasive mechanical ventilation in Finland in 2015-2019. ERJ Open Res 2020; 6:00223-2020. [PMID: 33263031 PMCID: PMC7682663 DOI: 10.1183/23120541.00223-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/01/2020] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION The prevalence of long-term invasive mechanical ventilation via tracheostomy in chronic respiratory insufficiency is largely unknown. We aimed to clarify prevalence and aetiology of the use of home invasive mechanical ventilation (HIMV) in Finland in 2015-2019. METHODS Information on HIMV patients was collected yearly from all Finnish Hospital District patient registries between 1 January 2015 and 1 January 2019. Data included underlying diagnosis, time from diagnosis to HIMV initiation, treatment length, mortality and basic sociodemographic data. RESULTS In 2015, we had 107 HIMV patients. During the follow-up we received 34 new patients (24.1%) and 46 patients (32.6%) died. In 2019, we had 95 HIMV patients and the prevalence in Finland was 2.0 in 100 000. The most common diagnoses were motor neurone disease (29.1%) and spinal cord injuries (19.9%). Mean duration of HIMV among all patients on 1 January 2019 was 12.3 years and among deceased patients, 11.2 years. Treatment durations ranged from 7.7 years for motor neurone disease patients to 47.3 years for post-polio syndrome patients. Most patients (81.6%) used HIMV 24 h·day-1. CONCLUSIONS HIMV is a rare, long-lasting treatment, most often used in chronic hypoventilation caused by chronic neurological disease. Based on our 4 year follow-up the prevalence of HIMV seems to be diminishing in Finland. Treatment duration and survival vary greatly depending on the underlying diagnosis. Most of the patients were totally dependent on HIMV, requiring 24-h care.
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Affiliation(s)
- Petra Kotanen
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Doctoral Programme in Clinical Research, University of Helsinki, Helsinki, Finland
| | - Hanna-Riikka Kreivi
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Aki Vainionpää
- Department of Rehabilitation, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Hannu Laaksovirta
- HUH Neurocenter, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pirkko Brander
- HUH Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Waltteri Siirala
- Dept of Anaesthesiology and Intensive Care, Turku University Hospital and University of Turku, Turku, Finland
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Niemi-Nikkola V, Koskinen E, Väärälä E, Kauppila AM, Kallinen M, Vainionpää A. Incidence of Acquired Nontraumatic Spinal Cord Injury in Finland: A 4-Year Prospective Multicenter Study. Arch Phys Med Rehabil 2020; 102:44-49. [PMID: 33007307 DOI: 10.1016/j.apmr.2020.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/05/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the incidence and epidemiologic characteristics of acquired nontraumatic spinal cord injury (NTSCI) in Finland. DESIGN Prospective 4-year epidemiologic multicenter study. SETTING Two of the 3 spinal cord injury (SCI) centers in Finland responsible for acute care, immediate rehabilitation, and lifelong follow-up for all SCI patients in a population of 3,073,052 (as of 2013). PARTICIPANTS All newly diagnosed NTSCI patients (N=430) admitted to Tampere University Hospital between 2012 and 2015 and Oulu University Hospital between 2013 and 2016 based on the evaluation of the designated rehabilitation teams. Patients with NTSCI resulting from congenital etiologies or progressive neurologic diseases were excluded. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Incidence and variables, according to the International SCI Core Data Set and the International Standards for Neurological Classification of SCI, including etiology and the severity of injury. RESULTS The incidence of NTSCI was 54.1 per million per year. NTSCI was more common in men (n=260, 60.5%) than women (n=170, 39.5%). The mean age was 62.0±14.6 years old. Degenerative causes were the most common etiology (n=219, 50.9%), followed by malignant (n=88, 20.5%) and benign (n=41, 9.5%) neoplasms. The injury resulted in tetraplegia in 177 patients (41.1%) and paraplegia in 249 patients (57.9%). American Spinal Injury Association Impairment Scale grade D injuries were common, with an incidence of 71% (n=304). Specialized inpatient rehabilitation was needed in 44% (n=189) of the cases. CONCLUSIONS There are no previous studies on the epidemiology of NTSCI in Finland, and international reporting has been limited. The incidence of NTSCI in our study was substantially higher than in most previous studies, which was likely owing to our study including individuals with less severe lesions who did not require inpatient rehabilitation.
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Affiliation(s)
- Ville Niemi-Nikkola
- Oulu University Hospital, Department of Medical Rehabilitation, Oulu, Finland.
| | - Eerika Koskinen
- Tampere University Hospital, Department of Neurosciences and Rehabilitation, Tampere, Finland
| | - Eija Väärälä
- Tampere University Hospital, Department of Neurosciences and Rehabilitation, Tampere, Finland
| | - Anna-Maija Kauppila
- Oulu University Hospital, Department of Medical Rehabilitation, Oulu, Finland
| | - Mauri Kallinen
- Central Finland Central Hospital, Rehabilitation Department, Jyväskylä, Finland; The Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Aki Vainionpää
- Seinäjoki Central Hospital, Department of Rehabilitation, Seinäjoki, Finland
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Nirmala BP, Srikanth P, Janardhana, Vranda MN, Kanmani TR, Khanna M. Clinical and sociodemographic profiles of persons with spinal cord injury. J Family Med Prim Care 2020; 9:4890-4896. [PMID: 33209818 PMCID: PMC7652105 DOI: 10.4103/jfmpc.jfmpc_427_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/25/2020] [Accepted: 05/29/2020] [Indexed: 11/04/2022] Open
Abstract
AIM To collect and correlate the sociodemographic and clinical details of persons with spinal cord injury who were admitted to the Department of Neurological Rehabilitation. OBJECTIVES To assess the sociodemographic characteristics and collect the clinical profiles of persons with spinal cord injury and to correlate their sociodemographic and clinical details. MATERIALS AND METHODS A retrospective file review was done over a period of 2 years from January 2017 to December 2018 to study patients with spinal cord injury who were admitted to the Neurological Rehabilitation ward of NIMHANS, Bengaluru, Karnataka, India. RESULTS A total of 60 patients were admitted with spinal cord injury. The mean age was 32.39 years and majority of the patients were young married males. Most of them belong to the low socioeconomic status and are housewives and daily wage laborers. Falls and road traffic accidents are the causes for the injury. Anxiety and depression are high among traumatic spinal cord injury patients. CONCLUSION This information may contribute to prevent SCI and to improve the quality of life of patients with SCI. It has implications for the primary care physicians who are at first contact to identify and refer them for specialized super speciality district hospitals for further treatment as they pose a great threat to public health and their proportions are increasing. It is imperative that trauma care is included in graduate medical training as well to facilitate early intervention after initial screening.
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Affiliation(s)
- Berigai P. Nirmala
- Additional Professor, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Pallerla Srikanth
- PhD Scholar, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Janardhana
- Additional Professor, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - MN Vranda
- Associate Professor, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - TR Kanmani
- Assistant Professor, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Meeka Khanna
- Additional Professor, Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Almendárez-Sánchez CA, Sotelo-Popoca T, Tafur-Grandett AA, Huato-Reyes R. Technical note: In Mexico, the majority of 147 traumatic spinal cord injuries occurred in the thoracic spine for young males. Surg Neurol Int 2020; 11:162. [PMID: 32637215 PMCID: PMC7332513 DOI: 10.25259/sni_284_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 06/06/2020] [Indexed: 11/04/2022] Open
Abstract
Background:
Traumatic spinal cord injury (TSCI) is a devastating problem typically associated with multi-organ disorders. Studies regarding TSCI and their attendant comorbidities are scarce from developing countries.
Methods:
The electronic files of 147 patients with TSCI (2017–2018) were reviewed; 78% of patients were males averaging 38 years of age. The following variables associated with the TSCI included age, sex, etiology of trauma, vertebral level, fracture classification, Frankel grade, treatment, complications, and mortality.
Results:
Of interest, most cases involved thoracic injuries with attendant chest trauma resulting from falls from substantial heights.
Conclusion:
In Mexico, the majority of TSCI occur in young males (average age 38) who have sustained falls from significant heights resulting in thoracic fractures with a high frequency of chest injuries. By providing such information for developing countries, we may develop future strategies to TSCI in vulnerable populations.
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Affiliation(s)
- César Adán Almendárez-Sánchez
- Departments of Neurosurgery, Centro Médico “Lic. Adolfo López Mateos,” Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca, Estado de México, México
| | - Thalía Sotelo-Popoca
- Departments of Internal Medicine, Centro Médico “Lic. Adolfo López Mateos,” Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca, Estado de México, México
| | - Abrahan Alfonso Tafur-Grandett
- Departments of Neurosurgery, Centro Médico “Lic. Adolfo López Mateos,” Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca, Estado de México, México
| | - Raúl Huato-Reyes
- Departments of Neurosurgery, Centro Médico “Lic. Adolfo López Mateos,” Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca, Estado de México, México
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Incidence of adult traumatic spinal cord injury in Saint Petersburg, Russia. Spinal Cord 2019; 57:692-699. [PMID: 30842631 DOI: 10.1038/s41393-019-0266-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 02/21/2019] [Accepted: 02/21/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective population-based cohort study. OBJECTIVES To characterise the epidemiology of traumatic spinal cord injury (TSCI) among the inhabitants of Saint Petersburg, Russia. SETTING All hospitals in Saint Petersburg. METHODS Charts for all individuals admitted to city hospitals from 1st January 1 2012 to 31st December 2016 with acute TSCI were reviewed. Incidence rates were calculated for the whole period and for each year separately. Gender-specific and age-specific incidence rates were calculated, and epidemiological characteristics and possible risk factors were analysed. RESULTS A total of 361 people were identified. The average annual incidence rate was 17.6 per million, varying from 21.2 (2013) to 13.6 (2016), and 70.9% were men. Mean age at injury was 42.1 years. Injuries from falls represented 49.8% of cases, and motor vehicle accidents 18.9%. The male:female ratio in the low-falls group was 1.2:1, and among the elderly patients, it was 0.5:1. Lesions at the cervical level were involved in 49.3%, thoracic in 24.7%, and lumbar/sacral in 23.5%. TSCI was complete in 16.9%. Concomitant injuries occurred in 47.2% of cases, and traumatic brain injuries in 37.7%. CONCLUSION TSCI incidence decreased during the observation period and was 2.4 times more common among men than women. In half of the cases, injuries involved the cervical level, and a fall was the most frequent injury cause. Elderly women more often had falls from a low height than men. Multiple injuries-most frequently traumatic brain injuries-were common.
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Smith É, Fitzpatrick P, Lyons F, Morris S, Synnott K. Prospective epidemiological update on traumatic spinal cord injury in Ireland. Spinal Cord Ser Cases 2019; 5:9. [PMID: 30701086 DOI: 10.1038/s41394-019-0152-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Prospective population-based epidemiological study on traumatic spinal cord injury in Ireland. Objectives To provide updated data for the global TSCI repository. Setting Republic of Ireland. Methods All cases of TSCI acquired during 2016 were included. ISCoS core dataset was collected on all cases. Descriptive statistics are reported. Results Overall crude incidence of TSCI was 12.8 per million (61 cases). Males accounted for 75.4%. Mean age at onset was 52.8 (19.9) years. Falls was the most common aetiology, 60.7% and AIS D was the most common injury level/AIS classification, 32.8%. The majority of patients (59%) were discharged home. Conclusions Overall incidence of TSCI has changed very little since 2000 but many aspects of injury such as age and aetiologies are different. This data can now be included in the next TSCI global mapping update. Sponsorship Health Research Board, Ireland.
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Affiliation(s)
- Éimear Smith
- 1National Rehabilitation Hospital, Rochestown Avenue, Dun Laoghaire, Co. Dublin, Ireland.,2Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Patricia Fitzpatrick
- 3School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Frank Lyons
- 4Spine/Trauma Clinical Fellowship, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Seamus Morris
- 2Mater Misericordiae University Hospital, Dublin 7, Ireland.,1National Rehabilitation Hospital, Rochestown Avenue, Dun Laoghaire, Co. Dublin, Ireland
| | - Keith Synnott
- 2Mater Misericordiae University Hospital, Dublin 7, Ireland.,1National Rehabilitation Hospital, Rochestown Avenue, Dun Laoghaire, Co. Dublin, Ireland
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Halvorsen A, Pettersen AL, Nilsen SM, Halle KK, Schaanning EE, Rekand T. Epidemiology of traumatic spinal cord injury in Norway in 2012-2016: a registry-based cross-sectional study. Spinal Cord 2018; 57:331-338. [PMID: 30573770 DOI: 10.1038/s41393-018-0225-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A registry-based cross-sectional study. OBJECTIVES To analyse the epidemiological and demographic characteristics of persons with traumatic spinal cord injury (TSCI) in Norway. SETTING TSCI patients admitted for primary rehabilitation to one of the three specialised spinal cord injury (SCI) departments (located in Bergen, Trondheim, and Oslo) and consented to the Norwegian Spinal Cord Injury Registry (NorSCIR). METHODS Analysis of data from NorSCIR during a 5-year period (2012-2016) was performed. Data were collected by using the International SCI Core Data Set as recommended by the International Spinal Cord Society (ISCoS). RESULTS The lowest incidence of TSCI was 11.4/million (2012), and the highest incidence was 15.9/million (2014). In the study period, 349 individuals were registered with TSCI. In total, 76% were male, and the mean age was 47 (SD ± 19) years. We observed dominance in the 60-74 years age group. The distribution between tetraplegia and paraplegia was 48%/42%. For those initially classified as American Spinal Cord Injury Association Impairment Scale (AIS) grade A (complete injury), 77% remained grade A at discharge. Considerable changes during primary rehabilitation after incomplete lesions were observed. Most patients (68%) were discharged home after primary rehabilitation. Falls were the main cause of TSCI (47%) and occurred more often during the weekend. CONCLUSION Through a National Medical Quality Registry based on internationally provided data sets, we are able to present systematic and updated data from Norway.
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Affiliation(s)
- A Halvorsen
- Department of Medical Quality Registries, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway. .,Clinic of Physical Medicine and Rehabilitation, Department of Spinal Cord Injuries, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - A L Pettersen
- Department of Medical Quality Registries, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - S M Nilsen
- Department of Medical Quality Registries, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway.,Center for Health Care Improvement, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - K Krizak Halle
- Department of Medical Quality Registries, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - E Elmenhorst Schaanning
- Department of Spinal Cord Injury, Follow up (inpatient), Sunnaas Rehabilitation Hospital, Nesodden, Norway
| | - T Rekand
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.,Sahlgrenska Academy, Institute for Physiology and Neuroscience, University of Gothenburg, Gothenburg, Sweden
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Yuan S, Shi Z, Cao F, Li J, Feng S. Epidemiological Features of Spinal Cord Injury in China: A Systematic Review. Front Neurol 2018; 9:683. [PMID: 30186222 PMCID: PMC6113592 DOI: 10.3389/fneur.2018.00683] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Spinal cord injury (SCI) is a severe condition that disrupts patients' physiological, mental, and social well-being state and exerts great financial burden on patients, their families and social healthcare system. This review intends to compile studies regarding epidemiological features of SCI in China. Methods: Searches were conducted on PubMed, EMBASE, Web of Science and Cochrane Library for relevant studies published through January, 2018. Studies reported methodological and epidemiological data were collected by two authors independently. Results: Seventeen studies met the inclusion criteria. Two studies reported incidence of SCI that is 60.6 in Beijing (2002) and 23.7 in Tianjin (2004–2008). All studies showed male had a larger percentage in SCI compared to female except Taiwan (2000–2003). The average male and female ratio was 3–4:1 in China and the highest male and female ratio was 5.74: 1 in Tianjin (2004–2007). Farmers, laborers and unemployed people accounted for more than half of the SCI patients in China. Fall was the primary causation with exception of Heilongjiang (2009–2013), Beijing (2001–2010), and Taiwan (2002–2003), where motor vehicle collision (MCVs) was the leading causation. Pulmonary infection, urinary tract infection and bedsore were common complications, accounting for approximately 70% of SCI patients in China. Conclusion: This review shows that epidemiological features of SCI are various in different regions in China and prevention should be implemented by regions. The number of patients with SCI result from fall and MCVs may become a main public health problem because population aging and economic developing in China. However, because all included studies were retrospective and lacking a register system in China, some data were incomplete and some cases may be left out, so the conclusion may not be generalizable to the other regions.
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Affiliation(s)
- Shiyang Yuan
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhongju Shi
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China.,F.M. Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Fujiang Cao
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiahe Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Shiqing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
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Smith E, Fitzpatrick P, Murtagh J, Lyons F, Morris S, Synnott K. Epidemiology of Traumatic Spinal Cord Injury in Ireland, 2010–2015. Neuroepidemiology 2018; 51:19-24. [DOI: 10.1159/000488146] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/28/2018] [Indexed: 11/19/2022] Open
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Kumar R, Lim J, Mekary RA, Rattani A, Dewan MC, Sharif SY, Osorio-Fonseca E, Park KB. Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume. World Neurosurg 2018; 113:e345-e363. [DOI: 10.1016/j.wneu.2018.02.033] [Citation(s) in RCA: 153] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
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Bárbara-Bataller E, Méndez-Suárez JL, Alemán-Sánchez C, Sánchez-Enríquez J, Sosa-Henríquez M. Change in the profile of traumatic spinal cord injury over 15 years in Spain. Scand J Trauma Resusc Emerg Med 2018; 26:27. [PMID: 29622032 PMCID: PMC5887209 DOI: 10.1186/s13049-018-0491-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic spinal cord injury remains a serious public health and social problem. Although incidence rates are decreasing in our environment, it is a high cost condition that is associated with great disability. The objective of this study was to describe the epidemiological and demographic characteristics of traumatic spinal cord injury and to analyse its epidemiological changes. METHODS This study was an observational study with prospective monitoring of all traumatic spinal cord injury patients in the Canary Islands, Spain (2.1 million inhabitants) between 2001 and 2015. RESULTS Over the specified period of the study, 282 patients suffered a traumatic spinal cord injury. The crude incidence rate was 9.3 cases per million people/year. The patients' mean age increased from 38 years (2001-2005) to 48 years (2011-2015) (p < 0.05). Overall, 80.1% of patients were males. The trauma mechanisms of spinal cord injury were falls in 44%, traffic accidents in 36.5%, diving accidents in 8.9% and others in 10.7%. While traffic accidents decreased, falls increased, particularly in the elderly (p < 0.05). The most frequently affected level was the cervical spine (50.9%), and incomplete tetraplegia was the most prevalent group (29.8%). A total of 76.6% of all patients suffered a vertebral fracture, and 91.6% of these required surgery. Among 282 patients, 12.5% were transferred to residences. The patients transferred increased from 8.5% in the first period to 20.0% (p < 0.05) in the last period. Such cases were related to age, cervical level injuries and injuries associated with poor functionality (p < 0.05). CONCLUSIONS The rise in the number of falls among the older population, as well as the reduction in traffic accidents, decreased the incidence of traumatic spinal cord injury in our environment. This change in the profile of new traumatic spinal cord injuries led us to reformulate the functional objectives planned for these patients upon admission to specialized units, to plan destination-upon-discharge in advance and to promote campaigns to prevent spinal cord injury in older adults.
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Affiliation(s)
- Enrique Bárbara-Bataller
- Unit of Spinal Cord Injury, Rehabilitation Service of the University Insular Hospital of Gran Canaria, Avenida Maritima S/N, 350016 Las Palmas de Gran Canaria, Spain
| | - José Luis Méndez-Suárez
- Unit of Spinal Cord Injury, Rehabilitation Service of the University Insular Hospital of Gran Canaria, Avenida Maritima S/N, 350016 Las Palmas de Gran Canaria, Spain
| | - Carolina Alemán-Sánchez
- Unit of Spinal Cord Injury, Rehabilitation Service of the University Insular Hospital of Gran Canaria, Avenida Maritima S/N, 350016 Las Palmas de Gran Canaria, Spain
| | - Jesús Sánchez-Enríquez
- Unit of Spinal Cord Injury, Rehabilitation Service of the University Insular Hospital of Gran Canaria, Avenida Maritima S/N, 350016 Las Palmas de Gran Canaria, Spain
| | - Manuel Sosa-Henríquez
- University Institute for Biomedical and Health Research, Osteoporosis and Mineral Metabolism Research Group, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Ihalainen T, Rinta-Kiikka I, Luoto TM, Thesleff T, Helminen M, Korpijaakko-Huuhka AM, Ronkainen A. Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury. Spine J 2018; 18:81-87. [PMID: 28673831 DOI: 10.1016/j.spinee.2017.06.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/18/2017] [Accepted: 06/26/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Laryngeal penetration-aspiration, the entry of material into the airways, is considered the most severe subtype of dysphagia and is common among patients with acute cervical spinal cord injury (SCI). PURPOSE The aim of this study was to investigate risk factors for penetration-aspiration in patients with acute traumatic cervical spinal cord injury (TCSCI). STUDY DESIGN This is a prospective cohort study. PATIENT SAMPLE Thirty-seven patients with TCSCI were included in the study. OUTCOME MEASURES The highest Rosenbek penetration-aspiration scale (PAS; range 1-8) score of each patient was the primary outcome measure. The risk factors consisted of patient characteristics, demographics, and clinical signs observed during a clinical swallowing trial. MATERIALS AND METHODS A clinical swallowing trial and videofluoroscopic swallowing study (VFSS) was performed on all patients within 28 days post injury. For group comparisons, the patients were divided into two groups: (1) penetrator-aspirators (PAS score ≥3) and (2) non-penetrator-aspirators (PAS score ≤2). RESULTS Of the 37 patients, 83.8% were male. The mean age at the time of the injury was 61.2 years. Most patients had an incomplete TCSCI (78.4%) caused by a fall (75.7%). In the VFSS, 51.4% of the patients were penetrator-aspirators, and 71.4% had silent aspiration. The risk factors for predicting penetration-aspiration were (1) necessity of bronchoscopies, (2) lower level of anterior cervical operation, (3) coughing, throat clearing, choking related to swallowing, and (4) changes in voice quality related to swallowing. Binary logistic regression identified coughing, throat clearing, choking, and changes in voice quality related to swallowing as independent risk factors for penetration-aspiration. CONCLUSIONS The necessity of bronchoscopies, postinjury lower cervical spine anterior surgery, coughing, throat clearing, choking, and changes in voice quality related to swallowing was a markedrisk factor for aspiration and penetration following a cervical SCI. These factors and signs should be used to suspect injury-related pharyngeal dysfunction and to initiate preventive measures to avoid complications. The clinical swallowing evaluation is a relevant adjunct in the management of these patients and can improve the detection of penetration and aspiration.
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Affiliation(s)
- Tiina Ihalainen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland; Faculty of Social Sciences, University of Tampere, Kalevantie 4, Tampere FI-33014, Finland.
| | - Irina Rinta-Kiikka
- Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland
| | - Tuomo Thesleff
- Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland
| | - Mika Helminen
- Science Center, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland; Health Sciences, Faculty of Social Sciences, University of Tampere, P.O. Box 100, Tampere FI-33104, Finland
| | | | - Antti Ronkainen
- Department of Neurosurgery, Tampere University Hospital, PO Box 2000, Tampere FI-33521, Finland
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Abstract
STUDY DESIGN A retrospective epidemiological study. OBJECTIVE To reveal incidence and epidemiological features of traumatic spinal injuries (TSI) in Northern Finland. SUMMARY OF BACKGROUND DATA In Finland the annual incidence of traumatic spine fractures requiring inpatient care has been found to be 27/100,000, while international incidences have varied across the range of 16-64/100,000. More specific epidemiological data from Finland is not available. Internationally, the most common mechanisms of injury are road traffic as well as low and high falls. Associated injuries occur in 30% to 55% of cases. METHODS The study sample included patients with traumatic spinal injury admitted to Oulu University Hospital (OYS) with injury between the January 1, 2007 and December 31, 2011. Patient information was collected from the hospital care register, including all inpatient and outpatient visits and surgical procedures. Traumatic spinal column and spinal cord injuries were identified using International Classification of Diseases 10th revision or Nordic Classification of Surgical Procedures codes and all patient records were manually reviewed. RESULTS Nine hundred seventy-one patients met the criteria for TSI. The mean annual incidence of hospitalized traumatic spinal injuries was 26/100,000 in the whole of Northern Finland and 35/100,000 in the OYS main responsibility area. The most frequent etiology of TSI was low falls, which accounted for 35.8% of the injuries, followed by road traffic and high falls. Lumbar spine was the most common site of the fracture. Spinal surgery was performed in 376 (38.7%) cases. Three hundred eight patients (31.7%) suffered from associated injuries, 101 (10.4%) had a spinal cord injury, and 71 (7.3%) a brain injury. CONCLUSION Low falls in elderly and road traffic injuries in younger age groups were the most common etiology of traumatic spinal injuries in Northern Finland and should be given more attention in primary prevention. LEVEL OF EVIDENCE 3.
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Ihalainen T, Rinta-Kiikka I, Luoto TM, Helminen M, Thesleff T, Korpijaakko-Huuhka AM, Ronkainen A. Reply to Saeid Safiri's Letter to the Editor: Risk factors for laryngeal penetration-aspiration in patients with acute traumatic cervical spinal cord injury. Spine J 2017; 17:1956-1957. [PMID: 29241823 DOI: 10.1016/j.spinee.2017.08.247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 08/21/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Tiina Ihalainen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland; Faculty of Social Sciences, University of Tampere, Kalevantie 4, FI-33014 Tampere, Finland
| | - Irina Rinta-Kiikka
- Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Teemu M Luoto
- Department of Neurosurgery, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Mika Helminen
- Science Center, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland; Health Sciences, Faculty of Social Sciences, University of Tampere, P.O. Box 100, FI-33104, Tampere, Finland
| | - Tuomo Thesleff
- Department of Neurosurgery, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
| | | | - Antti Ronkainen
- Department of Neurosurgery, Tampere University Hospital, P.O. Box 2000, FI-33521 Tampere, Finland
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Ihalainen T, Rinta-Kiikka I, Luoto TM, Koskinen EA, Korpijaakko-Huuhka AM, Ronkainen A. Traumatic cervical spinal cord injury: a prospective clinical study of laryngeal penetration and aspiration. Spinal Cord 2017. [PMID: 28631744 DOI: 10.1038/sc.2017.71] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES Dysphagia is a relatively common secondary complication in patients with traumatic cervical spinal cord injuries (TCSCI). The purpose of this study was to determine the incidence of aspiration and penetration in patients with acute TCSCI. SETTING Tampere University Hospital, Tampere, Finland. METHODS A total of 46 patients with TCSCI were evaluated with a videofluoroscopic swallowing study (VFSS). Rosenbek's penetration-aspiration scale (PAS) was used to classify the degree of penetration or aspiration. The medical records of each patient were systematically reviewed. RESULTS Of the 46 patients, 85% were male. The mean age at the time of the injury was 62.1 years. Most patients had an incomplete injury (78%), and most of them due to a fall (78%). In the VFSS 19 (41%) patients penetrated and 15 (33%) aspirated. Only 12 (26%) of the patients had a PAS score of 1 indicating that swallowed material did not enter the airway. Of the patients who aspirated, 73% had silent aspiration. CONCLUSION The incidence of penetration or aspiration according to VFSS is high in this cohort of patients with TCSCI. Therefore, the swallowing function of patients with acute TCSCI should be routinely evaluated before initiating oral feeding. VFSS is highly recommended, particularly to rule out the possibility of silent aspiration and to achieve information on safe nutrition consistency.
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Affiliation(s)
- T Ihalainen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - I Rinta-Kiikka
- Department of Radiology, Medical Imaging Centre of Pirkanmaa Hospital District, Tampere University Hospital, Tampere, Finland
| | - T M Luoto
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - E A Koskinen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | | | - A Ronkainen
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
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Biering-Sørensen F, DeVivo MJ, Charlifue S, Chen Y, New PW, Noonan V, Post MWM, Vogel L. International Spinal Cord Injury Core Data Set (version 2.0)—including standardization of reporting. Spinal Cord 2017; 55:759-764. [DOI: 10.1038/sc.2017.59] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/11/2017] [Accepted: 04/11/2017] [Indexed: 11/09/2022]
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Burns AS, Santos A, Cheng CL, Chan E, Fallah N, Atkins D, Dvorak MF, Ho C, Ahn H, Paquet J, Kwon BK, Noonan VK. Understanding Length of Stay after Spinal Cord Injury: Insights and Limitations from the Access to Care and Timing Project. J Neurotrauma 2017; 34:2910-2916. [PMID: 28245734 PMCID: PMC5653133 DOI: 10.1089/neu.2016.4935] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Costs associated with initial hospitalization following spinal cord injury (SCI) are substantial, and a major driver of costs is the length of stay (LOS); that is, the time that the injured individual remains hospitalized prior to community reintegration. Our aim was to study the factors and variables that contribute to LOS following traumatic SCI. Modeling (process mapping of the SCI healthcare delivery system in Canada and discrete event simulation) and regression analysis using a national registry of individuals with acute traumatic SCI in Canada, existing databases, and peer-reviewed literature were used to examine the driver of LOS following traumatic SCI. In different jurisdictions, there is considerable variation in the definitions and methods used to determine LOS following SCI. System LOS can be subdivided into subcomponents, and progression through these is not unidirectional. Modeling reveals that healthcare organization and processes are important contributors to differences in LOS independent of patient demographics and injury characteristics. Future research is required to identify and improve understanding of contributors to LOS following traumatic SCI. This will help enhance system performance. Work in this area will be facilitated by the adoption of common terminology and definitions, as well as by the use of simulations and modeling.
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Affiliation(s)
- Anthony S Burns
- 1 Division of Physiatry, Department of Medicine, University of Toronto , Toronto Ontario, Canada
| | - Argelio Santos
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | | | - Elaine Chan
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Nader Fallah
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Derek Atkins
- 3 Operations and Logistics Division, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
| | - Chester Ho
- 5 Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Henry Ahn
- 6 University of Toronto Spine Program , Toronto, Ontario, Canada
| | | | - Brian K Kwon
- 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
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Bertelli JA, Ghizoni MF. Nerve transfers for restoration of finger flexion in patients with tetraplegia. J Neurosurg Spine 2016; 26:55-61. [PMID: 27494781 DOI: 10.3171/2016.5.spine151544] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this paper was to report the authors' results with finger flexion restoration by nerve transfer in patients with tetraplegia. METHODS Surgery was performed for restoration of finger flexion in 17 upper limbs of 9 patients (8 male and 1 female) at a mean of 7.6 months (SD 4 months) after cervical spinal cord injury. The patients' mean age at the time of surgery was 28 years (SD 15 years). The motor level according to the ASIA (American Spinal Injury Association) classification was C-5 in 4 upper limbs, C-6 in 10, and C-7 in 3. In 3 upper limbs, the nerve to the brachialis was transferred to the anterior interosseous nerve (AIN), which was separated from the median nerve from the antecubital fossa to the midarm. In 5 upper limbs, the nerve to the brachialis was transferred to median nerve motor fascicles innervating finger flexion muscles in the midarm. In 4 upper limbs, the nerve to the brachioradialis was transferred to the AIN. In the remaining 5 upper limbs, the nerve to the extensor carpi radialis brevis (ECRB) was transferred to the AIN. Patients were followed for an average of 16 months (SD 6 months). At the final evaluation the range of finger flexion and strength were estimated by manual muscle testing according to the British Medical Research Council scale. RESULTS Restoration of finger flexion was observed in 4 of 8 upper limbs in which the nerve to the brachialis was used as a donor. The range of motion was incomplete in all 5 of these limbs, and the strength was M3 in 3 limbs and M4 in 1 limb. Proximal retrograde dissection of the AIN was associated with better outcomes than transfer of the nerve to the brachialis to median nerve motor fascicles in the arm. After the nerve to the brachioradialis was transferred to the AIN, incomplete finger flexion with M4 strength was restored in 1 limb; the remaining 3 limbs did not show any recovery. Full finger flexion with M4 strength was demonstrated in all 5 upper limbs in which the nerve to the ECRB was transferred to the AIN. No functional downgrading of elbow flexion or wrist extension strength was observed. CONCLUSIONS In patients with tetraplegia, finger flexion can be restored by nerve transfer. Nerve transfer using the nerve to the ECRB as the donor nerve produced better recovery of finger flexion in comparison with nerve transfer using the nerve to the brachialis or brachioradialis.
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Affiliation(s)
- Jayme A Bertelli
- Center of Biological and Health Sciences, Department of Neurosurgery, University of the South of Santa Catarina (Unisul), Tubarão; and.,Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil
| | - Marcos F Ghizoni
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Santa Catarina, Brazil
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Ning GZ, Mu ZP, Shangguan L, Tang Y, Li CQ, Zhang ZF, Zhou Y. Epidemiological features of traumatic spinal cord injury in Chongqing, China. J Spinal Cord Med 2016; 39:455-60. [PMID: 26674428 PMCID: PMC5102299 DOI: 10.1080/10790268.2015.1101982] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To describe the epidemiological characteristics and trends of traumatic spinal cord injury in Chongqing, China. STUDY DESIGN Hospital-based retrospective research. SETTING Xinqiao Hospital, Chongqing. METHODS We reviewed medical records of 554 patients with traumatic spinal cord injury (TSCI) admitted to Xinqiao Hospital from 2009 to 2013. Variables included gender, age, marital status, etiology, occupation, time of injury, level of injury, and severity of injury, the length of hospital stay, and treatment. RESULTS The mean age of patients with TSCI was 45.6 ± 13.8 years, and the male/female ratio was 4.33:1. 94.2% (522 patients) of all patients with TSCI were married. Falls, comprising low falls and high falls (10.8% and 50.9%, respectively), were the leading reason for a hospital visit. And the second reason was MVCs (21.8%). The most common injury site was the cervical spinal cord, accounting for nearly more than 54%. The length of hospital stay ranged between 1 and 219 days (mean: 28.3 days). The proportions of complete tetraplegia, incomplete tetraplegia, complete paraplegia and incomplete paraplegia were 17.1%, 37.8%, 22.2%, and 22.9%, respectively. CONCLUSION The result revealed that the proportion of males was higher, as well as falls and MVCs were the first two main reasons, with older mean age of patients with TSCI than other countries. The occupations with highest risk for TSCI were peasants and laborers. All of these results prompted that preventive methods should be based on the characteristics of different type of patients with TSCI.
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Affiliation(s)
| | | | | | | | | | - Zheng-Feng Zhang
- Correspondence to: Zheng-Feng Zhang and Yue Zhou, Department of Orthopedics, Xinqiao Hospital, Xinqiao Street, Shapingba District, Chongqing 400037, Peoples Republic of China.
| | - Yue Zhou
- Correspondence to: Zheng-Feng Zhang and Yue Zhou, Department of Orthopedics, Xinqiao Hospital, Xinqiao Street, Shapingba District, Chongqing 400037, Peoples Republic of China.
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Traumatic spinal cord injury in Tianjin, China: a single-center report of 354 cases. Spinal Cord 2015; 54:670-4. [DOI: 10.1038/sc.2015.173] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 08/31/2015] [Accepted: 09/04/2015] [Indexed: 11/08/2022]
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28
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Incidence and aetiology of traumatic spinal cord injury in Cape Town, South Africa: a prospective, population-based study. Spinal Cord 2015; 53:692-6. [DOI: 10.1038/sc.2015.51] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 11/08/2022]
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