Spinal cord injury: scenario in an Indian state

Cortical intermittent theta burst stimulation on gait pathomechanics and urinary tract dysfunction in incomplete spinal cord injury patients: Protocol for a randomized controlled trial

Gait impairment and neurogenic bladder are co-existing common findings in incomplete spinal cord injury (iSCI). Repetitive transcranial magnetic stimulation (rTMS), evident to be a promising strategy adjunct to physical rehabilitation to regain normal ambulation in SCI. However, there is a need to evaluate the role of Intermittent theta burst stimulation (iTBS), a type of patterned rTMS in restoring gait and neurogenic bladder in SCI patients. The aim of the present study is to quantify the effect of iTBS on spatiotemporal, kinetic, and kinematic parameters of gait and neurogenic bladder dyssynergia in iSCI. After maturing all exclusion and inclusion criteria, thirty iSCI patients will be randomly divided into three groups: Group-A (sham), Group-B (active rTMS) and Group-C (active iTBS). Each group will receive stimulation adjunct to physical rehabilitation for 2 weeks. All patients will undergo gait analysis, as well assessment of bladder, electrophysiological, neurological, functional, and psychosocial parameters. All parameters will be assessed at baseline and 6th week (1st follow-up). Parameters except urodynamics and gait analysis will also be assessed after the end of the 2 weeks of the intervention (post-intervention) and at 12th week (2nd follow-up). Appropriate statistical analysis will be done using various parametric and non-parametric tests based on results.

Bowel and Bladder Dysfunction after SCI: A Comparison between India and Canada

Background

The inclusion of people living with spinal cord injury (SCI) in research has allowed for an informed understanding of priorities of recovery of which bowel dysfunction and bladder dysfunction have been continuously identified. Research has also demonstrated the global disparities in SCI outcomes particularly when comparing high- and low-income countries. Currently, there is a lack of direct comparison between countries when assessing SCI outcomes.

Objectives

This is an exploratory study to better understand bowel and bladder dysfunction amongst individuals with SCI in India and Canada.

Methods

Data from 33 participants were analyzed. Participants completed an online questionnaire assessing demographic information and the Neurogenic Bowel Dysfunction (NBD) score, Wexner score, Neurogenic Bladder Symptom Score (NBSS), and the Incontinence Quality of Life Instrument (I-QOL). Continuous data were compared using t tests. For not normally distributed data, the independent Mann-Whitney U test was used. Categorical variables were evaluated for association using Fisher's exact or chi-square test, depending on the sample size.

Results

Independent Mann-Whitney U test demonstrated that the Canadian participants had poorer bowel function with higher total NBD scores (p = .007) and less frequent bowel movements (p = .036), and they were more likely to experience uneasiness, headaches, and perspiration during bowel movements (p < .001). NBSS results indicated a small but significantly higher proportion of the Indian participants were unsatisfied or unhappy with their bladder function (p = .049). The distribution of Wexner and I-QOL scores were the same across countries.

Conclusion

Potential explanations for differences include lifestyle, management, financial resources, patient and caregiver education, and societal pressures, which are all heavily influenced by cultural, geographical, and economic circumstances.

Epidemiology of Traumatic Spinal Cord Injury in the Himalayan Range and Sub-Himalayan region: A Retrospective Hospital Data-Based Study

OBJECTIVE

To compile epidemiological characteristics of traumatic spinal cord injury (TSCI) in the Northern Indian Himalayan regions and Sub-Himalayan planes.

METHODS

The present study is a retrospective, cross-sectional descriptive analysis based on hospital data conducted at the Department of Physical Medicine and Rehabilitation and Spine Unit of Trauma Centre in a tertiary care hospital in Uttarakhand, India. People hospitalized at the tertiary care center between August 2018 and November 2021 are included in the study sample. A prestructured proforma was employed for the evaluation, including demographic and epidemiological characteristics.

RESULTS

TSCI was found in 167 out of 3,120 trauma patients. The mean age of people with TSCI was 33.5±13.3, with a male-to-female ratio of 2.4:1. Eighty-three participants (49.7%) were from the plains, while the hilly region accounts for 50.3%. People from the plains had a 2.9:1 rural-to-urban ratio, whereas the hilly region had a 6:1 ratio. The overall most prevalent cause was Falls (59.3%), followed by road traffic accidents (RTAs) (35.9%). RTAs (57.2%) were the most common cause of TSCI in the plains' urban regions, while Falls (58.1%) were more common in rural plains. In both urban (66.6%) and rural (65.3%) parts of the hilly region, falls were the most common cause.

CONCLUSION

TSCI is more common in young males, especially in rural hilly areas. Falls rather than RTAs are the major cause.

A four year experience treating incomplete thoracolumbar spine injuries in an East African country

Background

Traumatic spine injuries are one of the most common causes of disability and mortality.

Objective

To assess post op neurologic status in patients with incomplete thoracic and lumbar spine injuries at two teaching hospitals in Addis Ababa, Ethiopia.

Methods

Institution based retrospective cross-sectional study was conducted among 60 hospitalized patients in these hospitals from February 1, 2017-January 31, 2021.

Results

Forty five (75.0%) of the study participants were males. The mean age was 30.77 years (range: 12-65 year). Only 8(13.3%) patients were operated within 3 days of trauma. The most common injury site was the thoracolumbar junction (T11-L2) in 80.0%. Significant number of patients (56.7%) had sphincters dysfunction. Pedicle screw fixation with or without laminectomy was performed in 98.3%. After minimum six month follow up, 37(61.7%) patients had access to the physiotherapy. Thirty seven (61.7%) patients were non ambulatory (AIS B and C) at presentation, of which 29 (78.4%) were ambulatory on the follow-up. Overall, 54(90%) patients had neurologic improvement on the follow up and 37(61.7%) returned to work. Preoperative neurologic status and sphincter function were found to be significantly associated with treatment outcome with P value 0 .000 and 0.002 respectively.

Conclusion

This study shows despite limited availability of post op physiotherapy, significant number of patientsreturned to work post-surgery. Preoperative neurologic function was an independent predictor of post-operative outcome.

Quality of life after traumatic thoracolumbar spinal cord injury: a North Indian perspective

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

To determine the Quality of Life (QOL) in individuals with traumatic Spinal Cord Injury (SCI) of thoracolumbar region in Indian population, the factors affecting QOL and to compare this to other SCI populations.

SETTING

Tertiary level hospital in low-middle income country.

METHODS

93 individuals with SCI of minimum 1 year duration since injury were included in the study. Baseline demographics, socioeconomic parameters, and incidence of complications were ascertained. World Health Organisation Quality of Life-BREF (WHOQOL-BREF) score was used for measurement of QOL and was then compared to healthy Indian population and other SCI studies. Subgroup analysis was done to find out impact of variables on different domains of WHOQOL-BREF.

RESULTS

The median (IQR) age of the study participants was 35 (25, 45) with a male predominance. The median (IQR) duration since injury in the study population was 50 (26, 70) months. Lowest mean (SD) score was observed in the psychological domain -50.3 (12.1) and comparison to healthy Indian and high-income SCI populations revealed drastically decreased scores across all domains (p < 0.01). Employed individuals and housewives had significantly higher scores across all domains than unemployed individuals (p < 0.05). American Spinal Injury Association Impairment Scale (AIS) grade, socioeconomic status, pain and presence of complications all had significant impact on domain scores (p < 0.05). Multiple regression analysis revealed that mobilisation status and pain had the greatest effect on QOL.

CONCLUSION

Individuals with SCI have low QOL scores as compared to general Indian population as well as SCI individuals from a high resource setting. Pain and dependent mobilisation were found to be most significant predictors of poor WHOQOL-BREF domain scores. Housewives were found to have domain scores comparable to employed individuals. Presence of complications negatively impacts QOL.

Spinal cord injury: molecular mechanisms and therapeutic interventions

Spinal cord injury (SCI) remains a severe condition with an extremely high disability rate. The challenges of SCI repair include its complex pathological mechanisms and the difficulties of neural regeneration in the central nervous system. In the past few decades, researchers have attempted to completely elucidate the pathological mechanism of SCI and identify effective strategies to promote axon regeneration and neural circuit remodeling, but the results have not been ideal. Recently, new pathological mechanisms of SCI, especially the interactions between immune and neural cell responses, have been revealed by single-cell sequencing and spatial transcriptome analysis. With the development of bioactive materials and stem cells, more attention has been focused on forming intermediate neural networks to promote neural regeneration and neural circuit reconstruction than on promoting axonal regeneration in the corticospinal tract. Furthermore, technologies to control physical parameters such as electricity, magnetism and ultrasound have been constantly innovated and applied in neural cell fate regulation. Among these advanced novel strategies and technologies, stem cell therapy, biomaterial transplantation, and electromagnetic stimulation have entered into the stage of clinical trials, and some of them have already been applied in clinical treatment. In this review, we outline the overall epidemiology and pathophysiology of SCI, expound on the latest research progress related to neural regeneration and circuit reconstruction in detail, and propose future directions for SCI repair and clinical applications.

Tele-rehabilitation in Spinal Cord Injury (SCI) in India: An Essential but Uphill Task

The number of spinal cord injury (SCI) patients is gradually increasing in India. But due to the unavailability of rehabilitation facilities at the grass root level and most of the patient's financial status, institution-based SCI rehabilitation is still not feasible for many of SCI patients. Tele-rehabilitation can help to rehabilitate the SCI patients to a satisfactory extent where providing hospital-based rehabilitation is not possible. During the COVID-19 pandemic, tele-rehabilitation showed its true potential already. Poverty, lack of education, and lack of technical knowledge of the patients can be a major barrier to its implication. However, with the government's support, suitable manpower, and will to serve, we can deliver tele-rehabilitation services for SCI patients in the remotest and poorest areas of India.

Pediatric Cervical Spine Injuries

Objective  Pediatric cervical spine injuries are rare and account for 1 to 2% of all pediatric spine injuries. There is a paucity of data on pediatric cervical spine injuries in developing countries like India. The purpose of this study is to review and analyze our 5 years of experience with pediatric cervical spine injuries. Methods  All the available medical records over the 5 years were reviewed retrospectively. The data was analyzed to know the epidemiology, mechanism of injury, injury patterns, management, and outcome. The patients were divided into two groups: 0 to 9 years and 10 to 18 years. Results  Seventy-five eligible records were included in our study. The incidence of cervical spine injuries was significantly lower in younger children than the older ones ( p  < 0.042). The most common mechanism of injury was fall from height: 33 (44%) patients followed by road traffic accidents: 27 (36%) patients. The involvement of the upper cervical spine was significantly higher in younger children ( p  < 0.001). Fractures with subluxation were the most common pattern of injury, observed in 35 (47%) patients. However, fractures with subluxation were uncommon in younger children compared with older children ( p  < 0.04). Spinal cord injury without radiographic abnormality (SCIWORA) was observed in 42% of younger children compared with 8% of older children ( p  < 0.02). Thirty (40%) patients were managed surgically; anterior cervical corpectomy with fusion was the most commonly performed procedure in 19 (63%) patients. The overall mortality was 20%. Conclusion  The results of our study revealed predominant involvement of the upper cervical spine in children younger than 10 years of age. SCIWORA was documented in both the age groups with a significantly higher incidence in younger children. The instrumentation and fusion techniques in children are safe; however, developing pediatric spine needs special considerations.

Very rare incidence of ascending paralysis in a patient of traumatic spinal cord injury: a case report

INTRODUCTION

After spinal cord injury, further neurological deterioration up to one to two neurological levels is not uncommon. Late neurological deterioration can occur after two months, mainly due to the syrinx formation. In a rare case like in sub-acute post-traumatic ascending myelopathy, the neurological level may ascend more than four levels from the initial level of injury and it usually starts within a few weeks after injury.

CASE PRESENTATION

Our case was diagnosed as a case of traumatic spinal cord injury having a lower thoracic neurological level of injury initially, which rapidly progressed over a few weeks into a higher thoracic neurological level. He was operated with pedicle screw fixation of the spine before admission to rehabilitation unit. He was having progressive ascending neurological deterioration, starting a few days after surgery, which was evident by the progression of neurological level by more than four segments clinically. Cerebrospinal fluid(CSF) study showed no significant abnormality. Magnetic resonance imaging (MRI) study showed involvement of the spinal cord at the upper thoracic region. Patient was monitored to note any further worsening. Rehabilitation and supportive measures were provided according to standard protocol.

DISCUSSION

Very few cases of ascending paralysis of more than four levels have been reported globally. It results in increased morbidity and mortality in spinal cord injury patients. In our case few possible reasons are ruled out but the actual underlying reason was not clear. Various hypotheses have been proposed as the cause in previous published literatures. Management is mostly supportive.

Bowel Management in Patients With Chronic Spinal Cord Injury: A Cross-Sectional Survey

Introduction

Spinal cord injury (SCI) impairs colorectal movement, transit time, and complete evacuation at defecation. Incontinence has been documented to affect quality of life across the globe in different proportions. Bowel management has been recognized as a key factor in SCI patients’ participation in the society and leading a satisfactory life. Limited information on bowel management in SCI patients drove us to study the demographic profile and bowel management in a group of chronic SCI patients at a tertiary care rehabilitation center.

Methods

A total of 42 adults (age: 18-60 years) with SCI and duration > 12 months were enrolled. Patients were evaluated with a semi-structured questionnaire containing both open and closed questions. Data were collected and analyzed using Statistical Package for Social Sciences (SPSS) Version 10.

Results

Most (52.4%) of the patients were manual laborers (85.7% males). Mean age was 37.6 ± 11 years. The injury level was predominantly thoracic level (69%). Only eight (19%) patients had fecal incontinence; 21(50%) patients used suppository and only six patients were using laxatives. Impacted stool was the most common complication followed by hemorrhoids.

Conclusion

Young paraplegics is the most common age group affected by SCI. Most of the patients managed their bowel well conservatively with good adherence to bowel rehabilitation program. The study findings emphasize on patient-centric bowel management in SCI patients to reduce the impact on quality of life and minimize complications.

"God will decide her fate": the trajectories of women with traumatic spinal cord injury in India

PURPOSE

Traumatic Spinal Cord Injury (SCI) is one of the most devastating physical disabilities that unexpectedly affects physical, mental, familial, social, and economic aspects of people's lives. This article analyses the trajectories of Indian women with SCI as they attempt to access health care after the injury.

METHODS

Based on a qualitative research paradigm, this study adopts a phenomenological approach and conducts in-depth interviews with 21 Indian women with traumatic SCI.

RESULTS

(A) A lack of awareness and basic knowledge about SCI in India makes emergency response and eventual reintegration of persons with SCI in the society challenging. (B) The Indian health systems fail to meet the comprehensive health care needs of women with SCI primarily due to inadequate healthcare infrastructure and lack of empathy, accountability and knowledge about SCI among general healthcare providers. (C) The lack of patient and caregiver education results in diminished health and wellbeing of injured and their families.

CONCLUSION

The issue of SCI is not only a health issue but an issue of human rights. The persons with SCI, particularly women, must get an equitable access to health care, education, employment, transportation and other basic amenities and opportunities. Implications for rehabilitationA comprehensive response to SCI entails concerted measures such as ramping up the disability-inclusive healthcare infrastructure and enhancing the capacities of all health care providers.Besides providing rehabilitation services through the primary, secondary and tertiary levels of the health systems, India should also prioritise and offer quality community-based rehabilitation, especially in remote and rural areas.Given the unique vulnerabilities faced by women with disabilities in India, a compressive package of gender sensitive rehabilitation services needs to be integrated within the overall rehabilitation services across the country.The persons with SCI (and their families) need to be empowered through comprehensive information, counselling and skills that could help them lead independent, productive, and dignified lives.There is an urgent need to foster SCI research and make disaggregated data on SCI publicly available so that policy response to SCI is based on scientific evidence and local realities.

Cervical Spinal Lesion, Completeness of Injury, Stress, and Depression Reduce the Efficiency of Mental Imagery in People With Spinal Cord Injury

OBJECTIVES

The aims of this study were to assess the relationships of (1) clinical variables (age, level of injury, time since injury [TSI], and completeness of injury) and (2) psychological variables (stress and depression) with mental imagery ability in individuals with spinal cord injury.

STUDY DESIGN

This was a cross-sectional study. Participants with spinal cord injury (N = 130) were requested to fill the Kinesthetic and Visual Imagery Questionnaire and Vividness of Motor Imagery Questionnaire. They also completed the Perceived Stress Scale and Patient Health Questionnaire 9 for the assessment of stress and depression, respectively.

RESULTS

Mental imagery scores were found to be significantly low in cervical injuries (P < 0.001) as compared with thoracic injuries (P < 0.001). Furthermore, higher levels of spinal injuries resulted in lower mental imagery scores. Completeness of injury (according to Asia Impairment Scale) also had a significant relationship (P < 0.001) with the mental imagery ability among spinal cord injury participants. Presence of stress (P < 0.001) and depression (P < 0.001) also associated with reduced efficiency of mental imagery in these individuals.

CONCLUSIONS

Injury type and psychological factors were associated with mental imagery in SCI patients. Imagery-based interventions should be designed after consideration of identified factors yielding effect on their outcomes.

TO CLAIM CME CREDITS

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.

CME OBJECTIVES

Upon completion of this article, the reader should be able to: (1) Determine the impact of clinical variables such as level of injury, completeness and chronicity of injury on mental imagery ability in spinal cord injury; (2) Discuss the role of stress and depression on mental imagery ability in spinal cord injury; and (3) Describe the various dimensions of mental imagery ability and its variability among individuals who have spinal cord injury.

LEVEL

Advanced.

ACCREDITATION

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Epidemiology of Traumatic Spinal Cord Injury in Developing Countries from 2009 to 2020: a Systematic Review and Meta-analysis

INTRODUCTION

Traumatic spinal cord injury (TSCI) is a catastrophic event with a considerable health and economic burden on individuals and countries. This study was performed to update an earlier systematic review and meta-analysis on epidemiological properties of TSCI in developing countries published in 2013.

METHODS

Various search methods including online searching in database of EMBASE and PubMed, and hand searching were performed (2012 to May 2020). The keywords 'Spinal cord injury', 'epidemiology', 'incidence' and 'prevalence' were used. Based on definition of developing countries by International Monetary Fund, studies related to developing countries included. Data selection was according to PRISMA guidelines. The quality of included studies was evaluated by Joanna Briggs Institute Critical Appraisal Tools. Results of meta-analysis were presented as pooled frequency, and forest, funnel and drapery plots.

RESULTS

we identified 47 studies from 23 developing countries. The pooled incidence of TSCI in developing countries was 22.55/million/year (95% CI: 13.52; 37.62/million/year). Males comprised 80.09% (95% CI: 78.29%; 81.83%) of TSCIs, and under 30 years patients were the most affected age group. Two leading etiologies of TSCIs were motor vehicle crashes (43.18% (95% CI: 37.80%; 48.63%)), and falls (34.24% (95% CI: 29.08%; 39.59%)), respectively. The difference among the frequency of complete injury (49.47% (95% CI: 43.11%; 55.84%)), and incomplete injury (50.53% (95% CI: 44.16%; 56.89%)) was insignificant. The difference among frequency of tetraplegia (46.25% (95% CI: 37.78%; 54.83%)) and paraplegia (53.75% (95% CI: 45.17%; 62.22%)) was not statistically significant. The most prevalent level of TSCI was cervical injury (43.42% (95% CI: 37.38%; 49.55%).

CONCLUSION

In developing countries, TSCIs are more common in young adults and males. Motor vehicle crashes and falls are the main etiologies. Understanding epidemiological characteristics of TSCIs could lead to implant appropriate cost-effective preventive strategies to decrease TSCIs incidence and burden.

Quality of Life after Surviving a Spinal Cord Injury: An Observational Study in South India

Background

Spinal cord injury (SCI) and its negative impact on the quality of life (QOL) is a significant public health concern in India. People with SCI suffer from serious health, economic, and social consequences in their lives. Often, care for SCI survivors is left to their immediate family members in India. Appropriate planning is needed for prevention, rehabilitation, health, and psychological care for SCI in the country.

Purpose

This study assessed the overall QOL of SCI survivors and their satisfaction levels with specific domains and their importance of QOL.

Materials and Methods

In this observational study, two instruments, Farrens and Power for QOL and Barthel Index for functional abilities, were administered to a convenience sample of participants drawn from Narayana Medical College, Nellore, in South India.

Results

Statistically, SCI survivors were found moderately and very satisfied with their QOL. Their perception about importance of health, functioning, social, and economic subscale also did not differ statistically.

Traumatic spine injuries in Eastern India: A retrospective observational study

Background:

Trauma is the leading cause of hospitalization globally, and trauma-induced spinal injuries can be devastating and permanent. The objective of this study was to describe the pattern, association, and outcome in patients with traumatic spine injury (TSI).

Methods:

A retrospective cross-sectional study was undertaken on patients with TSI who presented to the trauma and emergency department of a level 1 trauma center in eastern India between August 15, 2018, and August 14, 2019, by including 103 patients. Information pertaining to demography, mode of injury (MOI), fracture morphology, neurological grading, and associated spinal or other regional injuries was obtained. Correlation among injury severity score (ISS), neurological damage as per American Spinal Injury Association (ASIA), and morphological patterns was determined.

Results:

The median age was 39 years, and the gender ratio was 5.87:1. Fall from height (43.7%) was the most common MOI. The median ISS was 21, and the percentage of patients with polytrauma was 73% (ISS > 15). The cervical region (n = 30) was the most common site of injury, and multiple vertebral involvement (n = 32) was more common than isolated involvement. Type A pattern (53.4%) was the predominant type, followed by types C and B (29.1% and 15.5%, respectively) for primary spine injury, and type A was the predominant type for secondary spinal injury. Severe neurological damage (ASIA A-C) was noticed in 69 patients. The correlation between ISS and ASIA scores (Spearman's ρ = 0.561, P < 0.001) and between morphology type and ASIA score (Pearson's χ ²= 69.7, P < 0.001) was statistically significant. In total, 53 patients were managed surgically and 24 patients were managed by conservative measures.

Conclusion:

Our study found a predominantly younger population, multilevel involvement, significant neurological damage, multiple associated injuries, and higher ISS among the patients of TSI. The pattern in eastern India is different from previous reports from other parts of the country.

Literature review on assistive devices available for quadriplegic people: Indian context

PURPOSE

This literature review aims to find the current state of the art in self-help devices (SHD) available for people with quadriplegia.

MATERIALS AND METHODS

We searched original articles, technical and case studies, conference articles, and literature reviews published between 2014 to 2019 with the keywords ("Self-help devices" OR "Assistive Devices" OR "Assistive Product" OR "Assistive Technology") AND "Quadriplegia" in Science Direct, Pubmed, IEEE Xplore digital library and Web of Science.

RESULTS

Total 222 articles were found. After removing duplicates and screening these articles based on their title and abstracts 80 articles remained. After this, we reviewed the full text, and articles unrelated to SHD development or about the patients who require mechanical ventilation or where the upper limb is functional (C2 or above and T2 or below injuries) were discarded. After the exclusion of articles using the above-mentioned criterion 75 articles were used for further review.

CONCLUSION

The abandonment rate of SHD currently available in the literature is very high. The major requirement of the people was independence and improved quality of life. The situation in India is very bad as compared to the developed countries. The people with spinal cord injury in India are uneducated and very poor, with an average income of 3000 ₹ (41$). They require SHDs and training specially designed for them, keeping their needs in mind.Implications for rehabilitationPeople with quadriplegia are totally dependent on caregivers. Assistive devices not only help these people to do day-to-day tasks but also provides them self-confidence.Even though there are a lot of self-help devices currently available, still they are not able to fulfil the requirements of people with quadriplegia, hence there is a very high abandonment rate of such devices.This study provides an evidence that developing devices after understanding the functional and non-functional requirements of these subjects will decrease the abandonment rate and increase the effectiveness of the device.The results of this study can be used for planning and developing assistive devices which are more focussed on fulfilling the requirements of people with quadriplegia.

Sexuality and relationship experiences of women with spinal cord injury: reflections from an Indian context

Spinal cord injury (SCI) is one of the most devastating physical disabilities. It leads to varying degrees of loss in sensations and mobility below the level of injury and causes loss in autonomic functions, such as bladder/bowel control, and sexual impairments. Research, mostly conducted in the developed western nations, reveals that coming to terms with one's sexuality after SCI is most crucial for early reintegration in the society and quality of life for persons with SCI. Thus, experts advocate that the sexual rehabilitation of persons with SCI is an integral component of comprehensive rehabilitation. In the Indian context, however, the sexuality of persons with SCI, particularly women, has been largely overlooked by the disability rights movement, and discourses on gender, sexuality and rehabilitation. This article is based on an in-depth study of the experiences of sexuality and intimate relationships of 24 women with SCI in India. It demonstrates that sexuality and intimate relationships are integral aspects of health and well-being for women. But there are wide gaps in the sexual rehabilitation and support needs for women with SCI in India, making their sexual adjustment extremely challenging. By analysing women's journeys of sexual adjustment and rediscovery of sexual pleasure that echo their voices as sexual beings, this article argues for the development of evidence-based and gender-sensitive sexual rehabilitation services for women with SCI in India.

Surgical Outcome in Spinal Operation in Patients Aged 70 Years and Above

Introduction

The world is seeing a growth of the aging population and the number of surgical treatments in this age group which is also true for spinal conditions. The greatest increase in spinal fusion surgery has been observed in patients aged 65 years and above. Only a few works of literature were available on the issue, especially in India.

Materials and Methods

An observational study in which 70 patients aged 70 years and above who underwent spinal surgery for degenerative and traumatic spinal injury, from January 2013 to July 2017 in the neurosurgery department of a single institute, were reviewed. Around 53 patients were assessed for disability/functional outcome and their health-related quality of life (HRQOL) using the Oswestry disability index (ODI) and RAND 36-item health survey 1.0 scoring method (SF-36) comparing the preoperative and postoperative status.

Result

The mean age was 74.19 years (range 70-91 years). Laminectomy-19 (27.14%) was the most common surgical procedure performed. Overall there were nine (12.85%) major complications with mortality of five (7.14%) patients. There was a significant reduction of crippled patients (14-9, P = 0.009) in the ODI score. SF-36: There was significant improvement in degenerative patient (P = 0.000 to P = 0.012). In traumatic patient, only pain had significant improvement (P = 0.045).

Conclusion

This study showed that the age of the patient should not be the limiting factor for the surgical management of a patient with a degenerative or a traumatic spinal condition.

Pattern of spine fracture in Sub-Himalayan region: A prospective study

BACKGROUND

Though spine trauma contributes to great functional, psychological, and economic loss, research regarding the demographic profile of patients according to different regions of our country are lacking.This study aims to identify the demographic pattern and clinical profile of patients with spinal fracture in the Sub-Himalayan region.

METHOD

Patients with acute or subacute spine trauma presenting within 8weeks and involving fracture of cervical, dorsal, or lumbar vertebra, from July 2017 to December 2019 were included prospectively. Patients with osteoporotic or metastatic collapse, isolated transverse or spinous process fracture, penetrating trauma or ballistic injuries were excluded.

RESULTS

Out of 280 enrolled patients, 180 were males and 100 were females. The maximum number of spine trauma patients was in 16-30 years age group. The most common mechanism of injury was fall from height (FFH, 42.5%)> road traffic accident (RTA, 38.6%). RTA was more common among males and FFH among females (p < 0.0001). Most common location of injury was at thoracolumbar junction (D10-L2) (37.5%) followed by cervical spine (25.3%). 58.2% of patients had AO type A facture morphology followed by AO types C (36.1%) and AO type B (5.7%). Spinal Cord Injury (SCI) was seen in 82.1% spine trauma patients with statistically significant association with male gender (p- 0.045). Complete paralysis was seen maximum in patients with cervical spine injury (67.3%, p < 0.0001). Complete neurological deficit (ASIA grade A) was seen maximum in AO type C fracture morphology (74.25%, p < 0.001) followed by AO type A4 (29.6%). Seasonal distribution showed increased incidence during summer and monsoon season.

CONCLUSION

Young aged males in age group of 16-30 yrs were most commonly affected with fall from height as the most common mechanism of trauma. Association was found between gender and mechanism of injury (RTA in males and FFH in females). Most common vertebral injury level was thoracolumbar junction. AO type A was the most common fracture morphology. SCI seen in 82.1% of spine trauma. Statistically significant association was found between Complete SCI with Location of Injury (Cervical) and Fracture morphology (AO type C).

Impact of Patient Counseling and Socioeconomic Factors on Initiation of Rehabilitation Program in Spinal Cord Injury Patients Presenting to a Tertiary Spine Unit in India

Study Design

Prospective case series.

Purpose

This study aimed to investigate the impact of education, financial income, occupation, and patient counseling on the timing of enrolment in a spinal cord injury (SCI) rehabilitation program.

Overview of Literature

A rehabilitation program following SCI is essential to improve functional outcomes. Socioeconomic factors can affect the timing of enrolment to a rehabilitation program. Literature on the effects of socioeconomic factors among patients with SCI in the Indian scenario is limited.

Methods

A prospective, consecutive analysis of patients with SCI was performed with 1-year follow-up. Assessment of the timing of enrolment to a rehabilitation program was performed using the modified Kuppuswamy socioeconomic scores (MKSS). Patients admitted to the SCI unit (group A), underwent intensive individual, group, and family counseling sessions to encourage early enrolment into a rehabilitation program. Patients presenting directly for rehabilitation (group B) were analyzed for comparison.

Results

A total of 153 patients were recruited. Group A was composed of 122 patients who started the rehabilitation program after a mean of 28 days, compared with a mean of 149 days for 31 patients in group B. In group A, 104 patients (85%; mean MKSS, 14.02) and 18 patients (15%; mean MKSS, 15.61) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. In group B, 12 patients (39%; mean MKSS, 13.69) and 19 patients (61%; mean MKSS, 12.10) enrolled for rehabilitation <6 weeks and ≥6 weeks, respectively. The total MKSS and scores for education, income, and occupation did not show a significant difference between the two both groups (p>0.05).

Conclusions

Early patient counseling in the acute care unit helps in the early enrolment of patients with poor socioeconomic demographic profile to a rehabilitation program.

Surgery for Spinal Trauma: Early Days at a Young Institution in a Hilly State

Background Spinal trauma is associated with significant morbidity and affects the overall quality of life of the patient as well as their family. The aim of this study was to study the epidemiology, in-hospital outcome, and follow-up of patients undergoing surgery for spinal trauma.

Methods All patients who underwent surgery for spinal trauma at the Department of Neurosurgery between June 2016 and October 2019 were studied retrospectively. Data collected from patient record included demographic profile, mode of injury, level of injury, neurological status at admission, time from injury to operative intervention, hospital stay, neurological outcome at discharge, and follow-up. Postoperative computed tomography scans were done in all patients to check for adequacy of screw placement.

Results A total of 70 patients (45 males, 25 females) with a mean age of 36 years (range: 16–65 years) were operated for spinal injuries at our department during the study period. Fall was the most common mode of injury (77.1%), followed by road traffic accident (28.5%). Most common site of injury was lumbar spine (38.6%), followed by dorsal (32.9%) and cervical (28.5%). Out of the total, 27.1% of our patients were American Spinal Injury Association (ASIA) grade A at presentation whereas 18.6% were ASIA E. Remaining 54.3% patients had incomplete injuries (ASIA B, C, and D). Burst fracture was the most common morphology of injury (60%), followed by translational injuries (30%). Mean duration between injury and operative intervention was 20.8 days. The mean duration of hospital stay was 21.4 days (range: 8–90 days). Six patients expired during hospitalization. All these six cases had cervical spinal injury. One patient of dorsal spine injury with a complete neurological injury expired 6 months after discharge from the hospital (cause unknown). Nine of our cases showed neurological improvement on follow-up and in rest of the patients, neurological status remained same as preoperative status.

Conclusion Neurological status at admission (ASIA grade) and level of injury remain the most important predictor of the outcome. Spinal injury patients must be managed with a holistic and multidisciplinary approach. Rehabilitation is important for helping these patients in leading a productive life.

Epidemiology of Spinal Injury in North East India: A Retrospective Study

Aim:

To find out the epidemiology of spinal injury in North East India.

Material and Methods:

This study is a retrospective hospital-based analysis of spine injury patients admitted to Central Referral Hospital, Sikkim Manipal University from July 2013 to June 2017July 2013 to June 2017.

Results:

During the study period 57 patients with spinal injury were admitted and treated. Out of the 57 patients, 46 (81%) were male and 11 (19%) were female. The most common mode of injury was fall from height (59.64%) followed by RTA (35.08%). Most common affected age group in this study was 20-39 years followed by 50-59 years age group. Cervical spine injury was the most common (52.63%) followed by thoracic (19.29%) spine. Most common injury found was fracture dislocation of C5-C6 level. Most common associated injury is head trauma (10.52 %) followed by chest injury and 82.45% cases had no associated trauma. Average period of hospital stay was 22.83 days with maximum period of stay was 111 days. During treatment period one patient died due to respiratory complications.

Conclusion:

The epidemiology of spinal injuries in Sikkim & North Eastern India is different from rest of the India and other developing countries. In present study most common cause of spine injury was fall from height followed by motor vehicle accidents. RTA was the main cause in younger age group and fall from height was more common in elderly group.

Change in urodynamic pattern and incidence of urinary tract infection in patients with traumatic spinal cord injury practicing clean self-intermittent catheterization

Objective: To observe changes in cystometric parameters in individuals with spinal cord injury (SCI) with neurogenic bladder practicing clean intermittent self-catheterization (CIC) and incidence of urinary tract infection (UTI) in such patients.Design: Prospective, observational study.Setting: Tertiary Urban Rehabilitation Hospital.Participants: Persons with neurogenic bladder caused by traumatic SCI and practicing CIC.Interventions: Clinical evaluation, complete urine analysis, urine culture and sensitivity, ultrasonography of the abdomen and urodynamic study were evaluated at baseline and at follow-up (6 months to 1 year).Outcome Measures: Detrusor pattern, cystometric capacity, detrusor compliance, detrusor leak point pressure, residual urine, incidence of UTI.Results: Thirty-one participants were included in the study. The baseline cystometric study showed that 15 had overactive detrusor and 16 had detrusor areflexia. The mean cystometric capacity decreased significantly between baseline and follow-up in both the groups but remained within the normal threshold limit, decline being more marked in the overactive detrusor group, who also had more marked decrease in compliance. Mean detrusor leak point pressure was below 40 cm H₂O in all participants in both groups at baseline and follow-up. Mean residual urine improved at follow-up in both groups. Incidence of UTI was 2.29 episodes per patient per year, and more frequent in the overactive detrusor group. Escherichia coli was the causative agent in 45%.Conclusion: The cystometric capacity and compliance decreased significantly though patients were doing regular CIC and managed on antimuscarinics for detrusor overactivity (DO). UTI is more common in individuals with SCI with DO and E. coli is the most common cause of UTI.

Cervical Spine Evaluation in Pediatric Trauma: A Review and an Update of Current Concepts

The clinical presentation and diagnostic workup in pediatric cervical spine injuries (CSI) are different from adults owing to the unique anatomy and relative immaturity. The current article reviews the existing literature regarding the uniqueness of these injuries and discusses the current guidelines of radiological evaluation. A PubMed search was conducted using keywords "paediatric cervical spine injuries" or "paediatric cervical spine trauma." Six hundred and ninety two articles were available in total. Three hundred and forty three articles were considered for the review after eliminating unrelated and duplicate articles. Further screening was performed and 67 articles (original articles and review articles only) related to pediatric CSI were finally included. All articles were reviewed for details regarding epidemiology, injury patterns, anatomic considerations, clinical, and radiological evaluation protocols. CSIs are the most common level (60%-80%) for pediatric Spinal Injuries (SI). Children suffer from atlantoaxial injuries 2.5 times more often than adults. Children's unique anatomical features (large head size and highly flexible spine) predispose them to such a peculiar presentation. The role of National Emergency X-Ray Utilization Study, United State (NEXUS) and Canadian Cervical Spine Rule criteria in excluding pediatric cervical injury is questionable but cannot be ruled out completely. The minimum radiological examination includes 2- or 3-view cervical X-rays (anteroposterior, lateral ± open-mouth odontoid views). Additional radiological evaluations, including computerized tomography (CT) and magnetic resonance imaging (MRI) are obtained in situations of abnormal physical examination, abnormal X-rays, inability to obtain adequate X-rays, or to assess cord/soft-tissue status. The clinical criteria for cervical spine injury clearance can generally be applied to children older than 2 years of age. Nevertheless, adequate caution should be exercised before applying these rules in younger children. Initial radiographic investigation should be always adequate plain radiographs of cervical spine. CT and MRI scans should only be performed in an appropriate group of pediatric patients.

Epidemiological features of traumatic spinal cord injury in Chongqing, China

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.

Clinical proteomics of enervated neurons

The dynamic field of neurosciences entails ever increasing search for molecular mechanisms of disease states, especially in the domain of neurodegenerative disorders. The previous century heralded the techniques in proteomics when indexing of the human proteomes relating to various disease conditions became important. Early stage research in certain diseases or pathological conditions requires a more holistic approach of first discovering the proteins of interest for the condition. Despite its limitations, proteomics is one of the most powerful techniques available to us today to dissect the molecular scenario in a particular disease situation. In this review we will discuss about the current clinical research in neurodegenerative disorders that employ proteomics techniques. We will specifically focus on our understanding of Alzheimer’s disease, traumatic spinal cord injury and neuromyelitis optica. Discussions will include ongoing worldwide research in these areas, research in India and specifically our laboratory in these domains of neurodegenerative conditions.

Demographic and clinical characteristics of patients with spinal cord injury: a single hospital-based study

STUDY DESIGN

Retrospective study.

OBJECTIVES

To evaluate the demographic and clinical characteristics of patients diagnosed with spinal cord injury (SCI) admitted to a single center.

SETTING

Single center study, México.

METHODS

This study reviewed 433 patients with SCI. Data were extracted from medical records and retrospectively reviewed.

RESULTS

A total of 433 patients with a diagnosis of SCI were included in the analysis. Of these, 346 (79.9%) had traumatic SCI (TSCI) and 87 (20.1%) had non-traumatic SCI (NTSCI). The principal causes of traumatic TSCI were motor vehicle accidents in 150 patients (43.4%), falls in 107 patients (30.9%) and a result of firearms in 58 patients (16.8%). Tumoral cord compression was the main cause of NTSCI in 50 patients (57.4%), followed by degenerative disease-causing myelopathy in 17 patients (19.5%). The proportion of patients affected with NTSCI was significantly lower, 29.9 vs 79.1% (P=0.0001), the age of patients was higher 53.9 vs 37.8 (P<0.002) and SCI was less severe, AIS D 41.33 vs 9.5% (P=0.0001) compared with the TSCI group.

CONCLUSIONS

The demographic profiles of patients with TSCI and NTSCI differ in terms of proportion of total SCIs, patient age, male:female ratio and incomplete vs complete injury. The most common etiology of TSCI was motor vehicle accidents (43.4%), and neurological lesions were complete in 62.7% of patients. The most common etiology of NTSCI was tumoral spinal lesions (57.4%), and lesions were incomplete in 75.8% of patients.

Epidemiological study of traumatic spinal cord injuries: experience from a specialized spine center in Iran

STUDY DESIGN

A cross-sectional study.

OBJECTIVES

This study was performed for epidemiological assessment of Iranian Traumatic Spinal Cord Injuries (TSCI), referred to a specialized spine center.

SETTING

Patient recruitment and evaluations were conducted at the Brain and Spinal Injury Research Center, Tehran, Iran.

METHODS

This study was performed from September 2011 to March 2015 on 1137 consecutive TSCIs. History, clinicoradiological findings as well as chronic complications and social integration were recorded. The capture-recapture method was used to calculate a rough estimation of TSCI prevalence in Tehran Province.

RESULTS

Our report includes 1137 cases with a mean age of 29.1 years (s.d.=11.2 year)-79.2% of them being male (M/F=3.8/1). Rough estimation of TSCI prevalence in Tehran province was 2.36 per 10 000 population. Regarding etiology, 61.8% were due to motor vehicle accident (MVA), followed by falling 24.5%, heavy drop 5.2%, violence 3.8%, sport 2.8% and others causes 1.9%. Regarding injury level, 31.5% were cervical, 57.9% thoracic and 10.6% lumbar. Complete lesions were 53.5% of patients and 46.5% were incomplete. Most common neurological type was T1-S5 (American Spinal Injury Association Impairment Scale: A, B, C, 61.7%). Most common complications included urinary tract infection followed by pressure sore (grade III and IV, 37.5%), autonomic dysreflexia (37%) and neuropathic pain (31.2%). Substance abuse was observed in 8.8% of cases. Overall, ~25% in our cases were employed after TSCI. Secondary divorce was also much more frequent than normal matched controls.

CONCLUSION

MVA was the most common cause for TSCI. The elderly subjects were less frequent among our patients than more developed countries. The high rate of unemployment and divorce in our cases deserves special consideration.