Traumatic spinal cord injuries: evidence from 30 years in a single centre

Traumatische Rückenmarkverletzungen im Sport – eine Analyse eines spezialisierten Traumazentrums von 22 Jahren

Einführung Aktuell gibt es nur wenige Daten zu traumatischen Wirbelsäulenverletzungen mit neurologischer Beteiligung im Hinblick auf Sportunfälle in Deutschland. Ziel dieser Studie ist es, die Häufigkeit traumatischer Rückenmarksverletzungen, verursacht durch verschiedene Sportunfälle, aus den letzten 22 Jahren darzustellen. 

Methoden Die vorliegende Studie ist eine retrospektive Auswertung traumatischer Rückenmarksverletzungen (tSCI) bei sportlicher Aktivität eines Level-1-Traumazentrums mit Abteilung zur Behandlung von Rückenmarksverletzungen in Deutschland der letzten 22 Jahre.

Die Akten der in den Jahren 1998–2020 behandelten Patient*innen wurden im Hinblick auf die Anamnese untersucht und diejenigen Fälle genauer betrachtet, bei denen es sich ursächlich um Sportaktivitäten handelte. Zusätzlich wurden Art und Schwere der Verletzung sowie die Geschlechtsverteilung erfasst.

Ergebnisse Insgesamt wurden 1630 Patient*innen mit traumatischen Wirbelsäulenverletzungen mit Rückenmarksbeteiligung eingeschlossen. Von diesen 1630 Patient*innen waren n=116 (7,1%) Sportunfälle. Das Alter dieser Subpopulation war mit 41 Jahren signifikant jünger (p=0,05) als die Gesamtgruppe der tSCI mit 50 Jahren. Eine detailliertere Analyse der Sportverletzungen ergab, dass in absteigender Reihenfolge Reit- (n=22), Winter- (n=18), Luft- (n=16), Motor- (n=16) und Radsport (n=15) die häufigsten ursächlichen Faktoren für diese besonders schweren Wirbelsäulenverletzungen waren. Bei der Verteilung der Lokalisation der Wirbelsäulenverletzung in Bezug auf die Art des ausgeübten Sports zeigte sich im Luftsport ein signifikantes Ergebnis, wonach sich die Patient*innen dieser Gruppe hauptsächlich Verletzungen der Lendenwirbelsäule zuzogen (p<0,01). Die Geschlechterverteilung der einzelnen Sportarten zeigt im Pferdesport (männlich < weiblich, p < 0,01), im Luftsport (männlich > weiblich, p = 0,05) und im Radsport (männlich > weiblich, p = 0,07) signifikante Ergebnisse.

Fazit Zusammengefasst ist vor allem Reitsport beim weiblichen Geschlecht in der Kategorie Sportverletzungen am häufigsten ursächlich für traumatische Wirbelsäulenverletzungen, obwohl Frauen insgesamt einen deutlich geringeren Anteil der Patient*innen mit traumatischen Wirbelsäulenverletzungen einnehmen als Männer. Ferner führen Winter- (n=18), Luft- (n=16), Motor- (n=15) und Radsport (n=15) zu häufigen traumatischen Wirbelsäulenverletzungen im Sportsektor. Patient*innen mit traumatischen 

Wirbelsäulenverletzungen mit spinaler Beteiligung bedingt durch Sportunfälle waren signifikant jünger als diejenigen der Gesamtheit aller traumatischer Wirbelsäulenverletzungen.

Epidemiological profile of 338 traumatic spinal cord injury cases in Shandong province, China

STUDY DESIGN

Hospital-based retrospective review.

OBJECTIVE

To describe the epidemiological characteristics of traumatic spinal cord injury (TSCI) in Liaocheng, China.

SETTING

Liaocheng People's Hospital.

METHODS

Medical records of 338 persons with TSCI admitted to Liaocheng People's Hospital from 2013 to 2017 were reviewed. The detailed information included gender, age, marital status, occupation, time, etiology, level of injury, ASIA grade, spinal stenosis, concomitant injury, treatment, length of stay.

RESULTS

Over this period, the mean age (SD) of persons with TSCI was 50.1 (14.1) years, and the male/female ratio was 3.1:1. 96.4% of all were married. The leading cause was fall, followed by motor vehicle accident (MVA). The most common level of injury was the cervical cord. ASIA grade D and A injuries were the most common, accounting for 48.5 and 29.3% respectively. Among the concomitant injuries, spinal fractures were the most common. Within 24 h, 91.1% of individuals with TSCI arrived hospital, 63.3% of all accepted surgery.

CONCLUSION

The results showed that fall and MVA were the two main causes, so we should focused on preventing fall and reducing MVA. Cervical spinal stenosis can increase the risk of TSCI, so education should be provided to this population to raise their risk awareness. In addition, timely treatment was critical for TSCI, but the data showed that rescue process was not standard, so it was necessary for medical staff to popularize professional knowledge.

SPINE TRAUMA EPIDEMIOLOGICAL PROFILE IN A TERTIARY NEUROSURGERY HOSPITAL IN SOUTH BRAZIL

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.

NeuroRegen Scaffolds Combined with Autologous Bone Marrow Mononuclear Cells for the Repair of Acute Complete Spinal Cord Injury: A 3-Year Clinical Study

Spinal cord injury (SCI) remains among the most challenging pathologies worldwide and has limited therapeutic possibilities and a very bleak prognosis. Biomaterials and stem cell transplantation are promising treatments for functional recovery in SCI. Seven patients with acute complete SCI diagnosed by a combination of methods were included in the study, and different lengths (2.0–6.0 cm) of necrotic spinal cord tissue were surgically cleaned under intraoperative neurophysiological monitoring. Subsequently, NeuroRegen scaffolds loaded with autologous bone marrow mononuclear cells (BMMCs) were implanted into the cleaned site. All patients participated in 6 months of rehabilitation and at least 3 years of clinical follow-up. No adverse symptoms associated with stem cell or functional scaffold implantation were observed during the 3-year follow-up period. Additionally, partial shallow sensory and autonomic nervous functional improvements were observed in some patients, but no motor function recovery was observed. Magnetic resonance imaging suggested that NeuroRegen scaffold implantation supported injured spinal cord continuity after treatment. These findings indicate that implantation of NeuroRegen scaffolds combined with stem cells may serve as a safe and promising clinical treatment for patients with acute complete SCI. However, determining the therapeutic effects and exact application methods still requires further study.

Incidence of acute spinal cord injury in the Czech Republic: a prospective epidemiological study 2006-2015

STUDY DESIGN

A prospective study.

OBJECTIVES

Analysis of epidemiological data about acute spinal cord injury (SCI) in the Czech Republic over a period of 10 years (2006-2015).

METHODS

A data collection system was implemented in the rehabilitation centres which provides care to patients with acute SCI in the Czech Republic. The recorded variables are as follows: age at time of SCI; gender; cause of injury; neurological level of injury (NLI); and its severity (ASIA Impairment Scale (AIS)). Data from 2006 to 2015 were analysed and trends were determined.

RESULTS

The overall number of acute SCI ranges between 250 and 300 cases annually. Two-third of the affected population are males. The average age at time of SCI is 49.1 years. The average incidence of traumatic SCI is 15.5 cases per year and is gradually decreasing. The leading cause of SCI are falls (44.5%), followed by traffic accidents (28.2%) and sports injuries including diving into water (19.7%). The incidence of non-traumatic SCI is 8.6 cases per year on average and has an upward trend. Inflammatory lesions account for 26.7% of cases, tumours account for 20.9%, and vascular related injuries make up 17.7%. The NLI occurs most often in the cervical segments (45.3%). The most frequently occurring lesions are motor incomplete: AIS D (33.3%).

CONCLUSION

This study shows a stable occurrence of SCI in the Czech Republic, with cervical and motor incomplete cases being the leading ones. Epidemiological data are needed to improve the care of SCI patients and to promote an active life following it.

How safe is Bubble Soccer?

Traumatic neurologic injury in contact sports is a rare but serious consequence for its players. These injuries are most commonly associated with high-impact collisions, for example in football, but are found in a wide variety of sports. In an attempt to minimize these injuries, sports are trying to increase safety by adding protection for participants. Most recently is the seemingly 'safe' sport of Bubble Soccer, which attempts to protect its players with inflatable plastic bubbles. We report a case of a 16-year-old male sustaining a cervical spine burst fracture with incomplete spinal cord injury while playing Bubble Soccer. To our knowledge, this is the first serious neurological injury reported in the sport.

A descriptive study on the functioning profile of patients with spinal cord injury in a rehabilitation center in Russia

STUDY DESIGN

This is a cross-sectional study.

OBJECTIVES

(1) To use the International Classification of Functioning, Disability and Health (ICF) profile to assess the functioning of patients with spinal cord injury (SCI) admitted to a rehabilitation center; (2) To determine the role of the ICF in the operation of a rehabilitation center in Russia.

SETTING

This study was conducted in the Federal center for disability rehabilitation in Novokuznetsk, Russia.

METHODS

Eighty-one patients with SCI (59 men and 22 women; 31 with cervical, 41 with thoracic and 9 with lumbar level of injury) were included in the study. We determined the odds ratios of more pronounced impairments in ICF categories according to the duration of SCI and degree of neurological deficit.

RESULTS

Mean age of patients was 34.9±11.1 years, men/women ratio was 2.7:1 and the median of time from injury was 2.5 (1.5-6) years. On the basis of American Spinal Injury Association Impairment Scale (AIS), most patients had AIS A (N=31, 38.3%). Patients with tetraplegia and AIS A or AIS B were at risk for more significant impairments in b620 'urination functions' and b640 'sexual functions'. Patients with paraplegia and AIS A or AIS B were at risk for more significant impairments in b735 'muscle tone functions'.

CONCLUSION

Using the ICF, we were able to describe the range and extent of functioning problems experienced by patients with SCI who were admitted in our rehabilitation center. Moreover, the use of the ICF improved the interaction between specialists.

Epidemiology of sport-related spinal cord injuries: A systematic review

CONTEXT

Despite the recognition of sports as a significant contributor in the etiology of spinal cord injury (SCI), no studies have systematically explored the epidemiology of SCI caused by sports.

OBJECTIVE

This paper aims to give a systematic overview of the epidemiology of sport-related spinal cord injury around the world.

METHODS

A systematic review was conducted to identify published literature reporting the epidemiology of SCI caused by sports. The literature search was conducted in MEDLINE/PubMed, CINAHL, EMBASE, PsycINFO and Sportdiscus with date limits 1980 through to July 2015. Data from 54 studies covering 25 countries was extracted and collated.

RESULTS

Important findings include identification of 6 countries in which sports accounts for over 13% of SCI (highest to lowest: Russia, Fiji, New Zealand, Iceland, France and Canada); individual sports with high risk for SCI (diving, skiing, rugby, and horseback riding); and the most common level of injury for various sports (almost entirely cervical for hockey, skiing, diving and American football, while over half of horseback riding and snowboarding injuries are thoracic or lumbosacral).

CONCLUSION

This paper identifies countries and sports with higher rates of sport-related SCIs where implementation of prevention programs and reporting systems to track SCI epidemiology may be helpful, and highlights gaps in our current knowledge for further investigation. The comparison of SCI occurrence for each sport across countries, as well as examination of the specific characteristics of SCI incurred for individual sports will assist in directing efforts for prevention.

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.

The Neuroprotective Effect of Tetramethylpyrazine Against Contusive Spinal Cord Injury by Activating PGC-1α in Rats

Tetramethylpyrazine (TMP) has been suggested to have neuroprotective effects against spinal cord injury (SCI); however, few studies have examined these effects and the corresponding mechanism. Therefore, the present study aimed to investigate the neuroprotective effect and underlying mechanism of TMP against contusive SCI. Adult male Sprague-Dawley rats were randomly divided into Sham, normal saline (NS) and TMP groups. Each group was divided into subgroups according to the time of sacrifice: 1, 3, 7, 14, 21 and 28 days post-injury. Laminectomy was performed in all groups, followed by contusive SCI establishment in the TMP and NS groups. TMP (80 mg/kg) was injected thereafter daily from 3 to 7 days post-injury in the TMP group, which was replaced by equal volume of normal saline in the NS group. The Basso-Beattie-Bresnahan (BBB) Locomotor Rating Scale was measured at different time points post-injury to appraise locomotor functional recovery. Quantitative real-time PCR and immunofluorescence were used to assess the spatio-temporal expression of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), while western blot was adopted to detect the effect of TMP on PGC-1α. Neural apoptotic changes and neuronal survival were evaluated using the TUNEL method and Nissl staining, respectively. TMP treatment markedly increased PGC-1α expression, neuronal survival and BBB locomotor scores, while also reducing neural apoptosis. These results demonstrate that TMP is neuroprotective against contusive SCI, with the inhibition of neural apoptosis and increase of neuronal survival. The sustained expression of PGC-1α may partially contribute to the TMP-mediated neuroprotective effect.