Traumatic spinal cord injury in Tianjin, China: a single-center report of 354 cases

Exploring the Landscape of Hydrogel Therapy for Spinal Cord Injury: A Bibliometric and Visual Analysis (1991-2023)

BACKGROUND

This study aimed to conduct a bibliometric analysis of the literature on hydrogel therapy for spinal cord injury to visualize the research status, identify hotspots, and explore the development trends in this field.

METHODS

Web of science Core Collection database was searched for relevant studies published between January 1991 and December 2023. Data such as journal title, author information, institutional affiliation, country, citation, and keywords were extracted. Bibliometrix, CiteSpace, and VOSviewer were used to perform bibliometric analysis of the retrieved data.

RESULTS

A total of 1099 articles pertaining to hydrogel therapy for spinal cord injury were retrieved, revealing an upward trajectory in both annual publication volume and cumulative publication volume. Biomaterials emerged as the journal with the highest number of publications and the most rapid cumulative publication growth, contributing 84 articles. Among authors, Shoichet MS stood out with the highest number of publications and citations, totaling 66 articles. The University of Toronto led in institutional contributions with 65 publications, while China dominated in country-specific publications, accounting for 374 articles. However, to foster significant academic achievements, it is imperative for diverse authors, institutions, and countries to enhance collaboration. Current research in this field concentrates on scaffold architecture, nerve growth factor, the fibrotic microenvironment, and guidance channels. Simultaneously, upcoming research directions prioritize 3D bioprinting, injectable hydrogel, inflammation, and nanoparticles within the realm of hydrogel therapy for spinal cord injuries.

CONCLUSIONS

In summary, this study provided a comprehensive analysis of the current research status and frontiers of hydrogel therapy for spinal cord injury. The findings provide a foundation for future research and clinical translation efforts of hydrogel therapy in this field.

Assessment System for Child Head Injury from Falls Based on Neural Network Learning

Toddlers face serious health hazards if they fall from relatively high places at home during everyday activities and are not swiftly rescued. Still, few effective, precise, and exhaustive solutions exist for such a task. This research aims to create a real-time assessment system for head injury from falls. Two phases are involved in processing the framework: In phase I, the data of joints is obtained by processing surveillance video with Open Pose. The long short-term memory (LSTM) network and 3D transform model are then used to integrate key spots' frame space and time information. In phase II, the head acceleration is derived and inserted into the HIC value calculation, and a classification model is developed to assess the injury. We collected 200 RGB-captured daily films of 13- to 30-month-old toddlers playing near furniture edges, guardrails, and upside-down falls. Five hundred video clips extracted from these are divided in an 8:2 ratio into a training and validation set. We prepared an additional collection of 300 video clips (test set) of toddlers' daily falling at home from their parents to evaluate the framework's performance. The experimental findings revealed a classification accuracy of 96.67%. The feasibility of a real-time AI technique for assessing head injuries in falls through monitoring was proven.

Epidemiological features of traumatic spinal cord injury in China: A systematic review and meta-analysis

Background

Traumatic spinal cord injury (TSCI) is a highly fatal and disabling event, and its incidence rate is increasing in China. Therefore, we collated the epidemiological factors of TSCI in different regions of China to update the earlier systematic review published in 2018.

Method

We searched four English and three Chinese electronic databases from 1978 to October 1, 2022. From the included reports, information on sample characteristics, incidence, injury characteristics, prognostic factors, and economic burden was extracted. The selection of data was based on the PRISMA statement. The quality of the included studies was assessed by the Agency for Healthcare Research and Quality (AHRQ) tool. The results of the meta-analysis were presented in the form of pooled frequency and forest plots.

Results

A total of 59 reports (60 studies) from 23 provinces were included, of which 41 were in the Chinese language. The random pooled incidence of TSCI in China was estimated to be 65.15 per million (95% CI: 47.20-83.10 per million), with a range of 6.7 to 569.7 per million. The pooled male-to-female ratio was 1.95:1. The pooled mean age of the cases at the time of injury was 45.4 years. Motor vehicle accidents (MVAs) and high falls were found to be the leading causes of TSCI. Incomplete quadriplegia and AISA/Frankel grade D were the most common types of TSCI. Cervical level injury was the most prevalent. The pooled in-hospital mortality and complication rates for TSCI in China were 3% (95% CI: 2-4%) and 35% (95% CI: 23-47%). Respiratory problems were the most common complication and the leading cause of death.

Conclusion

Compared with previous studies, the epidemiological data on TSCI in China has changed significantly. A need to update the data over time is essential to implement appropriate preventive measures and formulate interventions according to the characteristics of the Chinese population.

Quantitative cervical spine injury responses in whiplash loading with a numerical method of natural neural reflex consideration

BACKGROUND AND OBJECTIVE

Neural reflex is hypothesized as a regulating step in spine stabilizing system. However, neural reflex control is still in its infancy to consider in the previous finite element analysis of head-neck system for various applications. The purpose of this study is to investigate the influences of neural reflex control on neck biomechanical responses, then provide a new way to achieve an accurate biomechanical analysis for head-neck system with a finite element model.

METHODS

A new FE head-neck model with detailed active muscles and spinal cord modeling was established and globally validated at multi-levels. Then, it was coupled with our previously developed neuromuscular head-neck model to analyze the effects of vestibular and proprioceptive reflexes on biomechanical responses of head-neck system in a typical spinal injury loading condition (whiplash). The obtained effects were further analyzed by comparing a review of epidemiologic data on cervical spine injury situations.

RESULT

The results showed that the active model (AM) with neural reflex control obviously presented both rational head-neck kinematics and tissue injury risk referring to the previous experimental and epidemiologic studies, when compared with the passive model (PM) without it. Tissue load concentration locations as well as stress/strain levels were both changed due to the muscle activation forces caused by neural reflex control during the whole loading process. For the bony structures, the AM showed a peak stress level accounting for only about 25% of the PM. For the discs, the stress concentrated location was transferred from C2-C6 in the PM to C4-C6 in the AM. For the spinal cord, the strain concentrated locations were transferred from C1 segment to around C4 segment when the effects of neural reflex control were implemented, while the gray matter and white matter peak strains were reduced to 1/3 and 1/2 of the PM, respectively. All these were well correlated with epidemiological studies on clinical cervical spine injuries.

CONCLUSION

In summary, the present work demonstrated necessity of considering neural reflex in FE analysis of a head-neck system as well as our model biofidelity. Overall results also verified the previous hypothesis and further quantitatively indicated that the muscle activation caused by neural reflex is providing a protection for the neck in impact loading by decreasing the strain level and changing the possible injury to lower spinal cord level to reduce injury severity.

Emerging Mechanisms and Targeted Therapy of Pyroptosis in Central Nervous System Trauma

Cell death can occur in different modes, ferroptosis, pyroptosis, apoptosis, and necroptosis. Recent studies have shown that pyroptosis can be effectively regulated and that like necroptosis, pyroptosis has been regarded as a type of programmed cell death. The mechanism of its occurrence can be divided into canonical inflammasome-induced pyroptosis and noncanonical inflammasome-induced pyroptosis. In the past research, pyroptosis has been shown to be closely related to various diseases, such as tumors, neurodegenerative diseases, and central nervous system trauma, and studies have pointed out that in central nervous system trauma, pyroptosis is activated. Furthermore, these studies have shown that the inhibition of pyroptosis can play a role in protecting nerve function. In this review, we summarized the mechanisms of pyroptosis, introduce treatment strategies for targeted pyroptosis in central nervous system trauma, and proposed some issues of targeted pyroptosis in the treatment of central nervous system injury.

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.

Epidemiological characteristics of traumatic cervical spinal cord injury in Chongqing, China, from 2009 to 2018

STUDY DESIGN

Hospital-based retrospective epidemiological research.

OBJECTIVES

To describe the epidemiological and demographic features of patients with traumatic cervical spinal cord injury in Chongqing, China from 2009 to 2018.

SETTING

Army Military Medical University Xinqiao Hospital in Chongqing.

METHODS

All patients diagnosed traumatic CSCI admitted to Xinqiao hospital from 2009 to 2018 were retrospectively reviewed. Data elements referred from the International SCI Core Data Set, included date of birth, date of injury, gender, etiology of injury, vertebral injury, associated injury, ventilatory assistance, and neurological status were collected.

RESULTS

A total of 503 patients with TCSCI met the criteria. The mean age of patients with TCSCI was 50.3 ± 13.9 years (15-85 years), and the male-to-female ratio was 4.7:1. Fall (67.2%) was the leading cause of injury, followed by transport (22.3%). The most common neurologic level of injury (NLI) was C5, accounting for 38.2%. The number of AIS D was the largest, accounting for 42%.

CONCLUSIONS

The results indicated that TCSCI occurred most frequently in the middle age and fall was the leading cause of injury. The number of patients with TCSCI was larger in male than in female. The most common NLI occurred in C5, and AIS D had the largest numbers.

Participatory continuous nursing using the WeChat platform for patients with spinal cord injuries

Objective

The study aim was to analyse the effect of participatory continuous nursing using the WeChat platform on the complications, family function and compliance of patients with spinal cord injuries.

Methods

This was a randomized controlled trial. Seventy-eight patients with stable disease treated by internal fixation were enrolled in the study from August 2017 to August 2019 and assigned equally to an observation group and a control group. The control group received regular care from the time of discharge. The observation group used the WeChat platform to participate in continuous care.

Results

Six months after discharge, the continuous nursing group had a significantly lower incidence of pressure ulcers, urinary tract infections, joint contractures and muscle atrophy than the control group. The continuous nursing group showed a significant improvement in family function level and compliance behaviour at 3 and 6 months after discharge.

Conclusion

A participation-based continuous nursing intervention using the WeChat platform can reduce the incidence of pressure ulcers, urinary tract infections, joint contracture and muscle atrophy; improve patient family function; and promote healthy compliance behaviour.

Role of pyroptosis in spinal cord injury and its therapeutic implications

BACKGROUND

Currently, spinal cord injury (SCI) is a pathological incident that triggers several neuropathological conditions, leading to the initiation of neuronal damage with several pro-inflammatory mediators' release. However, pyroptosis is recognized as a new programmed cell death mechanism regulated by the stimulation of caspase-1 and/or caspase-11/-4/-5 signaling pathways with a series of inflammatory responses.

AIM

Our current review concisely summarizes the potential role of pyroptosis-regulated programmed cell death in SCI, according to several molecular and pathophysiological mechanisms. This review also highlights the targeting of pyroptosis signaling pathways and inflammasome components and its therapeutic implications for the treatment of SCI.

KEY SCIENTIFIC CONCEPTS

Multiple pieces of evidence have illustrated that pyroptosis plays significant roles in cell swelling, plasma membrane lysis, chromatin fragmentation and intracellular pro-inflammatory factors including IL-18 and IL-1β release. In addition, pyroptosis is directly mediated by the recently discovered family of pore-forming protein known as GSDMD. Current investigations have documented that pyroptosis-regulated cell death plays a critical role in the pathogenesis of multiple neurological disorders as well as SCI. Our narrative article suggests that inhibiting the pyroptosis-regulated cell death and inflammasome components could be a promising therapeutic approach for the treatment of SCI in the near future.

Advances in immunotherapy for the treatment of spinal cord injury

Spinal cord injury (SCI) is a leading cause of morbidity and disability in the world. Over the past few decades, the exact molecular mechanisms describing secondary, persistent injuries, as well as primary and transient injuries, have attracted massive attention to the clinicians and researchers. Recent investigations have distinctly shown the critical roles of innate and adaptive immune responses in regulating sterile neuroinflammation and functional outcomes after SCI. In past years, some promising advances in immunotherapeutic options have efficaciously been identified for the treatment of SCI. In our narrative review, we have mainly focused on the new therapeutic strategies such as the maturation and apoptosis of immune cells by several agents, mesenchymal stem cells (MSCs) as well as multi-factor combination therapy, which have recently provided novel ideas and prospects for the future treatment of SCI. This article also illustrates the latest progress in clarifying the potential roles of innate and adaptive immune responses in SCI, the progression and specification of prospective immunotherapy and outstanding issues in the area.

The changing demographics of traumatic spinal cord injury in Beijing, China: a single-centre report of 2448 cases over 7 years

STUDY DESIGN

Retrospective study.

OBJECTIVES

To investigate the epidemiological changes in persons with traumatic spinal cord injury (TSCI) over the past 7 years in Beijing Bo'ai Hospital, China Rehabilitation Research Center, China.

SETTING

Beijing Bo'ai Hospital, China Rehabilitation Research Center (CRRC).

METHODS

A database containing the records of all persons treated with SCI from 1 January 2013 to 31 December 2019 was reviewed. Variables including demographic and clinical data were analysed. Comparisons were made with data previously published in 2002.

RESULTS

During the study period, 2448 persons with recent TSCI were included in the analysis. The mean age at the time of injury increased from 38.1 years to 40.2 years (P = 0.025). The percentage of elderly persons increased (8.8-14.6%, P = 0.036) and was higher than that in 2002. The percentage of retirees increased. Transport related injuries were the leading cause of injury and the percentage of TSCI due to low falls increased 6%. Low falls were the most common cause for elderly persons (y ≥ 60) and were even higher for elderly women. Persons with cervical injuries increased compared to the 2002-data (44.1% vs 4.9%). The percentage of persons with incomplete SCI increased significantly over the study duration.

CONCLUSIONS

Persons with TSCI are becoming older, and the percentage of elderly persons is increasing year by year. These changes are likely due to a combination of population ageing in the region and changes in aetiology, with corresponding changes including an increase in persons with cervical TSCI and persons with incomplete injury.

Male genital sensation after spinal cord injury: a review

Genital sensation (GS) is an essential component of male sexual function. Genital sensory disturbance (GSD) caused by spinal cord injury (SCI) has a severe impact on the patients' sexual function but has garnered little research focus. Under normal conditions, GS encompasses the erection, ejaculation, sexual arousal, and orgasm courses associated with physiological and psychological responses in male sexual activity. However, in SCI patients, the deficiency of GS makes the tactile stimulation of the penis unable to cause sexual arousal, disturbs the normal processes of erection and ejaculation, and decreases sexual desire and satisfaction. To provide an overview of the contemporary conception and management of male GS after SCI, we review the innervation and sexual function of male GS in this article, discuss the effects of GSD following SCI, and summarize the current diagnosis and treatment of GSD in male SCI patients.

Epidemiology of traumatic spinal cord injury in Tianjin, China: An 18-year retrospective study of 735 cases

Study Design: Hospital-based retrospective studyObjectives: To evaluate the pathogenetic features of traumatic spinal cord injury (TSCI) during 1999-2016 according to changed injury etiology with time, explore different characteristics of patients suffered a TSCI during 1999-2007 and 2008-2016 in Tianjin, China.Setting: Tianjin Medical University General HospitalMethods: In this study, the medical records of TSCI patients were obtained from Tianjin Medical University General Hospital (TMUGH) from 1st January 1999 to 31th December 2016. Variables were recorded, including age, gender occupation, etiology, the level of injury, America Spinal Injury Association (ASIA) impairment scale, the severity, concomitant injuries, death and its cause. To explore the differences in characteristics by etiology and by two periods, related statistical methods were used to calculate the correlation of some variables. Differences in etiology of TSCI during 1999-2016 were evaluated and differences in epidemiological characteristics were separately compared and analyzed between the 1999-2007 period and the 2008-2016 period.Results: From 1999-2016, 831 TSCI cases were identified and 96 cases were excluded from analyses. The male-to-female ratio was 2.9:1 and the mean age was 49.7±15.2 years, which changed significantly between 1999-2007 (45.1±14.2) and 2008-2016 (51.6±15.2). Traffic accidents (45.8%) were the leading cause of TSCI during the 1999-2007 period, followed by low falls (30.7%). However, the opposite result was observed during the 2008-2016 period. Significant difference was observed compared with thoracic, lumbar and sacral levels, cervical level was the most commonly affected levels and the percentage decreased to a certain degree between 1999-2007 and 2008-2016 (from 84.4% to 68.9%). The proportions of ASIA grades A, B, C, and D were 20.5%, 10.3%, 23.3%, and 45.9%, respectively. The percentage of complete tetraplegia decreased from 22.9% in 1999-2007 to 13.2% in 2008-2016, and the percentage of incomplete paraplegia increased from 9.7% to 27.9%.Conclusion: According to the changes in the epidemiological characteristics of TSCI, relevant health service, laws and regulations, preventative strategies should be readjusted to follow up the changing situation and epidemiological characteristics of TSCI.

Epidemiological characteristics and early complications after spinal cord injury in Former Yugoslav Republic of Macedonia

Study design

Prospective cohort study

Objectives

To describe epidemiological data and complications after acute traumatic spinal cord injury (tSCI) in Former Yugoslav Republic of Macedonia (FYROM).

Setting

University Clinic for Traumatology, Orthopedics, Anesthesia and Intensive Care Unit and Emergency Center (TOARILUC), Mother Teresa, Skopje, FYROM.

Method

During the inclusion period March 2015 to September 2016, 38 tSCI patients were included. MRI, CT scan, and clinical examinations including International Standards for Neurological Classification of SCI were performed at admission. The information included: demographic data, transport type, date of admission and discharge, past illnesses, addiction habits, cause and type of injury, injury level, associated injuries, injury-related complications, and mortality.

Results

Mean age was 43 years (median 41, range 17–83). Seventeen patients had a complete and 15 an incomplete SCI, six were unknown. Most frequent causes for tSCI were traffic accidents (42%) and falls (40%), 24% of the accidents were contracted at work. Sixteen patients were ventilator dependent at some point during the acute period. Common complications were pressure ulcers, gastrointestinal-related, and infections. Hospital length of stay (LOS) ranged from 1 to 73 days. The in-hospital mortality rate was 32%.

Conclusion

The annual incidence of tSCI in FYROM was in 2015–16 13 persons/million inhabitants per year. The epidemiological profile of tSCI in FYROM implies that preventive measures should be taken to reduce incidence of accidents in traffic and at work places. The high mortality rate and complications underline further actions to improve the acute care of tSCI in FYROM.

Epidemiological profile of thoracolumbar fracture (TLF) over a period of 10 years in Tianjin, China

CONTEXT/OBJECTIVE

The objective of the research was to illustrate the epidemiology profile of thoracolumbar fracture (TLF) in Tianjin Medical University General Hospital, China, from 2006-2015.

DESIGN

Hospital-based retrospective study.

SETTING

Tianjin Medical University General Hospital.

METHODS

Medical records of inpatient patients with TLF from 1 January 2006 to December 2015 were collected. Detailed information on epidemiological characters were analyzed based on the medical records suffering from TLF from T11-L2 level, including incidence, age and sex, marital, occupation, etiology and fracture type, types of injuries.

RESULTS

Totally 132 cases were identified. The incidence rate was 2.4 patient per million population at 2015. Male-to-female ratio was 1.4:1, with a mean age of 49.1 ± 17.7 years. The cases number in 46-60 group, totally 35 and accounting for 26.5%, was the largest. There is a significant differences of cases number between 2011-2015 group and 2006-2010 group. Retiree, taken up 48.5%, was the largest group among TLF patients. The most common injury level was T12 (34) accounting for 25.7%. Falls (57, 43.2%) (low falls and high falls) were the leading causes, followed by motor vehicle collisions (MVCs) (23, 17.4%).Compression is the only type of osteoporosis and took up 55.3%.

CONCLUSIONS

The incidence ratio is increased annually in TMUGH. Male was more vulnerable than female based on different social character. The average age was older in 2011-2015, retiree accounted for the main proportion and compression took up the largest percentage, the mean age increased and osteoporosis takes more in recent years.

Fasudil Promotes BMSC Migration via Activating the MAPK Signaling Pathway and Application in a Model of Spinal Cord Injury

Bone marrow-derived mesenchymal stem cells (BMSCs) are considered as transplants for the treatment of central nervous system (CNS) trauma, but the therapeutic effect is restricted by their finite mobility and homing capacity. Fasudil (FAS), a potent Rho kinase inhibitor, has been reported to alleviate nerve damage and induce the differentiation of BMSCs into neuron-like cells. However, the effect of FAS on the migration of BMSCs remains largely unknown. The present study revealed that FAS significantly enhanced the migration ability and actin stress fiber formation of BMSCs in vitro with an optimal concentration of 30 μmol/L. Moreover, we found that activation of the MAPK signaling pathway was involved in these FAS-mediated phenomena. In vivo, cells pretreated with FAS showed greater homing capacity from the injection site to the spinal cord injury site. Taken together, the present results indicate that FAS acts as a promoting factor of BMSC migration both in vitro and in vivo, possibly by inducing actin stress fiber formation via the MAPK signaling pathway, suggesting that FAS might possess synergistic effect in stem cell transplantation of CNS trauma.

Epidemiological Features of Spinal Cord Injury in China: A Systematic Review

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.

Epidemiological profile of spinal cord injuries at a tertiary rehabilitation center in Kuwait

Study design

Retrospective, descriptive study.

Objective

To describe the epidemiological profile of patients with spinal cord injury (SCI) in Kuwait.

Setting

Physical Medicine and Rehabilitation Hospital, Kuwait.

Methods

Review of medical records of 241 adult patients with SCI admitted during the period 2010-2015. The data collected included gender, age, etiology, neurological and vertebral level of injury and American Spinal Injury Association impairment scale (AIS).

Results

There were 155 (64.3%) traumatic SCI (TSCI) and 86 (35.7%) non-traumatic SCI (NTSCI) patients. In TSCI, the male to female ratio was 4.3:1, and in NTSCI it was 1.5:1. Road traffic accident was the most common cause of TSCI (52.9%), followed by fall from height (32.9%). Acute disc prolapse was the most common cause of NTSCI (29.1%), followed by degenerative disc disease (26.7%) and tumors (17.4%). Paraplegia (41.3%) was more common in TSCI, the level of injury being thoracic in 61% of cases. Cauda equina syndrome was the most common presentation in NTSCI (40.7%).

Conclusion

Road traffic accident was found to be the main cause of TSCI in Kuwait, whereas acute and degenerative disc lesions were the leading causes in NTSCI. Prevention strategies should be directed toward these causes to reduce the incidence of SCI in Kuwait.

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.

Advances in the management of infertility in men with spinal cord injury

Couples with a spinal cord injured male partner require assisted ejaculation techniques to collect semen that can then be further used in various assisted reproductive technology methods to achieve a pregnancy. The majority of men sustaining a spinal cord injury regardless of the cause or the level of injury cannot ejaculate during sexual intercourse. Only a small minority can ejaculate by masturbation. Penile vibratory stimulation and electroejaculation are the two most common methods used to retrieve sperm. Other techniques such as prostatic massage and the adjunct application of other medications can be used, but the results are inconsistent. Surgical sperm retrieval should be considered as a last resort if all other methods fail. Special attention must be paid to patients with T6 and rostral levels of injury due to the risk of autonomic dysreflexia resulting from stimulation below the level of injury. Bladder preparation should be performed before stimulation if retrograde ejaculation is anticipated. Erectile dysfunction is ubiquitous in the spinal cord injured population but is usually easily managed and does not pose a barrier to semen retrieval in these men. Semen analysis parameters of men with spinal cord injury are unique for this population regardless of the method of retrieval, generally presenting as normal sperm concentration but abnormally low sperm motility and viability. When sperm retrieval is desired in this population, emphasis should be placed on initially trying the simple methods of penile vibratory stimulation or electroejaculation before resorting to more advanced and invasive surgical procedures.