Epidemiology of spinal cord injuries and risk factors for complete injuries in Guangdong, China: a retrospective study

Therapeutic potential of natural compounds from herbs and nutraceuticals in spinal cord injury: Regulation of the mTOR signaling pathway

Spinal cord injury (SCI) is a disease in which the spinal cord is subjected to various external forces that cause it to burst, shift, or, in severe cases, injure the spinal tissue, resulting in nerve injury. SCI includes not only acute primary injury but also delayed and persistent spinal tissue injury (i.e., secondary injury). The pathological changes post-SCI are complex, and effective clinical treatment strategies are lacking. The mammalian target of rapamycin (mTOR) coordinates the growth and metabolism of eukaryotic cells in response to various nutrients and growth factors. The mTOR signaling pathway has multiple roles in the pathogenesis of SCI. There is evidence for the beneficial effects of natural compounds and nutraceuticals that regulate the mTOR signaling pathways in a variety of diseases. Therefore, the effects of natural compounds on the pathogenesis of SCI were evaluated by a comprehensive review using electronic databases, such as PubMed, Web of Science, Scopus, and Medline, combined with our expertise in neuropathology. In particular, we reviewed the pathogenesis of SCI, including the importance of secondary nerve injury after the primary mechanical injury, the roles of the mTOR signaling pathways, and the beneficial effects and mechanisms of natural compounds that regulate the mTOR signaling pathway on pathological changes post-SCI, including effects on inflammation, neuronal apoptosis, autophagy, nerve regeneration, and other pathways. This recent research highlights the value of natural compounds in regulating the mTOR pathway, providing a basis for developing novel therapeutic strategies for SCI.

Co-Administration of Resolvin D1 and Peripheral Nerve-Derived Stem Cell Spheroids as a Therapeutic Strategy in a Rat Model of Spinal Cord Injury

Spinal cord injury (SCI), primarily caused by trauma, leads to permanent and lasting loss of motor, sensory, and autonomic functions. Current therapeutic strategies are focused on mitigating secondary injury, a crucial aspect of SCI pathophysiology. Among these strategies, stem cell therapy has shown considerable therapeutic potential. This study builds on our previous work, which demonstrated the functional recovery and neuronal regeneration capabilities of peripheral nerve-derived stem cell (PNSC) spheroids, which are akin to neural crest stem cells, in SCI models. However, the limited anti-inflammatory capacity of PNSC spheroids necessitates a combined therapeutic approach. As a result, we investigated the potential of co-administering resolvin D1 (RvD1), known for its anti-inflammatory and neuroprotective properties, with PNSC spheroids. In vitro analysis confirmed RvD1's anti-inflammatory activity and its inhibitory effect on pro-inflammatory cytokines. In vivo studies involving a rat SCI model demonstrated that combined therapy of RvD1 and PNSC spheroids outperformed monotherapies, exhibiting enhanced neuronal regeneration and anti-inflammatory effects as validated through behavior tests, quantitative reverse transcription polymerase chain reaction, and immunohistochemistry. Thus, our findings suggest that the combined application of RvD1 and PNSC spheroids may represent a novel therapeutic approach for SCI management.

Incidence of spinal cord injuries in Germany

PURPOSE

The goal of this study was to provide recent data on incidence of spinal cord injuries (SCI) in Germany.

METHODS

The source of information was data collected via the mandatory submission of ICD-10 GM Codes by German public hospitals after patient discharge. Data from 2013 to 2020 were retrieved from the databases of the Federal Bureau of Statistics. ICD-10 Codes for acute SCI were identified. Statistical analysis was performed using Jamovi and Excel.

RESULTS

A total of 10,360 patients were reported, of whom 58.7% suffered from a cervical, 30.8% a thoracic and 10.4% a lumbar lesion. Two peaks in incidence were observed at approximately 30 and 70 years old. A population-size-adjusted overall incidence of 15.73 (SD 0.77) per million per year was calculated. We calculated the incidences in several subpopulations and discovered significantly higher incidences among males and among those over the age of 60. We discovered that differences in age groups mainly concerned injuries of the upper spine, with the incidence in the lumbar spine being similar among age groups. In addition, we found that while the probability of suffering from SCI increases with age, the relative risk of suffering from a complete injury decreases.

CONCLUSIONS

This study closes a long-lasting gap in epidemiological data regarding SCI in Germany, specifically by updating the incidence rates. We found that incidence depends on age, gender and type of lesion. We also provide some new angles for future research, especially considering the relative reduction in complete injuries among the elderly.

Epidemiological features of traumatic spinal cord injury in Wuhan, China

BACKGROUND

Spinal cord injuries are extremely debilitating and fatal injuries. There is currently little research focusing on traumatic spinal cord injuries, and there is little information available about the epidemiological characteristics of patients with traumatic spinal cord injury (TSCI).

OBJECTIVE

To describe the epidemiological features of traumatic spinal cord injury in Wuhan, China.

DESIGN

A retrospective hospital-based study.

SETTING

Rehabilitation department of Wuhan's Tongji Hospital.

PARTICIPANTS

People who had been diagnosed with a traumatic spinal cord injury (TSCI) were admitted to Tongji Hospital from 2016 to 2021 (n = 463).

INTERVENTIONS

Not applicable.

OUTCOME MEASURES

Epidemiological features such as sex, age, marital status, etiology, occupation, neurological level of injury, and the American Spinal Injury Association Impairment Scale on admission, hospitalization, and concomitant injuries were collected.

RESULTS

The mean age of patients with TSCI was 39.4 ± 14.3 years, and the male/female ratio was 3:1. The leading causes of TSCIs were traffic accidents (38.4%), followed by falls (low falls 24.0%, high falls 13.2%). The most common injury site was the cervical spinal cord, followed by the thoracolumbar level. Of all patients, 463 patients (67.2%) had complications and other injuries. During the hospitalization period, a total of 217 patients experienced complications, with a percentage of 46.9%. Urinary tract infection was the most common (15.6%), followed by pulmonary infection (14.0%).

CONCLUSION

The results found that the proportion of males was greater, and the first two main reasons were falls and traffic accidents. Farmers and workers are the occupations most vulnerable to SCI. We need to pay more attention to the elderly's risk of falling. These findings suggested that preventive strategies should be based on the features of different types of TSCI patients. Finally, the importance of SCI rehabilitation must be highlighted.

Incidence and pattern of traumatic spine injury in a single level I trauma center of southern Iran

PURPOSE

Spine injury is one of the leading causes of death and mortality worldwide. The objective of this study was to determine the incidence, pattern and outcome of trauma patients with spine injury referred to the largest trauma center in southern Iran during the last three years.

METHODS

This is a cross-sectional study conducted between 2018 and 2021 in the largest trauma center in the southern Iran. The data collection form included the age, sex, injury location (cervical, thoracic, and lumbar), canuse of injury (traffic accidents, falls, and assaults), length of hospital stay, injured segment of spine injury, severity of injury, and outcome. Statistical analyzes were performed using SPSS software version 24.

RESULTS

Totally 776 cases of spine injury were identified. The spine injury rate was 17.0%, and the mortality rate was 15.5%. Cervical spine injury (20.4%) more often occulted in motorcycle accident, and thoracic spine injury (20.1%) occulted in falls. The highest and lowest rates of spine injurys were related to lumbar spine injury (30.2%) and cervical spine injury (21.5%), respectively. There was a statistically significant relationship between the mechanism of injury and the location of spine injury (p ≤ 0.001). And patients with lumbar spine injury had the highest mortality rate (16.7%). Injury severity score (OR= 1.041, p ≤ 0.001) and length of stay (OR = 1.018, p ≤ 0.001) were strong predictors of mortality in trauma patients with spine injury.

CONCLUSION

The results of the study showed that the incidence of traumatic spine injury rate was approximately 17.0% in southern of Iran. Road traffic injury and falls are the common mechanism of injury to spine. It is important to improve the safety of roads, passages, and work environment, and increase the quality of cars. Also, paying attention to the pattern of spine injury may assist to prevent the missing diagnosis of SCI in multiple trauma patients.

Frequency and Causes of Traumatic and Non-traumatic Spinal Injury Reported at Two Major Tertiary Care Hospitals of Khyber Pakhtunkhwa

Introduction Spinal cord injury, due to traumatic or non-traumatic causes, is a medically challenging and life-disrupting condition. The injury disrupts neural signaling and is a medical emergency requiring immediate treatment that can reduce long-term effects like paralysis or partial disability of the body. It has costly consequences both for individuals and families because it causes not only physical disability but dependency on others. The main objectives of the study were to determine the frequency of spinal injuries, their nature, and their causes. Materials and methods A descriptive exploratory study was conducted in the neurosurgery wards of two major hospitals of Peshawar, Lady Reading Hospital and Hayatabad Medical Complex. Necessary permission was taken from the administration of both hospitals before starting data collection. The duration of the study was three months, from October to December 2014. A total of 768 patients were retrieved from the ward records for 2013, from which a 50% random sample was taken (384 patients) while incomplete patient records were excluded. The data were transferred and recorded on a pre-constructed proforma covering all the required variables of the study. Finally, the data were transferred to SPSS 15 (SPSS Inc., Chicago) for analysis of descriptive statistics. In addition, comparisons were done by gender, hospitals, types of injuries, and causes of injuries. The chi-square test was used to compare groups for significant differences in frequencies, keeping p ≤0.05 as significant. Results Major factors for spinal cord injury were traumatic and non-traumatic. This study revealed that out of the total patients, 35% faced trauma as a cause of spinal disorder out of which 42%, 29%, and 21% were sudden falls, road traffic accidents (RTAs), and weight lifting, respectively. While non-traumatic causes were 52% mostly due to congenital anomalies (24%), stenosis (23%), and tumor (12%). Levels most commonly involved were lumbar (42.3%) followed by patients involving multiple levels (32.52%), L5-S1 (20.87%), thoracic (2.42%), and cervical (1.92%). Conclusions The traumatic injury was the leading cause of spinal cord injury in the present study where RTAs and falls contributed the most. Congenital abnormalities and spinal cord stenosis were more frequent among non-traumatic spinal cord injuries. The surgical approach was the only way of management practiced for spinal cord injuries in both of the tertiary care hospitals.

The Outcomes of Robotic Rehabilitation Assisted Devices Following Spinal Cord Injury and the Prevention of Secondary Associated Complications

Spinal cord injuries (SCIs) have major consequences on the patient’s health and life. Voluntary muscle paralysis caused by spinal cord damage affects the patient’s independence. Following SCI, an irreversible motor and sensory deficit occurs (spasticity, muscle paralysis, atrophy, pain, gait disorders, pain). This pathology has implications on the whole organism: on the osteoarticular, muscular, cardiovascular, respiratory, gastrointestinal, genito-urinary, skin, metabolic disorders, and neuro-psychic systems. The rehabilitation process for a subject having SCIs can be considered complex, since the pathophysiological mechanism and biochemical modifications occurring at the level of spinal cord are not yet fully elucidated. This review aims at evaluating the impact of robotic-assisted rehabilitation in subjects who have suffered SCI, both in terms of regaining mobility as a major dysfunction in patients with SCI, but also in terms of improving overall fitness and cardiovascular function, respiratory function, as well as the gastrointestinal system, bone density and finally the psychosocial issues, based on multiple clinical trials, and pilot studies. The researched literature in the topic revealed that in order to increase the chances of neuro-motor recovery and to obtain satisfactory results, the combination of robotic therapy, a complex recovery treatment and specific medication is one of the best decisions. Furthermore, the use of these exoskeletons facilitates better/greater autonomy for patients, as well as optimal social integration.

Epidemiological characteristics of traumatic spinal cord injuries in a multicenter retrospective study in northwest China, 2017-2020

Background

Traumatic spinal cord injuries (TSCIs) are worldwide public health problems that are difficult to cure and impose a substantial economic burden on society. There has been a lack of extensive multicenter review of TSCI epidemiology in northwest China during the Corona Virus Disease 2019 (COVID-19) pandemic.

Method

A multicenter retrospective study of 14 selected hospitals in two provinces in northwest China was conducted on patients admitted for TSCI between 2017 and 2020. Variables assessed included patient demographics, etiology, segmental distribution, treatment, waiting time for treatment, and outcomes.

Results

The number of patients with TSCI showed an increasing trend from 2017 to 2019, while there were 12.8% fewer patients in 2020 than in 2019. The male-to-female ratio was 3.67:1, and the mean age was 48 ± 14.9 years. The primary cause of TSCI was high falls (38.8%), slip falls/low falls (27.7%), traffic accidents (23.9%), sports (2.6%), and other factors (7.0%). The segmental distribution showed a bimodal pattern, peak segments were C6 and L1 vertebra, L1 (14.7%), T12 (8.2%), and C6 (8.2%) were the most frequently injured segments. In terms of severity, incomplete injury (72.8%) occurred more often than complete injury (27.2%). The American Spinal Injury Association impairment scale of most patients did not convert before and after treatment in the operational group (71.6%) or the conservative group (80.6%). A total of 975 patients (37.2%) from urban and 1,646 patients (62.8%) from rural areas were included; almost all urban residents could rush to get treatment after being injured immediately (<1 h), whereas most rural patients get the treatment needed 4-7 h after injury. The rough annual incidence from 2017 to 2020 is 112.4, 143.4, 152.2, and 132.6 per million people, calculated by the coverage rate of the population of the sampling hospital.

Conclusion

The incidence of TSCI in northwest China is high and on the rise. However, due to pandemic policy reasons, the incidence of urban residents decreased in 2020. The promotion of online work may be an effective primary prevention measure for traumatic diseases. Also, because of the further distance from the good conditional hospital, rural patients need to spend more time there, and the timely treatment of patients from remote areas should be paid attention to.

Epidemiology of Traumatic Spinal Cord Injuries in Iran; a Systematic Review and Meta-Analysis

INTRODUCTION

Understanding the epidemiology of traumatic spinal cord injuries (TSCIs) can be helpful for policymakers and planners to consider appropriate strategies to control and prevent these injuries. This study aimed to determine the epidemiological characteristics of TSCI in Iran in order to increase knowledge and awareness of these injuries.

METHODS

A systematic literature search was conducted up to January 2022 in the electronic databases, including PubMed, Scopus, Web of Science, Google Scholar, SID, Iranmedex, and Magiran. The quality of included studies was evaluated using the STORBE checklist. Comprehensive meta-analysis was used to analyze the data.

RESULTS

Nineteen studies involving 9416 cases were included in the study. Participants' pooled mean age was 35.80 ± 1.07 years (95% CI: 33.69 to 37.91), of whom 69% (95% CI: 68% to 70%; P<0.05) were male. The most frequent TSCI occurred in the age group of less than 30 years. Motor vehicle collisions (MVCs) was the most common cause of TSCI (57%; 95% CI: 25% to 63%), followed by falls (32%; 95% CI: 26% to 38%). Most participants had thoracolumbar (27%; 95% CI: 10% to 55%) and cervical injuries (23%; 95% CI: 16% to 31%), respectively. The incidence of TSCI was estimated at 10.5 per million people. The prevalence of TSCI was 3 per 10000 people. The mortality rate due to TSCI was 3.9% (95% CI: 0.02 to 0.06; P<0.05).

CONCLUSION

Based on the findings of this meta-analysis, the pooled incidence and prevalence of TSCI in the Iranian population were 10.5/1000.000 people and 4.4/10.000 people, respectively. TSCIs had occurred more frequently in males following MVCs, and in the age group under 30 years. The pooled mortality rate due to TSCI was 3.9% (95% CI: 0.02 to 0.06; P<0.05).

Preliminary validation study of the WHO quality of life (WHOQOL) scales for people with spinal cord injury in Mainland China

OBJECTIVE

To validate the WHOQOL Scales (WHOQOL-BREF and WHOQOL-DIS module) for people with spinal cord injury in Mainland China.

DESIGN

Cross-sectional study.

SETTING

Shanghai Sunshine Rehabilitation Center.

PARTICIPANTS

249 adults with SCI who were admitted to a rehabilitation training program between 2017 and 2019.

INTERVENTIONS

Not applicable.

METHODS

Questionnaires about personal and injury characteristics, the WHOQOL Scales, global QOL, Zung Self-Rating Anxiety/Depression Scale (SAS/SDS), and Community Integration Questionnaire (CIQ) were administrated. Floor and ceiling effects, reliability, and validity analyses were tested.

RESULTS

The 8 domains of the WHOQOL Scales showed no floor or ceiling effects. Cronbach alpha values of the WHOQOL-BREF and the WHOQOL-DIS were 0.93 and 0.78, respectively. Test-retest reliability was good for the WHOQOL Scales. Satisfactory criterion-related validity was shown by the correlation analysis among the WHOQOL Scales, SAS/SDS, CIQ, and global QOL. Good item-domain correlations (>0.50) were found for 38 items of the 39-item WHOQOL Scales, excepting the "impact of disability" (0.48) of the WHOQOL-DIS. Confirmatory Factor Analysis (CFA) supported a construct of the WHOQOL-DIS as made of four domains: autonomy, social inclusion, social activities, and discrimination. CFI and RMSEA values were 0.91 and 0.07, respectively, for the four-domain structure WHOQOL-DIS, with a higher-order factor. WHOQOL-BREF domains and WHOQOL-DIS scores showed the predicted pattern among a priori known groups.

CONCLUSION

The WHOQOL Scales are valid and reliable, and they can be used to measure QOL in people with SCI in China. We suggest the WHOQOL-DIS be analyzed as one general item constituting a single 12-item domain.

The Difference of Disease Injury and Postoperative Recovery in the Occupational Characteristics of Thoracolumbar Fracture Patients: A Retrospective Study

Objectives

Understanding the occupational characteristics of patients is not only related to patients' life and health, but also conducive to improving their happiness. However, there were no studies that had been conducted on the relationship between occupation characteristic and postoperative recovery in patients with spinal fractures. The purpose of this study was to explore the relationship between the occupation characteristics of patients with thoracolumbar fracture and the characteristics of disease injury, treatment, and recovery so as to reduce the incidence and improve postoperative rehabilitation.

Methods

Patients (n = 719) with thoracolumbar fractures were recruited. Patients were grouped according to the characteristic of occupations: unemployed group (n = 299), white‐collar worker group (n = 20), and blue‐collar worker group (n = 400). Data were collected, including the characteristics, injury and treatment information, and the recovery records for 1 year after operation. One‐way ANOVA analysis, χ² test, and binary logistic regression analysis was used to explore the relationship among these factors.

Results

Male, high‐falling injuries and single segment injury (mainly T 11, T 12 and L2) were common in patients with thoracolumbar fractures, especially in the blue‐collar worker group (70.8%, 78.3%, and 85.4%). Compared with the unemployed group, the patients in the white‐collar worker group and blue‐collar worker group had a higher proportion of young patients, a higher height and weight, a lesser rate of hypertension or diabetes. One week after injury, 73.4% of patients underwent surgery, with the blue‐collar worker group accounted for the largest proportion. One month after surgery, 77.1% of patients were able to get out of bed, with the white‐collar worker group accounted for the largest proportion. In the postoperative recovery information, patients in the blue‐collar worker group were more likely to have severe low back pain (OR = 2.023, 95% CI: 1.440‐2.284) and pain‐disturbed sleep (OR = 2.287, 95% CI: 1.585‐3.299) than those who in the unemployed group.

Conclusions

Blue‐collar workers, with a high risk of thoracolumbar fracture, have a higher incidence of low back leg pain and pain‐disturbed sleep in the recovery after thoracolumbar fracture surgery, and this requires more attention.

Intrathecal administration of naringenin improves motor dysfunction and neuropathic pain following compression spinal cord injury in rats: relevance to its antioxidant and anti-inflammatory activities

Background

Spinal cord injury (SCI) is one of the most debilitating disorders throughout the world, causing persistent sensory-motor dysfunction, with no effective treatment. Oxidative stress and inflammatory responses play key roles in the secondary phase of SCI. Naringenin (NAR) is a natural flavonoid with known anti-inflammatory and antioxidative properties. This study aims at evaluating the effects of intrathecal NAR administration on sensory-motor disability after SCI.

Methods

Animals underwent a severe compression injury using an aneurysm clip. About 30 minutes after surgery, NAR was injected intrathecally at the doses of 5, 10, and 15 mM in 20 µL volumes. For the assessment of neuropathic pain and locomotor function, acetone drop, hot plate, inclined plane, and Basso, Beattie, Bresnahan tests were carried out weekly till day 28 post-SCI. Effects of NAR on matrix metalloproteinase (MMP)-2 and MMP-9 activity was appraised by gelatin zymography. Also, histopathological analyses and serum levels of glutathione (GSH), catalase and nitrite were measured in different groups.

Results

NAR reduced neuropathic pain, improved locomotor function, and also attenuated SCI-induced weight loss weekly till day 28 post-SCI. Zymography analysis showed that NAR suppressed MMP-9 activity, whereas it increased that of MMP-2, indicating its anti-neuroinflammatory effects. Also, intrathecal NAR modified oxidative stress related markers GSH, catalase, and nitrite levels. Besides, the neuroprotective effect of NAR was corroborated through increased survival of sensory and motor neurons after SCI.

Conclusions

These results suggest intrathecal NAR as a promising candidate for medical therapeutics for SCI-induced sensory and motor dysfunction.

Prevalence, Incidence, and External Causes of Traumatic Spinal Cord Injury in China: A Nationally Representative Cross-Sectional Survey

Background and Purpose

The epidemiological characteristics of traumatic spinal cord injury (TSCI) in China are unclear. Thus, we aimed to study prevalence, incidence, and external causes of TSCI in China nationwide.

Methods

In 2013, we conducted a nationally representative, door-to-door epidemiological survey on TSCI in China using a complex, multistage, probability sampling design.

Results

In China, the point prevalence of TSCI standardized to the China census population 2010 was 569.7 (95% CI: 514.2–630.4) per 1,000,000 in the population, 753.6 (95% CI: 663.3–854.3) per 1,000,000 among men, and 387.7 (95% CI: 324.8–461.1) per 1,000,000 among women. The incidence of TSCI standardized to the China census population 2010 was 49.8 (95% CI: 34.4–70.7) per 1,000,000 per year in the population, 63.2 (95% CI: 38.9–98.5) per 1,000,000 among men, and 36.9 (95% CI: 19.5–65.9) per 1,000,000 among women. Among the 415 TSCI events in 394 prevalent cases, the top three injury causes were falls (55.2%), motor vehicle collisions (MVCs) (26.5%), and strike injuries (10.1%), while other injury causes including gunshot and explosion accounted for 8.2%. Among the 394 prevalent cases, the mean age of patients at the time of injury was 43.7 ± 17.1 years; the male-to-female ratio was 1.86:1.

Conclusion

It is estimated that there are 759,302 prevalent patients with TSCI in total and 66,374 new TSCI cases annually in China. Falls and MVCs are still 2 major external causes for TSCI in China.

Neurogenic Bowel in Acute Rehabilitation Following Spinal Cord Injury: Impact of Laxatives and Opioids

Objective: To explore the association between bowel dysfunction and use of laxatives and opioids in an acute rehabilitation setting following spinal cord injury (SCI). Methods: Data was collected regarding individuals with acute traumatic/non-traumatic SCI over a two-year period (2012–2013) during both the week of admission and discharge of their inpatient stay. Results: An increase in frequency of bowel movement (BM) (p = 0.003) and a decrease in frequency of fecal incontinence (FI) per week (p < 0.001) between admission and discharge was found across all participants. There was a reduction in the number of individuals using laxatives (p = 0.004) as well as the number of unique laxatives taken (p < 0.001) between admission and discharge in our cohort. The number of individuals using opioids and the average dose of opioids in morphine milligram equivalents (MME) from admission to discharge were significantly reduced (p = 0.001 and p = 0.02, respectively). There was a positive correlation between the number of laxatives and frequency of FI at discharge (r = 0.194, p = 0.014), suggesting that an increase in laxative use results in an increased frequency of FI. Finally, there was a significant negative correlation between average dose of opioids (MME) and frequency of BM at discharge, confirming the constipating effect of opioids (r = −0.20, p = 0.009).

The Advent of Spinoplastics: Easing the Growing Global Disease Burden of Spinal Injury

Epidemiologic studies have demonstrated a growing global disease burden of pathologies affecting the vertebral column. Allograft or implant-based reconstruction and fusion surgeries have been the mainstay of treatment. The efficacy of various surgical methods and the reliability of instrumentation or implants to execute these surgeries continue to be debated in the literature. Advances such as the free-tissue transfer have improved postoperative measures; however, they add high operative risk. The advent of spinoplastics introduces a practical surgical model to augment these spinal surgeries using vascularized bone grafts. As this technique becomes more widespread, it can be utilized to ease the growing disease burden that spinal injury places on both patients and the health care system. Ultimately, it will ameliorate strains on health care resources, reduce health care costs, and improve patient outcomes and quality of life.

The demographics and traumatic causes of spinal cord injury in Nepal: An observational study

Introduction

There has been little systematic study of the epidemiology of traumatic spinal cord injury (TSCI) in Nepal, South-East Asia, and low- and middle-income countries (LMICs) in general. One third of the global morbidity and mortality due to injuries is concentrated in South-East Asia. We need to better understand the circumstances leading to TSCI if we are to make progress with prevention.

Method

The Spinal Injury Rehabilitation Centre (SIRC) in Nepal systemically collected prospective data describing people with TSCI admitted between September 2015 and August 2016. Descriptive analyses of variables yielded demographic, aetiological and clinical descriptors of this cohort. Cross-tabulations were used to explore the associations between variables.

Results

Of 184 admissions over one year, males were admitted to SIRC almost 2.3 times more often than females. Young adults (21–30 years) were the largest age group (34%). The majority of TSCI resulted in paraplegia (67%) and was complete in nearly half (49%). Falls caused the majority of TSCI (69%), and falls from trees were the most common. Road traffic injuries (RTIs) were the second leading cause (29%); the majority involved two- or three-wheeled motorised vehicles and patients were most commonly driving.

Conclusion

Falls were the leading cause of TSCI across both genders and all age groups, followed by RTIs, which occurred most often in young adults and men. Injury surveillance and further research would provide a greater understanding of the pattern of TSCI and enable progress in TSCI prevention and rehabilitation.

Effects of a rehabilitation program for individuals with chronic spinal cord injury in Shanghai, China

Background

Specialized Institution-Based Rehabilitation (SIBR) is the cornerstone of care and treatment for individuals with spinal cord injury, but most people with chronic spinal cord injury (CSCI) living in China have no SIBR experience after acute care hospital discharge. In 2009, an SIBR facility was set up in Shanghai (China) to fill this important gap in care. The purpose of the study was to evaluate the effectiveness of an integrated rehabilitation training program among individuals with CSCI living in Shanghai.

Methods

A within-subject pre-posttest design was used to evaluate the SIBR. The sample included 455 individuals ≥1 year post-SCI, who were older than 18 years of age and were enrolled in a rehabilitation center in Shanghai, China, between 2013 and 2019. The data included individuals’ sociodemographic and injury characteristics, and twenty-three indicators were used as outcome measurements to evaluate basic life skills and their applications in family and social life. Multivariate linear regression was conducted to determine which factors might have influenced the effectiveness of the SIBR.

Results

All basic life skills and their applications in family and social life were improved, but with variations across socio-demographics. Female individuals with CSCI had better outcomes in basic life skills than did males. In terms of basic life skills and their applications in family and social life, individuals with a low level (thoracic or lumbosacral) of injury achieved more significant functional gains than those with a higher level (cervical). The baseline score was also a relevant factor in functional outcome.

Conclusions

Even for individuals with a long SCI history, SIBR training can improve basic life skills and the applications of those skills in family and social life settings.

Cervical spine pathology and treatment: a global overview

Cervical spine pathology is becoming increasingly prevalent with an aging world population and is associated with significant morbidity, affecting all areas of the world. This review was undertaken to provide a global perspective on cervical spine pathology, including epidemiology, burden of disease, access to care, and plan of care in both developed and developing low- and middle-income countries (LMICs). We found that epidemiology, access to care, plan of care, and health outcomes were relatively similar between nations with similar economies. However, these aspects change dramatically when comparing developing nations to LMICs, with LMICs displaying substantial barriers to care and subsequently higher rates of morbidity and mortality. There is currently a need for large-scale, global, prospective multicenter studies that analyze not only the epidemiology and treatment of cervical spine pathology, but also consider patient outcomes.

Review of clinical nerve repair strategies for neurorestoration of central nervous system tumor damage

Central nervous system (CNS) tumors are common. In recent years, with the continuous development and popularization of neurosurgery and the advancement of diagnostic and therapeutic instruments, the diagnosis and treatment of diseases have made great progress, but the prognosis of patients depends on multiple clinical factors. In this study, we selected various literatures in the PubMed and Google Scholar search engines using the keywords "nerve repair strategies" , "central nervous system tumor" as well as searched scientifically reviewed historical perspectives and recent advancements and achievements in Neurorestoratology of the CNS. Therefore, this study focuses on the Neurorestoratology of the CNS and its prospects, aiming to provide scientific guidance for the clinical diagnosis and treatment of CNS tumors in the future, and improve the prognosis and quality of life of patients.

Melatonin Enhances Autophagy and Reduces Apoptosis to Promote Locomotor Recovery in Spinal Cord Injury via the PI3K/AKT/mTOR Signaling Pathway

Spinal cord injury (SCI) leads to neuronal death resulting in central nervous system (CNS) dysfunction; however, the pathogenesis is still poorly understood. Melatonin (MT), a hormone secreted mainly by the pineal gland, is associated with neuroprotective effects against SCI. Enhanced autophagy can promote the recovery of locomotor function and reduce apoptosis after SCI. Interestingly, MT increases autophagy in SCI in vivo. Nevertheless, the ability of MT to increase autophagy and decrease apoptosis, and the potential effects on the recovery of motor neurons in the anterior horn after SCI remain to be clarified. In this study, we discovered that MT treatment improved motor function recovery in a rat SCI model. Indeed, MT upregulated the expression of the phosphatidylinositol 3-kinase (PI3K), while expression of protein kinase B (AKT) and mammalian target of rapamycin (mTOR) was downregulated after SCI. Additionally, MT increased the expression of autophagy-activating proteins, while the expression of apoptosis-activating proteins in neurons was decreased following SCI. Furthermore, autophagy was inhibited, while apoptosis was induced in SCI model rats and lipopolysaccharide (LPS)-stimulated primary neurons by treatment with MT, the PI3K inhibitor 3-methyladenine (3-MA) and mTOR inhibitor Rapamycin (Rapa). Collectively, our results suggest that MT can improve the recovery of locomotor function by enhancing autophagy as well as reducing apoptosis after SCI in rats, probably via the PI3K/AKT/mTOR signaling pathway.

Melatonin Enhances Autophagy and Reduces Apoptosis to Promote Locomotor Recovery in Spinal Cord Injury via the PI3K/AKT/mTOR Signaling Pathway

Spinal cord injury (SCI) leads to neuronal death resulting in central nervous system (CNS) dysfunction; however, the pathogenesis is still poorly understood. Melatonin (MT), a hormone secreted mainly by the pineal gland, is associated with neuroprotective effects against SCI. Enhanced autophagy can promote the recovery of locomotor function and reduce apoptosis after SCI. Interestingly, MT increases autophagy in SCI in vivo. Nevertheless, the ability of MT to increase autophagy and decrease apoptosis, and the potential effects on the recovery of motor neurons in the anterior horn after SCI remain to be clarified. In this study, we discovered that MT treatment improved motor function recovery in a rat SCI model. Indeed, MT upregulated the expression of the phosphatidylinositol 3-kinase (PI3K), while expression of protein kinase B (AKT) and mammalian target of rapamycin (mTOR) was downregulated after SCI. Additionally, MT increased the expression of autophagy-activating proteins, while the expression of apoptosis-activating proteins in neurons was decreased following SCI. Furthermore, autophagy was inhibited, while apoptosis was induced in SCI model rats and lipopolysaccharide (LPS)-stimulated primary neurons by treatment with MT, the PI3K inhibitor 3-methyladenine (3-MA) and mTOR inhibitor Rapamycin (Rapa). Collectively, our results suggest that MT can improve the recovery of locomotor function by enhancing autophagy as well as reducing apoptosis after SCI in rats, probably via the PI3K/AKT/mTOR signaling pathway.

Neural Stem Cell Transplantation Improves Locomotor Function in Spinal Cord Transection Rats Associated with Nerve Regeneration and IGF-1 R Expression

Transplantation of neural stem cells (NSCs) is a potential strategy for the treatment of spinal cord transection (SCT). Here we investigated whether transplanted NSCs would improve motor function of rats with SCT and explored the underlying mechanism. First, the rats were divided into sham, SCT, and NSC groups. Rats in the SCT and NSC groups were all subjected to SCT in T10, and were administered with media and NSC transplantation into the lesion site, respectively. Immunohistochemistry was used to label Nestin-, TUNEL-, and NeuN-positive cells and reveal the expression and location of type I insulin-like growth factor receptor (IGF-1 R). Locomotor function of hind limbs was assessed by Basso, Beattie, Bresnahan (BBB) score and inclined plane test. The conduction velocity and amplitude of spinal nerve fibers were measured by electrophysiology and the anatomical changes were measured using magnetic resonance imaging. Moreover, expression of IGF-1 R was determined by real-time polymerase chain reaction and Western blotting. The results showed that NSCs could survive and differentiate into neurons in vitro and in vivo. SCT-induced deficits were reduced by NSC transplantation, including increase in NeuN-positive cells and decrease in apoptotic cells. Moreover, neurophysiological profiles indicated that the latent period was decreased and the peak-to-peak amplitude of spinal nerve fibers conduction was increased in transplanted rats, while morphological measures indicated that fractional anisotropy and the number of nerve fibers in the site of spinal cord injury were increased after NSC transplantation. In addition, mRNA and protein level of IGF-1 R were increased in the rostral segment in the NSC group, especially in neurons. Therefore, we concluded that NSC transplantation promotes motor function improvement of SCT, which might be associated with activated IGF-1 R, especially in the rostral site. All of the above suggests that this approach has potential for clinical treatment of spinal cord injury.

Impact of a Quality Improvement Program on the Neurological Outcome of Patients with Traumatic Spinal Cord Injury: A Before-After Mono-Centric Study

Spinal cord injury (SCI) is a major cause of severe disability. This study aims to assess the effectiveness of a quality improvement program on neurological recovery after SCI. Before-after study during two phases was done in one intensive care unit in a university hospital. The quality improvement project comprised protective mechanical ventilation, early tracheostomy in anatomical injury above the sixth cervical vertebra, early enteral nutrition, early mobilization, and active perineal care in adult SCI patients. The primary endpoint was the difference between the American Spinal Injury Association (ASIA) motor score between discharge and intensive care unit (ICU) admission (Delta ASIA). Fifty-seven and 60 patients were included in the control and in the intervention period respectively. The ASIA motor score upon ICU admission was 16 (7-37) before and 11 (2-30) after the implementation (p = 0.30). The implementation phase was associated with lower tidal volumes (p < 0.001), higher positive end-expiratory pressure (p < 0.001), earlier tracheostomy (p = 0.01), earlier enteral nutrition initiation (p < 0.05), earlier mobilization (p < 0.05), and more active perineal care (p < 0.05). The Delta ASIA was +16 [4-32] after versus +6 [0-14] before the intervention (p < 0.05). After adjustment for potential cofounders, the intervention phase was significantly associated with higher Delta ASIA (β coefficient, 11.4; CI₉₅ [1.9-21]; p = 0.01) in multi-variable analysis. No secular time trend unrelated to the intervention was highlighted. One year after trauma, the Delta ASIA was higher in the intervention period than in the control period (+34 [15-60] vs. +11 [0-33]; p < 0.05). After adjustment on potential confounders, an early in-ICU rehabilitation program in SCI patients was associated with higher neurological score upon ICU discharge.

The cell repair research of spinal cord injury: a review of cell transplantation to treat spinal cord injury

Through retrospective analysis of the literature on the cell repair of spinal cord injury worldwide, it is found that the mechanism of cell transplantation repairing spinal cord injury is mainly to replace damaged neurons, protect host neurons, prevent apoptosis, promote axonal regeneration and synapse formation, promote myelination, and secrete trophic factors or growth factors to improve microenvironment. A variety of cells are used to repair spinal cord injury. Stem cells include multipotent stem cells, embryonic stem cells, and induced pluripotent stem cells. The multipotent stem cells are mainly various types of mesenchymal stem cells and neural stem cells. Non-stem cells include olfactory ensheathing cells and Schwann cells. Transplantation of inhibitory interneurons to alleviate neuropathic pain in patients is receiving widespread attention. Different types of cell transplantation have their own advantages and disadvantages, and multiple cell transplantation may be more helpful to the patient’s functional recovery. These cells have certain effects on the recovery of neurological function and the improvement of complications, but further exploration is needed in clinical application. The application of a variety of cell transplantation, gene technology, bioengineering and other technologies has made the prospect of cell transplantation more extensive. There is a need to find a safe and effective comprehensive treatment to maximize and restore the patient’s performance.

Functional outcomes in geriatric patients with spinal cord injuries at a tertiary care rehabilitation hospital in Saudi Arabia

Study design

Retrospective study.

Objective

To identify demographic features, clinical characteristics, and complications associated with spinal cord injuries/disorders (SCI/D) among elderly individuals at a rehabilitation hospital and to measure the functional outcomes of rehabilitation.

Setting

Rehabilitation hospital in King Fahad Medical City (KFMC), Riyadh, Saudi Arabia.

Methods

The study was conducted in elderly individuals (aged ≥65 years) with SCI/D, admitted to an inpatient rehabilitation program between October 2014 and 2015. Demographic and clinical data were recorded along with functional independence measure (FIM) score at admission (FIMa) and discharge (FIMd). Data were descriptively analyzed. Association of non-metric and metric variables with complications was measured using χ², and Student's t-test, respectively.

Results

Twenty-four individuals with SCI/D (95.8% were male and retired) with mean (standard deviation, SD) age of 72.3 (6.3) years were included. The most common co-morbidities were hypertension (75.0%), and diabetes mellitus (58.3%). Degenerative cervical myelopathy (33.3%) was the most common cause of SCD. Of all, nine (37.5%) individuals had clinical complications (urinary tract infection(UTI); 8/9, surgical wound infection; 1/9). Mean (SD) hospitalization period during inpatient rehabilitation was 66.0 (13.9) days. Mean (SD) FIMa scores improved from 71.7 (17.3) to 85.3 (16.8) at discharge. Co-morbidities associated with complications were peripheral vascular disease, ischemic heart disease, and stroke.

Conclusion

In Saudi Arabia, non-traumatic spinal etiologies are the most frequent cause of spinal cord dysfunction in the elderly. Male gender, hypertension, and diabetes mellitus were high-risk factors among the geriatric age group with SCI/D. Elderly individuals with SCI/D without complications can have a shorter hospitalization period and higher functional gains during rehabilitation.

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.

Trends, Challenges, and Opportunities Regarding Research in Non-traumatic Spinal Cord Dysfunction

Background: Spinal cord dysfunction (SCDys) is caused by heterogeneous health conditions, and the incidence is increasing. Despite the growing interest in rehabilitation research for SCDys, research into SCDys faces many challenges. Objective: The objective of this project was to perform a clinical review of changes in SCDys research over the last 4 decades; identify challenges to conducting research in SCDys; and propose opportunities for improving research in SCDys. Methods: A triangulation approach was used for obtaining evidence: literature search (January 2017) using MEDLINE and Embase databases for publications in English (1974-2016) regarding SCDys; workshop discussions at the International Spinal Cord Society annual meeting, September 16, 2016, Vienna, Austria; and our collective expertise in SCDys clinical rehabilitation research. Results: There has been a substantial increase in publications on SCDys over the 4 decades, from 1,825 in 1974-1983 to 11,887 in the decade 2004-2013, along with an improvement in research methodology. Numerous challenges to research in SCDys rehabilitation were grouped into the following themes: (a) identification of cases; (b) study design and data collection; and (c) funding, preclinical, and international research. Opportunities for addressing these were identified. Conclusions: The increase in scientific publications on SCDys highlights the importance of this heterogeneous group among the research community. The overall lack of good quality epidemiological studies regarding incidence, prevalence, and survival in these patients serves as a benchmark for guiding improvements to inform evidence-based care and policy.

Epidemiological study of Spinal Cord Injury individuals from halfway houses in Shanghai, China

OBJECTIVE

To describe the characteristics of spinal cord injury (SCI) individuals in Shanghai and examine their treatment and rehabilitation for traumatic and complete SCI individuals.

DESIGN

Community-based secondary data analyses.

SETTING

Shanghai, China.

METHODS

We analyzed gender, age at injury, complications, disturbances of function, treatment, etiology, and severity of injury of SCI individuals that enrolled in "halfway houses", government-supported community co-op centers. Bivariate statistical analyses were conducted to examine the factors associated with complete and traumatic SCI.

RESULTS

We analyzed 808 SCI individuals who participated in halfway houses in Shanghai during 2009-2015. The male-to-female ratio was 2.1:1. The proportion of middle or elder age groups at injury (age 46 to 60 and age 61 or over) showed a rising trend from 1970 to 2015. The leading causes of SCIs in Shanghai were traumatic injuries (58%), followed by disease (29.5%). The proportion of traumatic injuries decreased over time, while the proportion of non-traumatic injuries rose significantly. A majority of traumatic injury individuals were aged between 16-45.

CONCLUSION

The middle or elder age groups at injury among SCI individuals increased continuously from 1970 to 2015. The principal causes of injury in Shanghai were traumatic injuries and disease-related injuries. Men had a higher prevalence of traumatic SCI in Shanghai. Preventive measures should focus on male and middle-aged adults. As a fast-aging society in Shanghai, more effective prevention, medical care, and rehabilitation schemes should be implemented for aging SCI individuals.

Relationships Between Community Reintegration and Clinical and Psychosocial Attributes in Individuals With Spinal Cord Injury in a Nigerian City

Background: The bio-psychosocial model for comprehensive understanding of community reintegration among individuals with spinal cord injury (SCI) varies across communities. Yet, information about community reintegration in Nigeria is not available. Objective: To investigate the association between community reintegration and clinical and psychosocial attributes among Nigerians with SCI. Methods: Fifty individuals (31 females; 19 males) with SCI aged 38.6 ± 11.1 years participated in this longitudinal survey. Pain, functional ability, and severity of injury were assessed at discharge and at 1, 2, and 3 months post-discharge from inpatient care using the Visual Analogue Scale (VAS), FIM^®, and American Spinal Injury Association Impairment Scale (AIS), respectively. Self-esteem (SE), social support (SS), and depression were also assessed using the Self-Esteem Questionnaire, Social Support Questionnaire, and Beck Depression Inventory, respectively. CR was assessed at 1, 2, and 3 months post-discharge using the Reintegration to Normal Living Index (RNLI). Data were analyzed using Spearman's rho correlation and Friedman test. Results: The psychosocial and clinical attributes were significantly different from baseline and across the 3 months post-discharge (p < .0001), except for SS. CR significantly correlated with level of injury, function ability, SE, and depression across the 3 months post-discharge (p < .01). CR was significantly correlated with SS only at 1 month post-discharge (p = .027). Conclusion: Individuals with SCI had significant improvement in clinical and psychosocial attributes from discharge to 3 months post-discharge. Improvements in these variables were associated with better reintegration into the community.

Melatonin for the treatment of spinal cord injury

Spinal cord injury (SCI) from trauma or disease severely impairs sensory and motor function. Neurorehabilitation after SCI is a complex medical process that focuses on improving neurologic function and repairing damaged connections in the central nervous system. An increasing number of preclinical studies suggest that melatonin may be useful for the treatment of SCI. Melatonin is an indolamine that is primarily secreted by the pineal gland and known to be regulated by photoperiodicity. However, it is also a versatile hormone with antioxidative, antiapoptotic, neuroprotective, and anti-inflammatory properties. Here, we review the neuroprotective properties of melatonin and the potential mechanisms by which it might be beneficial in the treatment of SCI. We also describe therapies that combine melatonin with exercise, oxytetracycline, and dexamethasone to attenuate the secondary injury after SCI and limit potential side effects. Finally, we discuss how injury at different spinal levels may differentially affect the secretion of melatonin.

Involvement of poly(ADP-ribose) polymerase-1 in development of spinal cord injury in Chinese individuals: a Chinese clinical study

Objective

We aimed to evaluate whether the polymorphism of poly(ADP-ribose) polymerase-1 (PARP-1) is involved as potential risk factor in the development of spinal cord injury (SCI) among Chinese individuals.

Patients and methods

Patients with a confirmed diagnosis of SCI (other than traumatic injury) and healthy individuals with no clinical symptoms of SCI were enrolled at Spinal Cord Injury Care Center, The Third People’s Hospital of Dalian, China. Genetic polymorphisms were studied in plasma samples by polymerase chain reaction-restriction fragment length polymorphism assay.

Results

A total of 130 Chinese patients with SCI and 130 healthy Chinese individuals were included. We found that patients with the GG genotype (odds ratio [OR]: 4.09, 95% confidence interval [CI] 2.42–6.90, P<0.001) and carriers of the G allele (OR 3.96, 95% CI 2.33–6.74, P<0.0001) were at high risk of developing SCI. A del/ins polymorphism of the NF-κB1 gene (OR 3.32, 95% CI 1.96–5.61, P<0.001) was also found to be associated with SCI.

Conclusion

Our study suggests that PARP-1 polymorphisms are involved in the development of SCI in Chinese individuals. Thus, PARP-1 polymorphisms can be considered as one of the potential risk factors for developing SCI.

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

BACKGROUND

Evidence indicates that, over time, patients with spinal cord injury (SCI) improve neurologically in various degrees. We sought to further investigate indicators of grade conversion in cervical SCI.

OBJECTIVE

To detect predictors of ASIA impairment scale (AIS) grade conversion in SCI following surgical decompression.

METHODS

In a retrospective study, demographics, clinical, imaging, and surgical data from 100 consecutive patients were assessed for predictors of AIS grade conversion.

RESULTS

American Spinal Injury Association motor score was 17.1. AIS grade was A in 52%, B in 29%, and C in 19% of patients. Surgical decompression took place on an average of 17.6 h following trauma (≤12 h in 51 and >12 h in 49). Complete decompression was verified by magnetic resonance imaging (MRI) in 73 patients. Intramedullary lesion length (IMLL) on postoperative MRI measured 72.8 mm, and hemorrhage at the injury epicenter was noted in 71 patients. Grade conversion took place in 26.9% of AIS grade A patients, 65.5% of AIS grade B, and 78.9% of AIS grade C. AIS grade conversion had statistical relationship with injury severity score, admission AIS grade, extent of decompression, presence of intramedullary hemorrhage, American Spinal Injury Association motor score, and IMLL. A stepwise multiple logistic regression analysis indicated IMLL was the sole and strongest indicator of AIS grade conversion (odds ratio 0.950, 95% CI 0.931-0.969). For 1- and 10-mm increases in IMLL, the model indicates 4% and 40% decreases, respectively, in the odds of AIS grade conversion.

CONCLUSION

Compared with other surrogates, IMLL remained as the only predictor of AIS grade conversion.

A progressive compression model of thoracic spinal cord injury in mice: function assessment and pathological changes in spinal cord

Non-traumatic injury accounts for approximately half of clinical spinal cord injury, including chronic spinal cord compression. However, previous rodent spinal cord compression models are mainly designed for rats, few are available for mice. Our aim is to develop a thoracic progressive compression mice model of spinal cord injury. In this study, adult wild-type C57BL/6 mice were divided into two groups: in the surgery group, a screw was inserted at T₉ lamina to compress the spinal cord, and the compression was increased by turning it further into the canal (0.2 mm) post-surgery every 2 weeks up to 8 weeks. In the control group, a hole was drilled into the lamina without inserting a screw. The results showed that Basso Mouse Scale scores were lower and gait worsened. In addition, the degree of hindlimb dysfunction in mice was consistent with the degree of spinal cord compression. The number of motor neurons in the anterior horn of the spinal cord was reduced in all groups of mice, whereas astrocytes and microglia were gradually activated and proliferated. In conclusion, this progressive compression of thoracic spinal cord injury in mice is a preferable model for chronic progressive spinal cord compression injury.

Creation of an Algorithm to Identify Non-traumatic Spinal Cord Dysfunction Patients in Canada Using Administrative Health Data

Background: The lack of consensus on the best methodology for identifying cases of non-traumatic spinal cord dysfunction (NTSCD) in administrative health data limits the ability to determine the burden of disease and provide evidence-informed services. Objective: The purpose of this study is to develop an algorithm for identifying cases of NTSCD with Canadian health administrative databases using a case-based approach. Method: Data were provided by the Canadian Institute for Health Information that included all acute care hospital and day surgery (Discharge Abstract Database), ambulatory (National Ambulatory Care Reporting System), and inpatient rehabilitation records (National Rehabilitation Reporting System) of patients with neurological impairment (paraplegia, tetraplegia, and cauda equina syndrome) between April 1, 2004 and March 31, 2011. The approach to identify cases of NTSCD involved using a combination of diagnostic codes for neurological impairment and NTSCD etiology. Results: Of the initial cohort of 23,703 patients with neurological impairment, we classified 6,362 as the "most likely NTSCD" group (had a most responsible diagnosis or pre-existing diagnosis of NTSCD and diagnosis of neurological impairment); 2,777 as "probable NTSCD" defined as having a secondary diagnosis of NTSCD, and 11,179 as "possible NTSCD" who had no NTSCD etiology diagnoses but neurological impairment codes. Conclusion: The proposed algorithm identifies an inpatient NTSCD cohort that is limited to patients with significant paralysis. This feasibility study is the first in a series of 3 that has the potential to inform future research initiatives to accurately determine the incidence and prevalence of NTSCD.

Current epidemiological profile and features of traumatic spinal cord injury in Heilongjiang province, Northeast China: implications for monitoring and control

STUDY DESIGN

A retrospective hospital-based study.

OBJECTIVES

Traumatic spinal cord injury (TSCI) is considered to be an important public health problem worldwide. Only a few studies concerning the regional epidemiological characteristics of TSCI have been published in China. The purpose is to evaluate the epidemiological characteristics of TSCI in Heilongjiang province in northeast China.

SETTING

The Second Affiliated Hospital of Harbin Medical University and the Fifth Hospital of Harbin City, Heilongjiang province.

METHODS

Information of 232 patients who suffered from TSCI was gathered from their charts between January 2009 and December 2013. Information on sociodemographic variables was collected from each chart, including the patient's age, sex, occupation, injury time, causes and extent of injury.

RESULTS

The average age of patients with TSCI was 45.35±14.35 years. The male/female ratio was 4:1. The incidence of TSCI increased gradually with age and peaked in the 46- to 60-year-old age category. The most common occupation was farm laborer (35.34%). Motor vehicle collisions, followed by falls, were found to be the leading cause of TSCI. Furthermore, the majority of TSCI patients (76.29%) suffered a cervical injury.

CONCLUSION

The present study reveals that TSCI is an issue in the province, and it should not be ignored. Our results provide preliminary evidence and theoretical basis for developing an integrated control program for TSCI.

Epidemiology of Aquatic and Recreational Water Sport Injuries: A Case-Control Analysis

The purposes of the current investigation are to evaluate the epidemiology of water sport injuries at a coastal tertiary trauma center and to determine the association of these activities with spinal column injury and to determine whether aquatic trauma injuries differ significantly from those that occur terrestrially. A retrospective review of a consecutive series of 105 patients with aquatic-based mechanisms of injury admitted to a Level II trauma center over a 3-year period, as well as a matched control cohort with terrestrial-based mechanisms of injury, was conducted. Patients were treated at a Level II trauma center from January 1, 2008, to December 31, 2010. All patients received a full trauma work-up on arrival. Patients were identified retrospectively from a prospectively collected database (N=5298). Eligible patients were identified from billing/coding data as having mechanisms of injury related to an aquatic setting. Patients were evaluated using standard trauma protocols. Spinal column and cord injury occurrence and differences between groups were reviewed. Personal watercrafts accounted for the majority of injuries (n=39). Cervical (33.3%), closed-head (25.7%), and thoracolumbar (21.9%) injuries accounted for the majority of injury types. The cervical spinal column and the spinal cord were at an increased risk of injury in the aquatic injury cohort (P<.0001). The current data show the high incidence of spinal column and cord injuries in this patient population relative to controls. Practitioners who care for trauma patients near an aquatic environment should be aware of the high prevalence of these injuries, with proper spinal cord preservation protocols in place to optimize outcome.

Toward developing a specific outcome instrument for spine trauma: an empirical cross-sectional multicenter ICF-based study by AOSpine Knowledge Forum Trauma

STUDY DESIGN

Empirical cross-sectional multicenter study.

OBJECTIVE

To identify the most commonly experienced problems by patients with traumatic spinal column injuries, excluding patients with complete paralysis.

SUMMARY OF BACKGROUND DATA

There is no disease or condition-specific outcome instrument available that is designed or validated for patients with spine trauma, contributing to the present lack of consensus and ongoing controversies in the optimal treatment and evaluation of many types of spine injuries. Therefore, AOSpine Knowledge Forum Trauma started a project to develop such an instrument using the International Classification of Functioning, Disability and Health (ICF) as its basis.

METHODS

Patients with traumatic spinal column injuries, within 13 months after discharge from hospital were recruited from 9 trauma centers in 7 countries, representing 4 AOSpine International world regions. Health professionals collected the data using the general ICF Checklist. The responses were analyzed using frequency analysis. Possible differences between the world regions and also between the subgroups of potential modifiers were analyzed using descriptive statistics and Fisher exact test.

RESULTS

In total, 187 patients were enrolled. A total of 38 (29.7%) ICF categories were identified as relevant for at least 20% of the patients. Categories experienced as a difficulty/impairment were most frequently related to activities and participation (n = 15), followed by body functions (n = 6), and body structures (n = 5). Furthermore, 12 environmental factors were considered to be a facilitator in at least 20% of the patients.

CONCLUSION

Of 128 ICF categories of the general ICF Checklist, 38 ICF categories were identified as relevant. Loss of functioning and limitations in daily living seem to be more relevant for patients with traumatic spinal column injuries rather than pain during this time frame. This study creates an evidence base to define a core set of ICF categories for outcome measurement in adult spine trauma patients.

LEVEL OF EVIDENCE

4.

Predictors of intramedullary lesion expansion rate on MR images of patients with subaxial spinal cord injury

OBJECT

Studies of preclinical spinal cord injury (SCI) in rodents indicate that expansion of intramedullary lesions (IMLs) seen on MR images may be amenable to neuroprotection. In patients with subaxial SCI and motor-complete American Spinal Injury Association (ASIA) Impairment Scale (AIS) Grade A or B, IML expansion has been shown to be approximately 900 μm/hour. In this study, the authors investigated IML expansion in a cohort of patients with subaxial SCI and AIS Grade A, B, C, or D.

METHODS

Seventy-eight patients who had at least 2 MRI scans within 6 days of SCI were enrolled. Data were analyzed by regression analysis.

RESULTS

In this cohort, the mean age was 45.3 years (SD 18.3 years), 73 patients were injured in a motor vehicle crash, from a fall, or in sport activities, and 77% of them were men. The mean Injury Severity Score (ISS) was 26.7 (SD 16.7), and the AIS grade was A in 23 patients, B in 7, C in 7, and D in 41. The mechanism of injury was distraction in 26 patients, compression in 22, disc/osteophyte complex in 29, and Chance fracture in 1. The mean time between injury onset and the first MRI scan (Interval 1) was 10 hours (SD 8.7 hours), and the mean time to the second MRI scan (Interval 2) was 60 hours (SD 29.6 hours). The mean IML lengths of the first and second MR images were 38.8 mm (SD 20.4 mm) and 51 mm (SD 36.5 mm), respectively. The mean time from the first to the second MRI scan (Interval 3) was 49.9 hours (SD 28.4 hours), and the difference in IML lengths was 12.6 mm (SD 20.7 mm), reflecting an expansion rate of 366 μm/ hour (SD 710 μm/hour). IML expansion in patients with AIS Grades A and B was 918 μm/hour (SD 828 μm/hour), and for those with AIS Grades C and D, it was 21 μm/hour (SD 304 μm/hour). Univariate analysis indicated that AIS Grade A or B versus Grades C or D (p < 0.0001), traction (p= 0.0005), injury morphology (p < 0.005), the surgical approach (p= 0.009), vertebral artery injury (p= 0.02), age (p < 0.05), ISS (p < 0.05), ASIA motor score (p < 0.05), and time to decompression (p < 0.05) were all predictors of lesion expansion. In multiple regression analysis, however, the sole determinant of IML expansion was AIS grade (p < 0.005).

CONCLUSIONS

After traumatic subaxial cervical spine or spinal cord injury, patients with motor-complete injury (AIS Grade A or B) had a significantly higher rate of IML expansion than those with motor-incomplete injury (AIS Grade C or D).