Neurologic recovery according to the spinal fracture patterns by Denis classification

A randomized controlled study on systematic nursing care based on health empowerment theory and its effect on the self-care and functional abilities of patients with spinal fractures

OBJECTIVE

In this study, we aimed to explore the effectiveness of systematic nursing care based on health empowerment theory on the self-care and functional abilities of patients with spinal fractures.

METHODS

We selected a total of 50 patients with spinal fractures from our hospital and randomly divided them into the control group and the observation group, with 25 patients in each group. Patients in the control group received conventional nursing care, while those in the observation group received systematic nursing care grounded in the health empowerment theory. We recorded and compared the self-care ability, functional ability, knowledge about the condition, and pain scores of patients in the two groups before and after the nursing intervention.

RESULTS

There was no significant difference in the baseline characteristics between the two groups (P > 0.05), and there was no significant difference in self-care ability, functional ability, knowledge about the condition, or the visual analog scale (VAS) score between the two groups before treatment (P > 0.05). After treatment, outcomes in the observation group in terms of self-care ability, functional ability, and knowledge about the condition were significantly better than those in the control group (P < 0.05), while the VAS score in the observation group was significantly lower than that in the control group (P < 0.05).

CONCLUSION

Compared with conventional nursing care, patients with spinal fractures who received systematic nursing inputs based on health empowerment theory reported significant improvements in pain, self-care, functional ability, and knowledge of the condition, and this is an approach that is worthy of promotion in clinical use.

Characterizing Natural Recovery after Traumatic Spinal Cord Injury

The predominant tool used to predict outcomes after traumatic spinal cord injury (SCI) is the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), in association with the American Spinal Injury Association (ASIA) Impairment Scale (AIS). These measures have evolved based on analyses of large amounts of longitudinal neurological recovery data published in numerous separate studies. This article reviews and synthesizes published data on neurological recovery from multiple sources, only utilizing data in which the sacral sparing definition was applied for determination of completeness. Conversion from a complete to incomplete injury is more common in tetraplegia than paraplegia. The majority of AIS conversion and motor recovery occurs within the first 6-9 months, with the most rapid rate of motor recovery occurring in the first three months after injury. Motor score changes, as well as recovery of motor levels, are described with the initial strength of muscles as well as the levels of the motor zone of partial preservation influencing the prognosis. Total motor recovery is greater for patients with initial AIS B than AIS A, and greater after initial AIS C than with motor complete injuries. Older age has a negative impact on neurological and functional recovery after SCI; however, the specific age (whether >50 or >65 years) and underlying reasons for this impact are unclear. Penetrating injury is more likely to lead to a classification of a neurological complete injury compared with blunt trauma and reduces the likelihood of AIS conversion at one year. There are insufficient data to support gender having a major effect on neurological recovery after SCI.

[Decompression by mini-open posterior approach assisted with microscope for thoracolumbar burst fracture with severe spinal canal stenosis]

Objective

To investigate the effectiveness of posterior microscopic mini-open technique (MOT) decompression in patients with severe spinal canal stenosis resulting from thoracolumbar burst fractures.

Methods

The clinical data of 28 patients with severe spinal canal stenosis caused by thoracolumbar burst fractures, who were treated by posterior microscopic MOT, which performed unilateral or bilateral laminectomy, poking reduction, intervertebral bone graft via spinal canal, and percutaneous pedicle screw fixation between January 2014 and January 2016 were retrospectively analyzed. There were 21 males and 7 females with a mean age of 42.1 years (range, 16-61 years). The involved segments included T 11 in 1 case, T 12 in 4 cases, L 1 in 14 cases, and L 2 in 9 cases. According to AO classification, there were 19 cases of type A3, 9 of type A4. According to American Spinal Injury Association (ASIA) grading, 12 cases were grade C, 13 grade D, and 3 grade E. The time between injury and operation was 3-7 days (mean, 3.6 days). To evaluate effectiveness, the changes in the visual analogue scale (VAS), percentage of anterior height of injured vertebrae, Cobb angle, rate of spinal compromise (RSC), and ASIA grading were analyzed.

Results

All patients were performed procedures successfully. The operation time was 135-323 minutes (mean, 216.4 minutes). The intraoperative blood loss was 80-800 mL (mean, 197.7 mL). The hospitalization time was 10-25 days (mean, 12.5 days). The incisions healed primarily, without wound infection, cerebrospinal fluid leakage, or other early complications. All the 28 patients were followed up 12-24 months (mean, 16.5 months). No breakage or loosening of internal fixation occurred. All fractures healed, and the healing time was 3-12 months (mean, 6.5 months). Compared with preoperative ones, the percentage of anterior height of injured vertebrae, Cobb angle, and RSC at immediate after operation and at last follow-up and the VAS scores at 1 day after operation and at last-follow were significantly improved ( P<0.05). There was no significant difference in the percentage of anterior height of injured vertebrae and Cobb angle between at immediate after operation and at last follow-up ( P>0.05). But the RSC at immediate after operation and VSA score at 1 day after operation were significantly improved when compared with those at last follow-up ( P<0.05). The ASIA grading at last follow-up was 1 case of grade C, 14 grade D, and 13 grade E, which was significantly improved when compared with preoperative ones ( Z=3.860, P=0.000).

Conclusion

MOT is an effective and minimal invasive treatment for thoracolumbar AO type A3 and A4 burst fractures with severe spinal canal stenosis, and it is beneficial to early rehabilitation for patients.

Posterior indirect reduction and pedicle screw fixation without laminectomy for Denis type B thoracolumbar burst fractures with incomplete neurologic deficit

Purpose

The aim of this study is to evaluate the efficacy of posterior indirect reduction and pedicle screw fixation without laminectomy for the treatment of Denis type B thoracolumbar burst fractures with incomplete neurologic deficit.

Methods

From March 2008 to May 2012, 36 consecutive patients of Denis type B thoracolumbar burst with incomplete neurologic deficit were enrolled. All of the patients accepted the treatments of posterior indirect reduction and pedicle screw fixation without laminectomy. Clinical and radiologic outcomes were assessed preoperatively and postoperatively.

Results

Operations were performed in a relatively short time without massive hemorrhage. Their neurologic functions were improved by at least one Frankel grade. The average score of American Spinal Injury Association (ASIA) motor increased from 25.4 ± 10.8 to 42.1 ± 10.5, and the recovery rate of the ASIA score was also increased. The pain level was relieved for all the patients. The local kyphosis angle was reduced from 25.9° ± 3.4° to 6.9° ± 2.2° (P <0.05) and remained 7.9° ± 2.0° (P > 0.05) at the latest follow-up. After the operation, the mean vertebral canal diameter increased from 5.5 ± 1.3 to 11.1 ± 2.2 mm (P < 0.05) and the mean canal stenosis index increased from 32.9 ± 7.8 to 84.8 ± 7.3 % (P < 0.05). There were no serious complications and fixation failures during follow-up.

Conclusion

Denis type B thoracolumbar burst fractures with incomplete neurologic deficit can be effectively treated by posterior indirect reduction and pedicle screw fixation without laminectomy.