Advantages and Limitations in the Evaluation of the Neurological and Functional Deficit in Patients with Spinal Cord Injuries

Psychosocial impact of scars following total hip arthroplasty: a comparative study of traumatic vs. non-traumatic etiologies

Background

This study aims to assess the psychosocial impact of the scars resulting from total hip arthroplasties (THA) in terms of internalization and adaptation related to the etiology of the joint damage (traumatic versus non-traumatic) and the specific surgical procedure, by using a modern approach.

Methods

A prospective study was carried out between October 2020 and September 2022, at the Orthopedics department, Bihor Emergency County Clinical Hospital in Oradea, located in North-west of Romania. Depending on diagnosis, the participants were divided into two relatively homogeneous groups: non-traumatic group with 113 subjects (55.66%) diagnosed with degenerative hip osteoarthritis and traumatic group with 90 (44.33%) patients who underwent total hip arthroplasty (THA) following a trauma.

Results

The highest internalization score was noted in uncemented THA cases performed as a consequence of traumatic coxarthrosis. The ANOVA coefficients of intergroup comparisons for the participants with traumatic coxarthrosis indicate that surgical procedures have a significant influence on scar internalization [F (2, 90) = 10.046; p<0.001; η2=0.188]. Scheffe's post hoc test indicated that patients with non-traumatic coxarthrosis who underwent uncemented THA procedures presented a higher level of psychosocial internalization compared to those who underwent cemented (Mdf = 3.87; p<0.02) and revision THA (Mdf = 4.60; p<0.004), but without surprising differences compared to revision of the soft tissue (Mdf = 3.31; p<0.08).

Conclusions

The relevance of the coxarthrosis etiology for subsequent surgical interventions was emphasized in this study. Coxarthrosis has a strong impact on the psychosocial internalization of postoperative scars, which indicates a change in the perception of social support as well as the perception of the quality of life.

Traumatic Spinal Cord Injury

OBJECTIVE

This article provides a review of the initial clinical and radiologic evaluation and treatment of patients with traumatic spinal cord injuries. It specifically highlights essential knowledge for neurologists who encounter patients with these complex injuries.

LATEST DEVELOPMENTS

There has been improvement in the care of patients with traumatic spinal cord injuries, particularly in the prehospital evaluation, approach for immediate immobilization, standardized spinal clearance, efficient triage, and transportation of appropriate patients to traumatic spinal cord injury specialized centers. Advancements in spinal instrumentation have improved the surgical management of spinal fractures and the ability to manage patients with spinal mechanical instability. The clinical evidence favors performing early surgical decompression and spine stabilization within 24 hours of traumatic spinal cord injuries, regardless of the severity or location of the injury. There is no evidence that supports the use of neuroprotective treatments to improve outcomes in patients with traumatic spinal cord injuries. The administration of high-dose methylprednisolone, which is associated with significant systemic adverse effects, is strongly discouraged. Early and delayed mortality rates continue to be high in patients with traumatic spinal cord injuries, and survivors often confront substantial long-term physical and functional impairments. Whereas the exploration of neuroregenerative approaches, such as stem cell transplantation, is underway, these methods remain largely investigational. Further research is still necessary to advance the functional recovery of patients with traumatic spinal cord injuries.

ESSENTIAL POINTS

Traumatic spinal cord injury is a complex and devastating condition that leads to long-term neurologic deficits with profound physical, social, and vocational implications, resulting in a diminished quality of life, particularly for severely affected patients. The initial management of traumatic spinal cord injuries demands comprehensive interdisciplinary care to address the potentially catastrophic multisystem effects. Ongoing endeavors are focused on optimizing and customizing initial management approaches and developing effective therapies for neuroprotection and neuroregeneration to enhance long-term functional recovery.

A future blood test for acute traumatic spinal cord injury

Acute spinal cord injury (SCI) requires prompt diagnosis and intervention to minimize the risk of permanent neurologic deficit. Presently, SCI diagnosis and interventional planning rely on magnetic resonance imaging (MRI), which is not always available or feasible for severely injured patients. Detection of disease-specific biomarkers in biofluids via liquid biopsy may provide a more accessible and objective means of evaluating patients with suspected SCI. Cell-free DNA, which has been used for diagnosing and monitoring oncologic disease, may detect damage to spinal cord neurons via tissue-specific methylation patterns. Other types of biomarkers, including proteins and RNA species, have also been found to reflect neuronal injury and may be included as part of a multi-analyte assay to improve liquid biopsy performance. The feasibility of implementing liquid biopsy into current practices of SCI management is supported by the relative ease of blood sample collection as well as recent advancements in droplet digital polymerase chain reaction technology. In this review, we detail the current landscape of biofluid biomarkers for acute SCI and propose a framework for the incorporation of a putative blood test into the clinical management of SCI.