1
|
Wecht JM, Weir JP, Huang V, Escalon MX, Bryce TN. Treatment of orthostatic hypotension during acute inpatient rehabilitation after spinal cord injury: usual care versus anti-hypotensive therapy. Am J Hypertens 2024:hpae057. [PMID: 38712567 DOI: 10.1093/ajh/hpae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND To compare pharmacological treatment of hypotension and orthostatic hypotension (OH) initiated based upon a blood pressure (BP) threshold, regardless of symptoms (TXT), to usual care pharmacological treatment of symptomatic hypotension (UC), during acute inpatient rehabilitation (AIR) following spinal cord injury (SCI). METHODS Block randomization, based on the neurological level of injury as: cervical lesions (C1-C8); high thoracic lesions (T1-T5) and low thoracic lesions (T6-T12), was used to determine responses to the primary question "was the therapy session affected by low BP or concern for low BP development?". Study participants and therapists were unaware of group assignment. RESULTS A total of 66 participants enrolled; 25 (38%) in the TXT group, 29 (44%) in the UC group, and 12 (18%) withdrew. Responses to the primary question were recorded for 32 participants, 15 in the TXT and 17 in the UC group. There was an average of 81±51 therapy sessions/participant in the TXT and 60±27 sessions/participant in the UC group. Of those therapy sessions, low BP or concerns for low BP affected an average of 9±8 sessions/participant in the TXT group and 10±12 sessions/participant in the UC group. Neither the total number of therapy sessions (p=0.16) nor group assignment (p=0.83) significantly predicted the number of sessions affected by low BP. CONCLUSIONS These data are not conclusive but indicate that the treatment of asymptomatic hypotension and OH does not increase time spent in therapy compared to usual care treatment of symptomatic hypotension and OH in newly injured patients with SCI.
Collapse
Affiliation(s)
- Jill M Wecht
- James J Peters VA Medical Center, Bronx, NY
- Department of Rehabilitation & Human Performance, the Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS
| | - Vincent Huang
- Department of Rehabilitation & Human Performance, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Miguel X Escalon
- Department of Rehabilitation & Human Performance, the Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas N Bryce
- Department of Rehabilitation & Human Performance, the Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
2
|
Keightley JGA, Haagman B, Magner JD, Debenham JR. Models of care for musculoskeletal shoulder pain in spinal cord injury: A scoping review. J Spinal Cord Med 2024; 47:327-344. [PMID: 36913538 PMCID: PMC11044743 DOI: 10.1080/10790268.2023.2183335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
CONTEXT Spinal cord injury (SCI) is a neurological condition that significantly impacts a person's lifestyle, health and well-being. Many individuals with SCI experience secondary musculoskeletal shoulder pain. This scoping review examines the current research on the diagnosis and management of shoulder pain in SCI. OBJECTIVE The aim of this Scoping Review was (1) to chart peer-reviewed literature regarding the diagnosis and management of shoulder pain as it relates to SCI and (2) identify gaps in this body of literature to inform future research priorities. METHODS Six electronic databases were searched from inception until April 2022. In addition, reviewers scanned the reference lists of identified articles. Articles from peer-reviewed sources that reported diagnostic or management procedures for musculoskeletal shoulder conditions within the SCI population were considered and 1679 articles were identified. Title and abstract screening, full text review, and data extraction were undertaken by two independent reviewers. RESULTS Eighty seven articles were included, covering diagnosis or management of shoulder pain in SCI. CONCLUSION Whilst the most commonly reported diagnostic procedures and management strategies reflect contemporary practice for shoulder pain, the entire body of literature demonstrates inconsistencies in methodologies. In places, the literature continues to perceive value in procedures inconsistent with best practice. These findings encourage researchers to pursue the development of robust models of care for musculoskeletal shoulder pain in SCI using a collaborative and integrated approach, combining best practice for musculoskeletal shoulder pain alongside clinical expertise in the management of SCI.
Collapse
Affiliation(s)
- Jordan G. A. Keightley
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
| | - Bianca Haagman
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
| | - Julie D. Magner
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
| | - James R. Debenham
- National School of Nursing, Midwifery, Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Active Linc (Home Based Services), Innaloo, Western Australia, Australia
- Majarlin Kimberley Centre for Remote Health, The University of Notre Dame Australia, Broome, Western Australia, Australia
| |
Collapse
|
3
|
Aru RG, Stonko DP, Tan LT, Sorber RA, Hicks CW, Black JH. Utility of Motor Evoked Potentials in Contemporary Open Thoracoabdominal Aortic Repair. J Vasc Surg 2024:S0741-5214(24)00984-4. [PMID: 38614141 DOI: 10.1016/j.jvs.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/31/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVES Paraplegia remains one of the major complications of contemporary open thoracoabdominal aortic aneurysm (TAAA) repair. Intraoperative motor-evoked potentials (MEPs) act as a surrogate measure for spinal cord homeostasis. The purpose of this study was to evaluate the results of intraoperative neuromonitoring in contemporary TAAA repair and its association with postoperative spinal cord ischemia. METHODS Patients who underwent open type 2 or 3 TAAA or completion aortic repair utilizing intraoperative neuromonitoring were identified between May 2006 and November 2023. Patient demographics, comorbidities, indication for the procedure, procedural details, and outcomes were recorded. The groups were divided based on type of repair, and univariate statistics were then utilized to evaluate the association of these metrics versus the type of repair. RESULTS Seventy-nine patients underwent open type 2 (N=41) and 3 (N=23) TAAA and completion aortic (N=15; open in 14, endovascular in 1) repairs by a single surgeon. The cohort was predominantly male (N=48, 60.8%) with a mean age of 52.5±16.2 years. There was a high incidence of hypertension (N=53, 67.1%), smoking history (N=42, 53.1%), and connective tissue disorders (N=37, 46.8%). Operative indications included dissection-related (N=50, 63.3%) and degenerative (N=26, 32.9%) TAAA and dissection-related malperfusion (N=3, 3.8%). Left heart bypass was often (N=73, 92.4%) utilized for distal aortic perfusion, and cerebrospinal fluid drainage (N=77, 97.5%) was a common adjunct. MEPs were classified as no change (N=43, 54.4%), reversible change (N=26, 32.9%), irreversible change (N=4, 5.1%), and unreliable (N=6, 7.6%). MEP changes were predominantly bilateral (N=70, 88.6%) and occurred most often during repair of the abdominal aortic segment (N= 13, 16.5%). The median number of replaced vertebral levels was associated with MEP changes (P=0.013). SCI was only observed in repairs greater than 6 replaced vertebral levels with an overall frequency of 17.7%. It was most prevalent in completion aortic repairs (26.7%). Immediate and delayed SCI occurred in 10.1% and 7.6% of patients, respectively; it was most commonly (71.8%) reversible. Permanent paraplegia occurred in 4 patients (5.1%), with equal immediate and delayed onsets. MEPs demonstrated poor sensitivity (53.9%) and specificity (62.3%) for SCI, however there was a high negative predictive value (86.4%) in this population. In-hospital mortality occurred in 5 (6.3%). CONCLUSIONS No changes in intraoperative MEPs are highly predictive of spinal cord homeostasis. The number of replaced vertebral levels and previous aortic repair should guide intraoperative neuroprotective measures including intercostal reimplantation and should take precedence over intraoperative monitoring, especially when MEP changes occur.
Collapse
Affiliation(s)
- Roberto G Aru
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - David P Stonko
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Li T Tan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rebecca A Sorber
- Division of Vascular Surgery, University of Washington, Seattle, WA, United States
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - James H Black
- Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| |
Collapse
|
4
|
Zhu A, Tan C, Chard R, Orr Y. In patients supported with peripheral veno-arterial extracorporeal membrane oxygenation, what factors are associated with the development of spinal cord ischaemia? Interdiscip Cardiovasc Thorac Surg 2024; 38:ivae052. [PMID: 38530798 PMCID: PMC10997430 DOI: 10.1093/icvts/ivae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/13/2023] [Accepted: 03/22/2024] [Indexed: 03/28/2024]
Abstract
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'in patients supported with peripheral veno-arterial extracorporeal membrane oxygenation, what factors are associated with the development of spinal cord ischaemia'? Altogether, more than 22 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Of the 28 patients reported by included studies, the thoracic spinal cord was most commonly affected. Twenty patients (71%) survived to hospital discharge and 7 (25%) were reported to have neurological recovery. Potential confounders included coronary angiography, cardiac arrest requiring chest compressions and concomitant intra-aortic balloon pump. Consequently, all papers highlighted the likely multifactorial aetiology of spinal cord infarction in these patients. We propose that close neurological observation, particularly in patients who have received chest compressions, and management of potential aetiological factors is crucial to aid in timely diagnosis and potential prevention of this rare complication. Limiting sedation and neuromuscular blockade to enable neurologic assessment of the lower limbs may allow more timely diagnosis.
Collapse
Affiliation(s)
- Alison Zhu
- Department of Cardiothoracic Surgery, Westmead Hospital, Westmead, NSW, Australia
- Discipline of Surgery, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Charis Tan
- Department of Cardiothoracic Surgery, Westmead Hospital, Westmead, NSW, Australia
- Discipline of Surgery, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Richard Chard
- Department of Cardiothoracic Surgery, Westmead Hospital, Westmead, NSW, Australia
- Discipline of Surgery, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| | - Yishay Orr
- Department of Cardiothoracic Surgery, Westmead Hospital, Westmead, NSW, Australia
- Discipline of Surgery, Faculty of Medicine and Health, University of Sydney, NSW, Australia
| |
Collapse
|
5
|
Khanna A, Fares MY, Koa J, Abboud JA. Improving shoulder function and pain in a paraplegic patient with massive irreparable rotator cuff tear using a subacromial balloon spacer. Clin Shoulder Elb 2024:cise.2023.00913. [PMID: 38556911 DOI: 10.5397/cise.2023.00913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/26/2023] [Indexed: 04/02/2024] Open
Abstract
The subacromial balloon spacer is a promising treatment option for alleviating symptoms in patients with massive irreparable rotator cuff tears (MIRCTs). The balloon provides faster pain relief and easier rehabilitation than other options (such as arthroscopic partial rotator cuff repair). For a paraplegic MIRCT patient, the need for speedy recovery and rehabilitation is crucial, as these patients rely on their upper limbs for daily life activities and independence. In this report, we present a 60-year-old male paraplegic patient who presented to the clinic with an MIRCT of the right shoulder. After a holistic investigation and assessment of the patient, a subacromial balloon spacer with an upper border subscapularis repair was chosen as the treatment of choice. The patient had an uneventful recovery, and at the 1-year mark, had forward elevation of 170°, an American Shoulder and Elbow Surgeons score of 95, and a visual analogue scale pain score of 0.
Collapse
Affiliation(s)
- Akshay Khanna
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Jonathan Koa
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, PA, USA
| |
Collapse
|
6
|
Milner SM, Mathis R. Pathogenesis of Pressure Injuries. Eplasty 2024; 24:ic16. [PMID: 38685991 PMCID: PMC11056629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Stephen M. Milner
- Professor of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (Ret.)
| | - Ryan Mathis
- Department of Research and Development, PolarityTE, Inc, Salt Lake City, Utah
| |
Collapse
|
7
|
Lee A, Katznelson R, Ouzounian M, Au D, Chung J, Djaiani G, Lindsay T. Adjunctive hyperbaric oxygen therapy for spinal cord ischemia after complex aortic repair. J Vasc Surg 2024; 79:478-484. [PMID: 37925040 DOI: 10.1016/j.jvs.2023.10.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE Spinal cord ischemia (SCI) with paraplegia or paraparesis is a devastating complication of complex aortic repair (CAR). Treatment includes cerebrospinal fluid drainage, maintenance of hemoglobin concentration (>10 g/L), and elevating mean arterial blood pressure. Animal and human case series have reported improvements in SCI outcomes with hyperbaric oxygen therapy (HBOT). We reviewed our center's experience with HBOT as a rescue treatment for spinal cord ischemia post-CAR in addition to standard treatment. METHODS A retrospective review of the University Health Network's Hyperbaric Medicine Unit treatment database identified HBOT sessions for patients with SCI post-CAR between January 2013 and June 2021. Mean estimates of overall motor function scores were determined for postoperative, pre-HBOT, post-HBOT (within 4 hours of the final HBOT session), and at the final assessment (last available in-hospital evaluation) using a linear mixed model. A subgroup analysis compared the mean estimates of overall motor function scores between improvement and non-improvement groups at given timepoints. Improvement of motor function was defined as either a ≥2 point increase in overall muscle function score in patients with paraparesis or an upward change in motor deficit categorization (para/monoplegia, paraparesis, and no deficit). Subgroup analysis was performed by stratifying by improvement or non-improvement of motor function from pre-HBOT to final evaluation. RESULTS Thirty patients were treated for SCI. Pre-HBOT, the motor deficit categorization was 10 paraplegia, three monoplegia, 16 paraparesis, and one unable to assess. At the final assessment, 14 patients demonstrated variable degrees of motor function improvement; eight patients demonstrated full motor function recovery. Seven of the 10 patients with paraplegia remained paraplegic despite HBOT. The estimated mean of overall muscle function score for pre-HBOT was 16.6 ± 2.9 (95% confidence interval [CI], 10.9-22.3) and for final assessment was 23.4 ± 2.9 (95% CI, 17.7-29.1). The estimated mean difference between pre-HBOT and final assessment overall muscle function score was 6.7 ± 3.1 (95% CI, 0.6-16.1). The estimated mean difference of the overall muscle function score between pre-HBOT and final assessment for the improved group was 16.6 ± 3.5 (95% CI, 7.5-25.7) vs -4.9 ± 4.2 (95% CI, -16.0 to 6.2) for the non-improved group. CONCLUSIONS HBOT, in addition to standard treatment, may potentially improve recovery in spinal cord function following SCI post-CAR. However, the potential benefits of HBOT are not equally distributed among subgroups.
Collapse
Affiliation(s)
- Angela Lee
- Division of Vascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
| | - Rita Katznelson
- Hyperbaric Medicine Unit, Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Darren Au
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jennifer Chung
- Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - George Djaiani
- Department of Anaesthesia and Pain Management, Toronto General Hospital, Toronto, Ontario, Canada
| | - Thomas Lindsay
- Division of Vascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Verma R, Chakraborty R. Behr's syndrome mimicking a case of hereditary spastic paraparesis. eNeurologicalSci 2024; 34:100494. [PMID: 38292290 PMCID: PMC10827389 DOI: 10.1016/j.ensci.2024.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/21/2023] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, India
| | | |
Collapse
|
9
|
Su X, Song Z, Zhang H, Zhang P, Ma Y. Sudden lower extremity weakness caused by an isolated sinus intracranial dural arteriovenous fistula. Acta Neurol Belg 2024:10.1007/s13760-024-02501-4. [PMID: 38407810 DOI: 10.1007/s13760-024-02501-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Affiliation(s)
- Xin Su
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Zihao Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
| | - Yongjie Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China
| |
Collapse
|
10
|
Wei J, Hu Z, Wang W, Ding R, Chen Z, Yuan X, Xu F. Posterior False Lumen and Paraplegia Following FET Procedure in Acute Type A Aortic Dissection. Ann Thorac Surg 2024:S0003-4975(24)00099-7. [PMID: 38331207 DOI: 10.1016/j.athoracsur.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/04/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Postoperative paraplegia is the major concern for frozen elephant trunk (FET) procedure in acute type A aortic dissection (ATAAD) patients. It is crucial to determine patients with high risk of paraplegia before implementing FET procedure. METHODS From January 2013 to December 2018, 544 ATAAD patients undergoing FET procedure were included in this study. The segment number of posterior false lumen (PFL) between T9-L2 levels was calculated. In-hospital outcomes and long-term survival were investigated based on the number of PFL. RESULTS The average age was 46.5±9.9 years old and the proportion of female was 19.5% in this cohort. The incidence of postoperative paraplegia was significantly increased when PFL was presented in 3 or more segments. Patients were divided into high-PFL (3-6 segments) (n=124) and low-PFL group (0-2 segments) (n=420). The demographic characteristics were similar between the two groups. The involvement of celiac trunk and superior mesenteric artery were significantly lower in the high-PFL group (all P<0.05). The other baseline characteristics and procedural information were statistically balanced. The incidence of postoperative paraplegia was significantly higher in the high-PHL groups (7.3% vs 1.9%, P=0.006). Multivariable logistic analysis revealed that the high-PFL was independently associated with postoperative paraplegia following FET procedure (OR=3.812, 95%CI: 1.378-10.550, P=0.010). Additionally, the moderate nasopharyngeal temperature of hypothermic circulatory arrest (≧23.0°C) was clarified as a protective factor for paraplegia (OR=0.112, 95%CI: 0.023-0.535, P=0.006). CONCLUSIONS ATAAD patients presenting with High-PFL between T9-L2 levels have significant high risk of postoperative paraplegia if undergoing FET procedure.
Collapse
Affiliation(s)
- Jinhua Wei
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Zhan Hu
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Wei Wang
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Runyu Ding
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Zujun Chen
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Xin Yuan
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China
| | - Fei Xu
- Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
| |
Collapse
|
11
|
Ertlen C, Seblani M, Bonnet M, Brezun JM, Coyle T, Sabatier F, Fuentes S, Decherchi P, Serratrice N, Marqueste T. Efficacy of the immediate adipose-derived stromal vascular fraction autograft on functional sensorimotor recovery after spinal cord contusion in rats. Stem Cell Res Ther 2024; 15:29. [PMID: 38303017 PMCID: PMC10835949 DOI: 10.1186/s13287-024-03645-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Spinal cord injuries (SCI) lead to functional alteration with important consequences such as motor and sensory disorders. The repair strategies developed to date remain ineffective. The adipose tissue-derived stromal vascular fraction (SVF) is composed of a cocktail of cells with trophic, pro-angiogenic and immunomodulatory effects. Numerous therapeutic benefits were shown for tissue reconstitution, peripheral neuropathy and for the improvement of neurodegenerative diseases. Here, the therapeutic efficacy of SVF on sensorimotor recovery after an acute thoracic spinal cord contusion in adult rats was determined. METHOD Male Sprague Dawley rats (n = 45) were divided into 3 groups: SHAM (without SCI and treatment), NaCl (animals with a spinal lesion and receiving a saline injection through the dura mater) and SVF (animals with a spinal lesion and receiving a fraction of fat removed from adipocytes through the dura mater). Some animals were sacrificed 14 days after the start of the experiment to determine the inflammatory reaction by measuring the interleukin-1β, interleukin-6 and Tumor Necrosis Factor-α in the lesion area. Other animals were followed once a week for 12 weeks to assess functional recovery (postural and locomotor activities, sensorimotor coordination). At the end of this period, spinal reflexivity (rate-dependent depression of the H-reflex) and physiological adjustments (ventilatory response to metabosensitive muscle activation following muscle fatigue) were measured with electrophysiological tools. RESULTS Compared to non-treated animals, results indicated that the SVF reduced the endogenous inflammation and increased the behavioral recovery in treated animals. Moreover, H-reflex depression and ventilatory adjustments to muscle fatigue were found to be comparable between SHAM and SVF groups. CONCLUSION Our results highlight the effectiveness of SVF and its high therapeutic potential to improve sensorimotor functions and to restore the segmental sensorimotor loop and the communication between supra- and sub-lesional spinal cord regions after traumatic contusion.
Collapse
Affiliation(s)
- Céline Ertlen
- Aix-Marseille Univ, CNRS, ISM UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité Des Systèmes Nerveux Et Musculaire (PSNM), Parc Scientifique Et Technologique de Luminy, Aix Marseille Univ, CC910 - 163, Avenue de Luminy, 13288, Marseille Cedex 09, France
| | - Mostafa Seblani
- Aix-Marseille Univ, CNRS, ISM UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité Des Systèmes Nerveux Et Musculaire (PSNM), Parc Scientifique Et Technologique de Luminy, Aix Marseille Univ, CC910 - 163, Avenue de Luminy, 13288, Marseille Cedex 09, France
| | - Maxime Bonnet
- Aix-Marseille Univ, CNRS, ISM UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité Des Systèmes Nerveux Et Musculaire (PSNM), Parc Scientifique Et Technologique de Luminy, Aix Marseille Univ, CC910 - 163, Avenue de Luminy, 13288, Marseille Cedex 09, France
| | - Jean-Michel Brezun
- Aix-Marseille Univ, CNRS, ISM UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité Des Systèmes Nerveux Et Musculaire (PSNM), Parc Scientifique Et Technologique de Luminy, Aix Marseille Univ, CC910 - 163, Avenue de Luminy, 13288, Marseille Cedex 09, France
| | - Thelma Coyle
- Aix-Marseille Univ, CNRS, ISM UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité Des Systèmes Nerveux Et Musculaire (PSNM), Parc Scientifique Et Technologique de Luminy, Aix Marseille Univ, CC910 - 163, Avenue de Luminy, 13288, Marseille Cedex 09, France
| | - Florence Sabatier
- Assistance Publique - Hôpitaux de Marseille (AP-HM), INSERM 1409 Centre d'Investigation Clinique en Biothérapies, Unité de Culture Et Thérapie Cellulaire, Hôpital de La Conception, 147, Boulevard Baille, 13385, Marseille Cedex 05, France
| | - Stéphane Fuentes
- Assistance Publique - Hôpitaux de Marseille (AP-HM), Service de Neurochirurgie, Hôpital de La Timone, 264, Rue Saint-Pierre, 13005, Marseille, France
| | - Patrick Decherchi
- Aix-Marseille Univ, CNRS, ISM UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité Des Systèmes Nerveux Et Musculaire (PSNM), Parc Scientifique Et Technologique de Luminy, Aix Marseille Univ, CC910 - 163, Avenue de Luminy, 13288, Marseille Cedex 09, France.
| | - Nicolas Serratrice
- Aix-Marseille Univ, CNRS, ISM UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité Des Systèmes Nerveux Et Musculaire (PSNM), Parc Scientifique Et Technologique de Luminy, Aix Marseille Univ, CC910 - 163, Avenue de Luminy, 13288, Marseille Cedex 09, France
- Assistance Publique - Hôpitaux de Marseille (AP-HM), Service de Neurochirurgie, Hôpital de La Timone, 264, Rue Saint-Pierre, 13005, Marseille, France
| | - Tanguy Marqueste
- Aix-Marseille Univ, CNRS, ISM UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité Des Systèmes Nerveux Et Musculaire (PSNM), Parc Scientifique Et Technologique de Luminy, Aix Marseille Univ, CC910 - 163, Avenue de Luminy, 13288, Marseille Cedex 09, France.
| |
Collapse
|
12
|
Butler Forslund E, Löfvenmark I. Effects of the SmartDrive on mobility, activity, and shoulder pain among manual wheelchair users with spinal cord injury - a prospective long-term cohort pilot study. Disabil Rehabil Assist Technol 2024; 19:397-406. [PMID: 35793399 DOI: 10.1080/17483107.2022.2091670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 06/14/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE to investigate long-term effects of SmartDrive on mobility, everyday activity, and shoulder pain among spinal cord injured manual wheelchairs users. MATERIAL AND METHODS A prospective pilot intervention study was conducted at Spinalis/Aleris Rehab Station, Sweden. Participants were consecutively invited when evaluated for SmartDrive prescription. Assessments were done at baseline, intervention (use of SmartDrive), and after six months. A smartwatch registered wheelchair utilization including push intensity and pushes/day. Wheelchair Outcome Measure, pain rating instruments including Wheelchair User's Shoulder Pain Index, a wheelchair test, and semi-structured interviews were used. Descriptive statistics and content analysis approach were used. RESULTS Twenty-five persons were screened, six of 14 included completed the study. Drop-out reasons were not related to SmartDrive for five of the eight persons. After intervention, there was a tendency of decreased pain (median (IQR) 5/10 (2.6-6.6) vs 2.5 (2-3.2). All participants reported increased satisfaction of performance when "taking a walk", from median (IQR) 45/100 (27-70) at baseline to 95 (80-100) at 6 months. Two persons who could not ascend a slope at baseline could manage using the SmartDrive. Interviews revealed that the in general positive response persisted at six months. Also, with the SmartDrive the participants could go out despite pain, providing a sense of freedom and independence. Three incidents were reported. CONCLUSION This long-term pilot study indicates that a SmartDrive might be a valuable assistive device to promote mobility despite of shoulder pain. All participants considered it easy to use and experienced increased independence, however skills training and follow-ups are necessary. IMPLICATIONS FOR REHABILITATIONA Rear Drive Power Assist Device (RD-PAD) could increase satisfaction with self-selected activities.A RD-PAD could increase functional mobility by facilitating propelling longer distances and steeper slopes.A RD-PAD could improve perseverance of daily activities in spite of shoulder pain.A RD-PAD could be a valuable assistive aid for persons with paraplegia with different level of wheelchair skills but with good self-awareness regarding their abilities.Thorough assessment of initial wheelchair skills, training, and follow-up are important to enhance safety and maximize performance when using the RD-PAD.
Collapse
Affiliation(s)
- Emelie Butler Forslund
- Spinalis Aleris Rehab Station, Solna, Sweden
- Department of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| | - Inka Löfvenmark
- Spinalis Aleris Rehab Station, Solna, Sweden
- Department of Neurogeriatrics, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
13
|
Di Giulio F, Castellini C, Palazzi S, Tienforti D, Antolini F, Felzani G, Baroni MG, Barbonetti A. Correlates of metabolic syndrome in people with chronic spinal cord injury. J Endocrinol Invest 2024:10.1007/s40618-023-02298-8. [PMID: 38285309 DOI: 10.1007/s40618-023-02298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/28/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE We aimed at identifying clinical risk factors or early markers of metabolic syndrome (MetS) in people with spinal cord injury (SCI) that would facilitate a timely diagnosis and implementation of preventive/therapeutic strategies. METHODS One hundred sixty-eight individuals with chronic (> 1 year) SCI underwent clinical and biochemical evaluations. MetS was diagnosed according to modified criteria of the International Diabetes Federation validated in people with SCI. Wilcoxon rank-sum test and χ2 test were used to compare variables between groups with and without MetS. Multiple logistic regression analysis was performed to reveal independent associations with MetS among variables selected by univariate linear regression analyses. RESULTS MetS was diagnosed in 56 of 132 men (42.4%) and 17 of 36 women (47.2%). At univariate regression analyses, putative predictors of MetS were an older age, a higher number of comorbidities, a lower insulin-sensitivity, the presence and intensity of pain, a shorter injury duration, a poorer leisure time physical activity (LTPA) and an incomplete motor injury. At the multiple logistic regression analysis, a significant independent association with MetS only persisted for a poorer LTPA in hours/week (OR: 0.880, 95% CI 0.770, 0.990) and more severe pain symptoms as assessed by the numeral rating scale (OR: 1.353, 95% CI 1.085, 1.793). CONCLUSION In people with chronic SCI, intense pain symptoms and poor LTPA may indicate a high likelihood of MetS, regardless of age, SCI duration, motor disability degree, insulin-sensitivity and comorbidities.
Collapse
Affiliation(s)
- F Di Giulio
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, Coppito, L'Aquila, Italy
| | - C Castellini
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, Coppito, L'Aquila, Italy
| | - S Palazzi
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, Coppito, L'Aquila, Italy
| | - D Tienforti
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, Coppito, L'Aquila, Italy
| | - F Antolini
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, Coppito, L'Aquila, Italy
| | - G Felzani
- Spinal Unit, San Raffaele Sulmona Institute, Sulmona, Italy
| | - M Giorgio Baroni
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, Coppito, L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - A Barbonetti
- Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila, 67100, Coppito, L'Aquila, Italy.
| |
Collapse
|
14
|
Clampitt B, Monsour M, Kazelka M, Schimmel S, Croci DM. Intraoperative View of a Multinodal, Paralysis-Inducing Spinal Melanocytoma: Case Report and Literature Review. World Neurosurg 2024; 181:2. [PMID: 37777173 DOI: 10.1016/j.wneu.2023.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
Melanocytomas arising from the leptomeningeal melanocytes within the central nervous system are a rare occurrence, accounting for 0.06%-0.1% of brain tumors and having an incidence of 1/10 million people per year.1-14 Here, we describe the case of 68-year-old male presenting with bilateral lower extremity weakness progressing to paralysis and urinary incontinence (Video 1). Upon examination, this gentleman had no sensation below T11. Magnetic resonance imaging showed multiple contrast-enhancing lesions with a major intradural lesion at level T11 arising from the ventrolateral surface and causing severe spinal cord compression. The multifocal nature of this tumor further adds to its rarity. Interdisciplinary indication for surgical resection of the intradural lesion was made. This was accomplished through a T11 laminectomy and concomitant T11-12 stabilization with neuromonitoring. Pathologic analysis of the resected tumor identified an S100+, HMB45+, pigmented melanocytoma. No complications occurred during the procedure. The patient was discharged to rehabilitation with persistent neurologic deficits. Routine follow-up is indicated given the high rates of recurrence and the multiple remaining tumor nodules.14.
Collapse
Affiliation(s)
- Bryan Clampitt
- USF Health, Morsani College of Medicine, Tampa, Florida, USA
| | - Molly Monsour
- USF Health, Morsani College of Medicine, Tampa, Florida, USA
| | - Maryam Kazelka
- USF Health, Morsani College of Medicine, Tampa, Florida, USA
| | | | - Davide Marco Croci
- Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA; Department of Neurosciences, Lakeland Regional Hospital, Lakeland, Florida, USA.
| |
Collapse
|
15
|
Di Giulio F, Castellini C, Tienforti D, Felzani G, Baroni MG, Barbonetti A. Independent association of hypovitaminosis d with non-alcoholic fatty liver disease in people with chronic spinal cord injury: a cross-sectional study. J Endocrinol Invest 2024; 47:79-89. [PMID: 37273143 DOI: 10.1007/s40618-023-02124-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE Non-alcoholic fatty liver disease (NAFLD) and hypovitaminosis D are highly prevalent in people with spinal cord injury (SCI) and could exert an unfavorable influence on cardiovascular profile and rehabilitation outcomes. We aimed to assess the independent association between low 25-hydroxy vitamin D (25(OH)D) levels and NAFLD in people with chronic (> 1 year) SCI. METHODS One hundred seventy-three consecutive patients with chronic SCI (132 men and 41 women) admitted to a rehabilitation program underwent clinical/biochemical evaluations and liver ultrasonography. RESULTS NAFLD was found in 105 patients (60.7% of the study population). They were significantly older and exhibited a poorer leisure time physical activity (LTPA) and functional independence in activities of daily living, a greater number of comorbidities and a higher prevalence of metabolic syndrome (MetS) and its correlates, including lower HDL and higher values of body mass index (BMI), systolic blood pressure, HOMA-index of insulin resistance and triglycerides. 25(OH)D levels were significantly lower in NAFLD (median: 10.6 ng/ml, range: 2.0-31.0) than in non-NAFLD group (22.5 ng/ml, 4.2-51.6). When all these variables were included in a multiple logistic regression analysis, a significant independent association with NAFLD only persisted for lower 25(OH)D levels, a greater number of comorbidities and a poorer LTPA. The ROC analysis revealed that 25(OH)D levels < 18.25 ng/ml discriminated patients with NAFLD with a sensitivity of 89.0% and a specificity of 73.0% (AUC: 85.7%; 95%CI: 79.6-91.7%). NAFLD was exhibited by 83.9% of patients with 25(OH)D levels < 18.25 ng/ml and by 18% of those with 25(OH)D levels ≥ 18.25 ng/ml (p < 0.0001). CONCLUSION In people with chronic SCI, 25(OH)D levels < 18.25 ng/ml may represent a marker of NAFLD independent of MetS-related features. Further studies are warranted to define the cause-effect relationships of this association.
Collapse
Affiliation(s)
- F Di Giulio
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - C Castellini
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - D Tienforti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - G Felzani
- Spinal Unit, San Raffaele Sulmona Institute, Sulmona, Italy
| | - M G Baroni
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Neuroendocrinology and Metabolic Diseases, IRCCS Neuromed, Pozzilli, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| |
Collapse
|
16
|
Oleson CV, Olsen AC, Shermon S. Spinal cord infarction attributed to SARS-CoV-2, with post-acute sequelae of COVID-19: A case report. World J Clin Cases 2023; 11:8542-8550. [PMID: 38188200 PMCID: PMC10768511 DOI: 10.12998/wjcc.v11.i36.8542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND While stroke and lower extremity venous thromboemboli have been commonly reported following acute infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spinal cord infarction or ischemia has been extremely rare. Findings of long coronavirus disease (COVID) in this select population have not been studied. CASE SUMMARY We present the case of a 70-year-old female with sudden onset of trunk and lower extremity sensorimotor loss due to spinal cord infarction, attributed to acute infection with SARS-CoV-2. Diagnostic work up confirmed a T3 complete (ASIA impairment Scale A) paraplegia resulting from a thrombotic infarct. Her reported myalgias, neuropathic pain, spasticity, bladder spasms, and urinary tract infections exceeded the frequency and severity of many spinal cord injury (SCI) individuals of similar age and degree of neurologic impairment. In her first year after contracting COVID-19, she underwent 2 separate inpatient rehabilitation courses, but also required acute hospitalization 6 additional times for subsequent infections or uncontrolled pain. Yet other complications of complete non-traumatic SCI (NTSCI), including neurogenic bowel and temperature hypersensitivity, were mild, and pressure injuries were absent. She has now transitioned from the acute to chronic phase of spinal cord injury care, with subsequent development of post-acute sequelae of SARS-CoV-2 infection (PASC). CONCLUSION This individual experienced significant challenges with the combined effects of acute T3 NTSCI and acute COVID-19, with subsequent progression to PASC.
Collapse
Affiliation(s)
- Christina V Oleson
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Rehabilitation Institute, Cleveland, OH 44109, United States
| | - Andrew C Olsen
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Rehabilitation Institute, Cleveland, OH 44109, United States
| | - Suzanna Shermon
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Rehabilitation Institute, Cleveland, OH 44109, United States
| |
Collapse
|
17
|
Liu Y, George R, Tan GYH. Spontaneous spinal epidural hematoma leading to acute paraplegia: a case report. J Med Case Rep 2023; 17:545. [PMID: 38093265 PMCID: PMC10720198 DOI: 10.1186/s13256-023-04297-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Spontaneous spinal epidural hematoma is an infrequent yet potentially debilitating condition characterized by blood accumulation in the epidural space, with only 300 documented cases globally. Although the exact etiology of spontaneous spinal epidural hematoma remains poorly understood, theories suggest arteriovenous malformations, rupture of epidural vessels, or epidural veins as possible causes. CASE PRESENTATION This study presents a 58-year-old Malay woman patient from Singapore with well-controlled hypertension, hyperlipidemia, type II diabetes mellitus, and microscopic hematuria. Despite a prior cystoscopy revealing no abnormalities, she presented to the emergency department with sudden-onset back pain, weakness, and numbness in both lower limbs. Rapidly progressing symptoms prompted imaging, leading to the diagnosis of a spinal epidural hematoma from thoracic (T) 9 to lumbar (L) 1. Prompt decompressive surgery was performed, and the patient is currently undergoing postoperative rehabilitation for paralysis. CONCLUSION This case emphasizes the severity and life-altering consequences of spontaneous spinal epidural hematomas. Despite various proposed causative factors, a definitive consensus remains elusive in current literature. Consequently, maintaining a low threshold of suspicion for patients with similar presentations is crucial. The findings underscore the urgent need for swift evaluation and surgical intervention in cases of acute paraplegia.
Collapse
Affiliation(s)
- Yu Liu
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore.
| | - Rajeesh George
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Gamaliel Yu Heng Tan
- Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore, Singapore
| |
Collapse
|
18
|
Jaramillo JP, Johanson ME, Kiratli BJ. Adherence and perceptions of a home sports video gaming program in persons with spinal cord injuries: A pilot study. J Spinal Cord Med 2023:1-11. [PMID: 37975789 DOI: 10.1080/10790268.2023.2268328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE Sports video-gaming can facilitate increased activity levels in persons with limited exercise options. Understanding how persons with spinal cord injuries (SCI) participate in home-based video-gaming and its potential impact on maintaining or enhancing physical function remains largely unexplored. The purpose of this study was to evaluate adherence, perceptions, and potential physical effects of a home sports video-game program for persons with chronic SCI. PARTICIPANTS Fourteen individuals with chronic SCI (9 tetraplegia, 5 paraplegia). DESIGN This was a prospective study. Wii video-gaming systems that included four sports games were provided to participants for home use. Participants were instructed to play for 8 weeks 3-4 days/week. The video consoles recorded the time and number of sessions played. OUTCOME MEASURES At baseline and at the conclusion of the program, measurements were made of upper extremity strength, perceived exertion, active heart rate, pain, balance, and a functional upper extremity (UE) test. The total time and number of sessions were compared to the prescribed game play as a measure of adherence. Scores from a self-reported survey were used to gauge participants' satisfaction and perceptions of their gaming experience. RESULTS Overall mean gaming adherence was 85% during the first 4 weeks and 69% for the second 4 weeks. There were no significant changes in upper extremity strength, active heart rate, balance, pain, or functional UE test for either group. All of the participants rated video gaming as enjoyable and 85.7% perceived that it could be used as a form of exercise. CONCLUSION The Wii sports home video-gaming intervention elicited overall high adherence rates and was well received by study participants indicating that it may have value as an adjunctive tool for increasing physical activity for individuals with SCI.
Collapse
Affiliation(s)
- Jeffrey P Jaramillo
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - M Elise Johanson
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
- University of California San Francisco, San Francisco State University Graduate Program in Physical Therapy, San Francisco, California, USA
| | - B Jenny Kiratli
- Spinal Cord Injury and Disorders Center, VA Palo Alto Health Care System, Palo Alto, California, USA
| |
Collapse
|
19
|
Carlozzi NE, Kallen MA, Morin KG, Fyffe DC, Wecht JM. Item Banks for Measuring the Effect of Blood Pressure Dysregulation on Health-Related Quality of Life in Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2023; 104:1872-1881. [PMID: 37172674 DOI: 10.1016/j.apmr.2023.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/24/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To report on the development and calibration of the new Blood Pressure Dysregulation Measurement System (BPD-MS) item banks that assess the effect of BPD on health-related quality of life (HRQOL) and the daily activities of Veterans and non-Veterans with spinal cord injury (SCI). DESIGN Cross-sectional survey study. SETTING Two Veteran Affairs medical centers and a SCI model system site. PARTICIPANTS 454 respondents with SCI (n=262 American Veterans and n=192 non-Veterans; N=454). INTERVENTIONS Not applicable MAIN OUTCOME MEASURES: The BPD-MS item banks. RESULTS BPD item pools were developed and refined using literature reviews, qualitative data from focus groups, and cognitive debriefing of persons with SCI and professional caregivers. The item banks then underwent expert review, reading level assessment, and translatability review prior to field testing. The items pools consisted of 180 unique questions (items). Exploratory and confirmatory factor analyses, item response theory modeling, and differential item function investigations resulted in item banks that included a total of 150 items: 75 describing the effect of autonomic dysreflexia on HRQOL, 55 describing the effect of low blood pressure (LBP) on HRQOL, and 20 describing the effect of LBP on daily activities. In addition, 10-item short forms were constructed based on item response theory-derived item information values and the clinical relevance of item content. CONCLUSIONS The new BPD-MS item banks and corresponding 10-item short forms were developed using established rigorous measurement development standards, which represents the first BPD-specific patient-reported outcomes measurement system unique for use in the SCI population.
Collapse
Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kel G Morin
- Veterans Affairs Rehabilitation Research & Development Service (VA RR&D) Center of Excellence for Medical Consequences of SCI, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Spinal Cord Damage Research Center, James J. Peters VAMC, Bronx, NY
| | - Denise C Fyffe
- Kessler Foundation, West Orange, NJ; Rutgers New Jersey Medical School, Newark, NJ
| | - Jill M Wecht
- Veterans Affairs Rehabilitation Research & Development Service (VA RR&D) Center of Excellence for Medical Consequences of SCI, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Spinal Cord Damage Research Center, James J. Peters VAMC, Bronx, NY; Department of Human Performance and Rehabilitation Medicine, the Icahn School of Medicine, Mount Sinai, New York, NY; Department of Medicine, the Icahn School of Medicine, Mount Sinai, New York, NY
| |
Collapse
|
20
|
L Boettcher M, Oldenburg KS, Neel G, Kunkle B, Eichinger JK, Friedman RJ. Perioperative complications and outcomes in patients with paraplegia undergoing rotator cuff repair. Shoulder Elbow 2023; 15:3-14. [PMID: 37974609 PMCID: PMC10649483 DOI: 10.1177/17585732211036461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/13/2021] [Indexed: 11/19/2023]
Abstract
Background Patients with paraplegia often experience chronic shoulder pain due to overuse. We sought to determine if these patients have an increased prevalence of perioperative complications and higher rates of re-admissions and rotator cuff re-tears relative to able-bodied controls following rotator cuff repair (RCR). Methods We queried the NRD (2011-2018) to identify all patients undergoing primary RCR (n = 34,451) and identified cohorts of matched paraplegic and non-paraplegic patients (n = 194 each). We compared demographic factors, comorbidity profiles, perioperative complication rates, length of stay, revision rates, and re-admission rates between the two groups. Results Patients with paraplegia had lower rates of chronic obstructive pulmonary disease (p = 0.02), hypertension (p = 0.007), congestive heart failure (p = 0.027), obesity (p < 0.001), and prior myocardial infarction (p = 0.01). Additionally, patients with paraplegia experienced higher rates of urinary tract infections (11.9% vs. 2.1%, p < 0.001), lower rates of acute respiratory distress syndrome (0% vs. 3.1%, p = 0.041), and had a longer length of stay (4-days vs. 1-day, p < 0.001). Revision rates were similar for the two groups. Conclusions Compared to matched controls, patients with paraplegia were found to have similar demographic characteristics, less comorbidities, similar perioperative complication rates, and similar revision rates. These findings address a gap in the literature regarding surgical management of shoulder pain in patients with paraplegia by providing a matched comparison with a large sample size.
Collapse
Affiliation(s)
- Marissa L Boettcher
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Kirsi S Oldenburg
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Garrett Neel
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Bryce Kunkle
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Josef K Eichinger
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Richard J Friedman
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
21
|
Paiva VCDE, Nunes CV, Antonialli CV, Moraes PHC, Foizer GA, Vasconcelos ITDE, San Juan Dertkigil S, Cliquet Junior A, Miranda JBDE. EPIDEMIOLOGY OF POST-TRAUMATIC SPINAL CORD INJURY IN A TERTIARY HOSPITAL. Acta Ortop Bras 2023; 31:e264492. [PMID: 37876866 PMCID: PMC10592369 DOI: 10.1590/1413-785220233105e264492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/14/2022] [Indexed: 10/26/2023]
Abstract
Objective to outline the profile of risk groups for spinal cord injury (SCI) at the Hospital de Clinicas de Campinas by an epidemiological survey of 41 patients with SCI. Methods Data from patients with SCI were collected and analyzed: demographic data, level of neurological injury, visual analogue scale (VAS), and the current American Spinal Injury Association (ASIA) impairment scale (AIS), using questionnaires, medical records, and imaging tests. Fisher's exact test was used to assess the relationship between categorical variables, Spearman's correlation coefficient was used for numerical variables, and the Mann-Whitney and Kruskal-Wallis tests were used to analyze the relationship between categorical and numerical variables, with significance level of 5%. Results There was a prevalence of 82.9% of men, a mean age of 26.5 years, and traffic accidents as the cause of SCI in 56.1% of cases. Conclusion Results suggest the importance of SCI prevention campaigns directed at this population. Level of Evidence II, Retrospective Study.
Collapse
Affiliation(s)
- Vagner Clayton DE Paiva
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Camilo Velloso Nunes
- Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Caio Villela Antonialli
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Pedro Henrique Calegari Moraes
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Guilherme Augusto Foizer
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - Iuri Tomaz DE Vasconcelos
- Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, Departamento de Ortopedia e Traumatologia, São Paulo, SP, Brazil
| | - Sergio San Juan Dertkigil
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Serviço de Radiologia, Campinas, SP, Brazil
| | - Alberto Cliquet Junior
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| | - João Batista DE Miranda
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Campinas, SP, Brazil
| |
Collapse
|
22
|
Heuer A, Koepke LG, Viezens L, Schroeder M. [Perioperative management after traumatic paraplegia : Avoiding complications]. Unfallchirurgie (Heidelb) 2023; 126:749-755. [PMID: 37306757 DOI: 10.1007/s00113-023-01342-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/13/2023]
Abstract
This article describes the current status of modern treatment options for traumatic spinal cord injuries with a particular focus on the perioperative phase. Along with a recognition of age-related specific features that can impact successful treatment of spinal injuries, prompt interdisciplinary treatment while adhering to the "time is spine" principle is of high importance. By considering this approach and using modern diagnostic and surgical techniques, successful surgical treatment can be achieved while taking into account individual characteristics, such as reduced bone quality, accompanying injuries as well as oncological and inflammatory rheumatic comorbidities. The preventive and treatment strategies for frequently occurring complications in the management of traumatic spinal cord injuries are presented. By considering case-specific factors, utilizing modern surgical techniques, avoiding or promptly treating typical complications and initiating interdisciplinary treatment, crucial groundwork for a successful long-term treatment of this highly debilitating and life-altering injury can be established in the perioperative phase.
Collapse
Affiliation(s)
- Annika Heuer
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Leon-Gordian Koepke
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Lennart Viezens
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Malte Schroeder
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Sektion Wirbelsäulenchirurgie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| |
Collapse
|
23
|
Al Tobing SD, Malau VD. Anterior and posterior fusion via a posterior and costotransversectomy approach for thoracic spinal tuberculosis: A case report. Int J Surg Case Rep 2023; 111:108698. [PMID: 37757733 PMCID: PMC10539854 DOI: 10.1016/j.ijscr.2023.108698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Left untreated, spinal tuberculosis can lead to irreversible neurological deficit in patients, lowering quality of life. Combination of antitubercular drugs and surgical approach is important in managing spinal tuberculosis. We report a case of thoracic spinal tuberculosis treated by anterior and posterior fusion via a posterior and costotransversectomy approach. PRESENTATION OF CASE A 38 years-old woman diagnosed with paraplegia due to spinal tuberculosis of the thoracic vertebra (Th8) with Frankel A grade for spinal function. Pre-op kyphotic angle was 27.2°. Antitubercular drugs prescribed did not improve paraplegia symptom. Thoracal X-ray and MRI showed pathological fracture on Th8 and paravertebral abscess along anterior corpus of the Th6-9. We performed Sapardan's alternative VI approach that consists of debridement and abscess evacuation, decompression by laminectomy of the Th8, flavectomy and costotransversectomy of the Th8, posterior stabilization of the Th6-7 and Th9-10, and interbody fusion of the Th8. One month postoperative follow up showed improvement on motor function and sensory function. Post op kyphotic angle was 26.7°. CLINICAL DISCUSSION Adequate debridement followed by costotransversectomy, interbody fusion and surgical stabilization relieves pain, improves neurologic function, and prevents deformity of spinal tuberculous patient. CONCLUSION Although costotransversectomy approach is rarely used in surgical management of spinal TB, it is beneficial in cases with massive abscess involvement since it provides better view to collect and drain massive abscess.
Collapse
Affiliation(s)
- S Dohar Al Tobing
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| | - Vino Daniel Malau
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
| |
Collapse
|
24
|
Ofli T, Kiran G, Kunt A. Sertoli leydig cell tumor of the ovary in a woman with cushing syndrome: A case report. Gynecol Oncol Rep 2023; 49:101277. [PMID: 37809349 PMCID: PMC10558708 DOI: 10.1016/j.gore.2023.101277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023] Open
Abstract
Sertoli-Leydig cell tumor (SLCT) is a rare tumor of the ovary.Cushing's syndrome (CS), on the other hand, is a clinical picture formed by the long-term high levels of glucocorticoids in the blood for any reason and the resulting symptoms. Exceptionally in some of cases, a tumor far from the adrenal region synthesizes adrenocortical hormones. Among such ectopic neoplasms, CS Tumors of the ovary that secrete cortisol as a cause of the disease is an exceptional case. In other words, in this case, we argue that the tumor in the ovary causes Cushing's syndrome by secreting cortisol and ACTH-like peptides. There are 5 cases reported in the literature. In this case report we present a case in which SCLT of the ovary was detected by histopathological examination in a patient who underwent laparoscopic surgery due to Cushing's syndrome and bilateral adnexal mass.
Collapse
Affiliation(s)
- Tuba Ofli
- Department of Obstetrics and Gynecology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Gurkan Kiran
- Department of Obstetrics and Gynecology, Bezmialem University, Faculty of Medicine, Istanbul, Turkey
| | - Atilla Kunt
- Department of Obstetrics and Gynecology, Medeniyet University, Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
25
|
Piazza M, Squizzato F, Bilato MJ, Forcella E, Grego F, Antonello M. The "safe-line" technique as theoretical additional attempt to mitigate spinal cord ischemia after urgent complete endovascular exclusion of a thoracoabdominal aortic aneurysm. J Vasc Surg Cases Innov Tech 2023; 9:101215. [PMID: 37408941 PMCID: PMC10319321 DOI: 10.1016/j.jvscit.2023.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/01/2023] [Indexed: 07/07/2023] Open
Abstract
We describe the feasibility of a technique for temporary aneurysm sac reperfusion after endovascular single-stage thoracoabdominal aortic aneurysm exclusion, to be used in the case of postoperative spinal cord ischemia. Two cases were treated for impending rupture of a thoracoabdominal aortic aneurysm. Before completion of sac exclusion, a supplementary buddy wire (V-18 control guidewire; Boston Scientific) was advanced in parallel fashion from the left percutaneous femoral access into the aneurysmal sac on the posterior aspect of the endograft. Distal aneurysm exclusion was completed using the main superstiff guidewire, and the femoral access was closed with a percutaneous closure device (ProGlide; Abbott) in standard fashion, leaving in place the sole V-18 guidewire, draped in sterile fashion. In the case of spinal cord ischemia, the "safe-line" can be rapidly used for spinal reperfusion after trans-sealing exchange with a 6F, 65-cm-long Destination sheath (Terumo) connected to a 6F introducer on the contralateral femoral artery.
Collapse
Affiliation(s)
- Michele Piazza
- Correspondence: Michele Piazza, MD, Vascular and Endovascular Surgery Division, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, School of Medicine, Padua University, Via Giustiniani 2, Padua 35125, Italy
| | | | | | | | | | | |
Collapse
|
26
|
Kim CH, Kim P, Ju CI, Kim SW. Massive Epidural Hematoma Caused by Percutaneous Epidural Neuroplasty: A Case Report. Korean J Neurotrauma 2023; 19:393-397. [PMID: 37840607 PMCID: PMC10567531 DOI: 10.13004/kjnt.2023.19.e20] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/25/2023] [Indexed: 10/17/2023] Open
Abstract
Percutaneous epidural neuroplasty (PEN) has been used to manage chronic back pain or radicular pain refractory to other conservative treatments, such as medication, injection, and physical therapy. However, similar to all invasive treatment modalities, it has serious complications, such as dural tears, infections, and hematoma formation. Herein, we present a rare case of an 81-year-old female patient on dementia medication who developed paraplegia 5 days after PEN. This is the first report of a poor outcome in a patient with dementia who developed paraplegia after PEN despite an emergency operation for spinal epidural hematoma.
Collapse
Affiliation(s)
- Chi Ho Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Pius Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| |
Collapse
|
27
|
Tavola F, Ruggeri M, Carrera I, Pumarola M, Alegria PM, Tauro A. Lumbar vertebral canal stenosis due to marked bone overgrowth after routine hemilaminectomy in a dog. Acta Vet Scand 2023; 65:37. [PMID: 37644545 PMCID: PMC10466704 DOI: 10.1186/s13028-023-00700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Bone overgrowth after decompressive surgery for lumbar stenosis resulting in recurrence of neurological signs has not been reported in veterinary literature. However, there are few cases described in human medicine. CASE PRESENTATION A 13-month-old entire female dog, a crossbreed between a Springer Spaniel and a Border Collie, weighing 24 kg, was referred with a 5-day history of progressive spastic paraplegia, indicative of a T3-L3 myelopathy. Magnetic resonance (MR) imaging revealed a right-sided L2-L3 compressive extradural lesion, compatible with epidural haemorrhage, which was confirmed by histopathology. The lesion was approached via right-sided L2-L3 hemilaminectomy and was successfully removed. One-year postoperatively the dog re-presented with pelvic limb ataxia. MR and computed tomography (CT) images demonstrated excessive vertebral bone formation affecting the right articular processes, ventral aspect of the spinous process of L2-L3, and contiguous vertebral laminae, causing spinal cord compression. Revision surgery was performed, and histopathology revealed normal or reactive osseous tissue with a possible chondroid metaplasia and endochondral ossification, failing to identify a definitive reason for the bone overgrowth. Nine-month postoperatively, imaging studies showed a similar vertebral overgrowth, resulting in minimal spinal cord compression. The patient remained stable with mild proprioceptive ataxia up until the last follow-up 18 months post-revision surgery. CONCLUSION This is the first report in the veterinary literature of bone overgrowth after lumbar hemilaminectomy which resulted in neurological deficits and required a revision decompressive surgery.
Collapse
Affiliation(s)
| | - Marco Ruggeri
- ChesterGates Veterinary Specialists, Units E & F, Telford Court, Gates Lane, Chester, Cheshire, CH1 6LT, UK
| | - Ines Carrera
- Vet Oracle Teleneurology, CVS Limited, Owen Road, Diss, Norfolk, IP22 4ER, UK
| | - Martí Pumarola
- Mouse and Comparative Pathology Unit, Department of Animal Medicine and Surgery, Veterinary Faculty, Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Universitat Autònoma de Barcelona, Campus UAB, Bellaterra, 08193, Barcelona, Spain
| | - Pablo Menendez Alegria
- ChesterGates Veterinary Specialists, Units E & F, Telford Court, Gates Lane, Chester, Cheshire, CH1 6LT, UK
| | - Anna Tauro
- ChesterGates Veterinary Specialists, Units E & F, Telford Court, Gates Lane, Chester, Cheshire, CH1 6LT, UK.
| |
Collapse
|
28
|
Xu Z, Tong Z, Guo J, Qi Y, Li L, Guo L. Acute Paraplegia Result from Spinal Ischemia Nine Years After Hybrid Total Arch Repair with Frozen Elephant Trunk: A Case Report. Braz J Cardiovasc Surg 2023; 38:e20220327. [PMID: 37540197 PMCID: PMC10399581 DOI: 10.21470/1678-9741-2022-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Spinal cord ischemia due to decreased cord perfusion is a devastating complication in patients with thoracoabdominal dissection following frozen elephant trunk (FET) repair surgery. However, rare occurrence of spinal cord ischemia leading to paraplegia after long-term follow-up of FET repair has been reported. Here, we describe a case of spinal cord ischemia resulting in paraplegia nine years after hybrid total arch repair with FET. Cerebrospinal fluid drainage and serial treatment were utilized to decrease intraspinal pressure and increase blood flow to the spinal cord. Three months after the onset of paraplegia and with treatment and rehabilitation, the patient recovered to walk.
Collapse
Affiliation(s)
- Zeqin Xu
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, People's Republic of China
| | - Zhu Tong
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, People's Republic of China
| | - Jianming Guo
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, People's Republic of China
| | - Yixia Qi
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, People's Republic of China
| | - Liqiang Li
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, People's Republic of China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuan Wu Hospital and Institute of Vascular Surgery, Capital Medical University, Beijing, People's Republic of China
| |
Collapse
|
29
|
Hussein H, Ali W. Unusual presentation of acute spinal cord injury with ischaemic electrocardiographic changes: a case report. Eur Heart J Case Rep 2023; 7:ytad359. [PMID: 37575529 PMCID: PMC10422689 DOI: 10.1093/ehjcr/ytad359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
Background Spinal cord injury (SCI) is a significant cause of morbidity and mortality with an incidence of 40-83/million/year. Sympathetic denervation in SCI leads to cardiovascular abnormalities including orthostatic hypotension, rhythm disturbance, and repolarization changes. Electrocardiographic (ECG) findings include bradyarrhythmias, ectopic beats, long QT interval, and ST-T changes that may be mistaken for myocardial ischaemia. Case summary A patient in their 40 s with free past medical history was referred to our centre with the diagnosis of non-ST elevation acute coronary syndrome. On presentation, chest pain was diffuse and radiating to the back. Twelve-lead ECG showed deep symmetrical T-wave inversion. Echocardiography and cardiac troponin were normal. The patient was scheduled for multi-slice computed tomography coronary angiography which was normal; however, a few hours after admission, the patient developed rapidly progressive motor weakness in both lower limbs with urine retention. Examination revealed motor power Grade 1 in both lower limbs. All sensations were diminished with a sensory level at T6. Urgent magnetic resonance imaging spine revealed neoplastic infiltration of the whole vertebrae with D5/D6 fracture exerting spinal cord compression. The patient was referred for urgent decompression surgery. Conclusion Electrocardiographic changes could be the earliest sign for ongoing SCI. ST-elevation is reported in higher levels of complete injury, while ST depression and inverted T waves can occur independent of lesion level or severity. Misinterpretation of these changes may cause a delay in reaching the correct diagnosis. We highlight the importance of considering neurological causes for ischaemic-like ECG changes, as early recognition could prevent irreversible functional loss.
Collapse
Affiliation(s)
- Hossameldin Hussein
- Department of Cardiology, Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt
- Department of Adult Cardiology, Aswan Heart Center, Kasr-El Hagar Street, Aswan 81511, Egypt
| | - Wessam Ali
- Department of Adult Cardiology, Aswan Heart Center, Kasr-El Hagar Street, Aswan 81511, Egypt
| |
Collapse
|
30
|
Tsoutsoubi L, Ioannou LG, Alba BK, Cheung SS, Daanen HA, Mekjavic IB, Flouris AD. Central versus peripheral mechanisms of cold-induced vasodilation: a study in the fingers and toes of people with paraplegia. Eur J Appl Physiol 2023; 123:1709-1726. [PMID: 37005962 PMCID: PMC10363085 DOI: 10.1007/s00421-023-05175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/07/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE This study examined physiological and perceptual parameters related to cold-induced vasodilation (CIVD) in the fingers and toes of people with paraplegia and compared them with responses observed in able-bodied individuals. METHODS Seven participants with paraplegia and seven able-bodied individuals participated in a randomized matched-controlled study involving left-hand and -foot immersion in cold water (8 ± 1 °C) for 40 min during exposure to cool (16 ± 1 °C), thermoneutral (23 ± 1 °C), and hot (34 ± 1 °C) ambient conditions. RESULTS Similar CIVD occurrence was observed in the fingers in the two groups. In toes, three of the seven participants with paraplegia revealed CIVDs: one in cool, two in thermoneutral, and three in hot conditions. No able-bodied participants revealed CIVDs in cool and thermoneutral conditions, while four revealed CIVDs in hot conditions. The toe CIVDs of paraplegic participants were counterintuitive in several respects: they were more frequent in cool and thermoneutral conditions (compared to the able-bodied participants), emerged in these conditions despite lower core and skin temperatures of these participants, and were evident only in cases of thoracic level lesions (instead of lesions at lower spinal levels). CONCLUSION Our findings demonstrated considerable inter-individual variability in CIVD responses in both the paraplegic and able-bodied groups. While we observed vasodilatory responses in the toes of participants with paraplegia that technically fulfilled the criteria for CIVD, it is unlikely that they reflect the CIVD phenomenon observed in able-bodied individuals. Taken together, our findings favor the contribution of central over peripheral factors in relation to the origin and/or control of CIVD.
Collapse
Affiliation(s)
- Lydia Tsoutsoubi
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Karies, 42100, Trikala, Greece
| | - Leonidas G Ioannou
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Karies, 42100, Trikala, Greece
| | - Billie K Alba
- Thermal and Mountain Medicine Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, 01760, USA
| | - Stephen S Cheung
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Hein A Daanen
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Igor B Mekjavic
- Department of Automation, Biocybernetics and Robotics, Józef Stefan Institute, 1000, Ljubljana, Slovenia
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada
| | - Andreas D Flouris
- FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Karies, 42100, Trikala, Greece.
| |
Collapse
|
31
|
Kröger I, Wackerle H, Maier D, Mach O, Augat P. [Movement analysis in spinal cord injuries : Assistance in clinical decision making]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04409-y. [PMID: 37490136 PMCID: PMC10400683 DOI: 10.1007/s00132-023-04409-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/26/2023]
Abstract
For motor incomplete spinal cord injured patients, improvement of walking function is an important aim in the rehabilitation program. In specialized treatment centers, the 6‑minute walking test, the 10-meter walking test or the timed-up-and-go test are used as an assessment tool to determine walking ability, but these tests are not able to assess the quality of gait. Marker-based movement analysis can be used as a reliable method to evaluate the gait pattern. This allows an objective assessment of gait quality over time or can be used to support therapy planning. The benefit of such an analysis is presented by means of two case studies.
Collapse
Affiliation(s)
- Inga Kröger
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland.
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich.
| | - Hannes Wackerle
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
| | - Doris Maier
- Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Orpheus Mach
- Zentrum für Rückenmarkverletzte, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Deutschland
| | - Peter Augat
- Institut für Biomechanik, Berufsgenossenschaftliche Unfallklinik Murnau, Professor-Küntscher-Straße 8, 82418, Murnau, Deutschland
- Institut für Biomechanik, Paracelsus Medizinische Privatuniversität Salzburg, Salzburg, Österreich
| |
Collapse
|
32
|
Wecht JM, Weir JP, Katzelnick CG, Dyson-Hudson TA, Bauman WA, Kirshblum SC. Clinical trial of home blood pressure monitoring following midodrine administration in hypotensive individuals with spinal cord injury. J Spinal Cord Med 2023; 46:531-539. [PMID: 36972219 DOI: 10.1080/10790268.2021.1977904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) above thoracic level-6 (T6) experience impaired descending cortical control of the autonomic nervous system which predisposes them to blood pressure (BP) instability, including includes hypotension, orthostatic hypotension (OH), and autonomic dysreflexia (AD). However, many individuals do not report symptoms of these BP disorders, and because there are few treatment options that have been proven safe and effective for use in the SCI population, most individuals remain untreated. OBJECTIVE The primary aim of this investigation was to determine the effects of midodrine (10 mg) prescribed TID or BID in the home environment, compared to placebo, on 30-day BP, study withdrawals, and symptom reporting associated with OH and AD in hypotensive individuals with SCI. DESIGN/METHODS Participants were randomly assigned to received midodrine/placebo or placebo/midodrine, with a 2-weeks washout period in between, and both the participants and investigators were blinded to randomization order. Study medication was taken 2 or 3 times/day, depending on their sleep/wake schedule, BP, and any related symptoms were recorded before and 1 h after each dosage and periodically throughout the day. RESULTS Nineteen individuals with SCI were recruited; however, 9 withdrew prior to completion of the full protocol. A total of 1892 BP recordings (75 ± 48 recordings/participant/30-day period) were collected in the 19 participants over the two 30-day monitoring periods. Average 30-day systolic BP was significantly increased with midodrine compared to placebo (114 ± 14 vs. 96 ± 11 mmHg, respectively; P = 0.004), and midodrine significantly reduced the number of hypotensive BP recordings compared to placebo (38.7 ± 41.9 vs. 73.3 ± 40.6, respectively; P = 0.01). However, compared to placebo, midodrine increased fluctuations in BP, did not improve symptoms of OH, but did significantly worsen the intensity of symptoms associated with AD (P = 0.03). CONCLUSION Midodrine (10 mg) administered in the home environment effectively increases BP and reduces the incidence of hypotension; however these beneficial effects come at the expense of worsened BP instability and AD symptom intensity.
Collapse
Affiliation(s)
- Jill M Wecht
- James J Peters VA Medical Center, Bronx, NY, USA
- Departments of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Rehabilitation Medicine and Human Performance at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, KS, USA
| | - Caitlyn G Katzelnick
- James J Peters VA Medical Center, Bronx, NY, USA
- Kessler Foundation, West Orange, NJ, USA
| | - Trevor A Dyson-Hudson
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - William A Bauman
- James J Peters VA Medical Center, Bronx, NY, USA
- Departments of Medicine, the Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Rehabilitation Medicine and Human Performance at the Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven C Kirshblum
- Kessler Foundation, West Orange, NJ, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
- Kessler Institute for Rehabilitation, West Orange, NJ, USA
| |
Collapse
|
33
|
Ashkin A, Parmenter J, Plowman K, Franco-Sadud R. Spontaneous Hemorrhage of Thoracic Cavernous Malformation Leading to Bilateral Lower Extremity Paralysis. J Community Hosp Intern Med Perspect 2023; 13:62-64. [PMID: 37877057 PMCID: PMC10593171 DOI: 10.55729/2000-9666.1180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/10/2023] [Accepted: 02/22/2023] [Indexed: 10/26/2023] Open
Abstract
Cavernous malformations (CMs) are abnormal clusters of thin-walled blood vessels located in the central nervous system. An 87-year-old male with a history of heart failure with reduced ejection fraction, coronary artery disease, and atrial fibrillation on rivaroxaban was admitted for acute onset, bilateral lower extremity weakness. He was found to have hemorrhagic transformation of a pre-existing spinal cord cavernous malformation located at the level of T9 of the thoracic column worsened by his use of anticoagulation. Surgical resection remains the only definitive management. Patients at high risk for surgical intervention are managed with supportive care and physical therapy.
Collapse
|
34
|
Stuhr M, Kowald B, Schulz AP, Meyer M, Hirschfeld S, Böthig R, Thietje R. Demographics and functional outcome of shallow water diving spinal injuries in northern Germany - A retrospective analysis of 160 consecutive cases. Injury 2023:S0020-1383(23)00198-5. [PMID: 36990902 DOI: 10.1016/j.injury.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/22/2023] [Accepted: 03/04/2023] [Indexed: 03/31/2023]
Abstract
AIM To describe demographic findings, typical injuries and functional neurological outcomes in patients with cervical trauma and tetraplegia sustained after diving into shallow water. PATIENTS AND METHODS A retrospective study was performed including all patients treated in BG Klinikum Hamburg suffering from tetraplegia after jumping into shallow water between 1st June 1980 and 31st July 2018. RESULTS One hundred and sixty patients with cervical spinal injuries and tetraplegia following a dive into shallow water were evaluated. Of these, 156 patients (97.5%) were male. The mean age was 24.3 years ± 8.1 and the accidents occurred most often in inland waters (56.2%) and mostly between May and August (90.6%). In all cases there was one vertebra fractured, whereas in 48.1% of cases, two vertebrae were severed. In the majority of cases (n = 146), a surgical procedure was performed. Overall, the mean hospital stay was 202 days (±72, range: 31-403) and one patient died. On admission, 106 patients (66.2%) showed a complete lesion according to AIS A, with incomplete lesions in the remaining 54 patients (AIS B: n = 25 [15.6%], AIS C: n = 26 [16.3%], AIS D: n = 3 [1.9%]). In two thirds of the patients, the level of paralysis on admission was at the level of segments C4 (31.9%) or C5 (33.7%). Seventeen patients (10.6%) needed prehospital resuscitation. In 55 patients (34.4%), the neurological findings improved during the course of inpatient treatment and rehabilitation. Sixty-eight patients (42.5%) developed pneumonia, of which 52 patients (76.5%) were ventilated. In addition, 56.5% of patients with paralysis levels C0-C3 required ventilation, whereas only 6.3% of patients with paralysis levels C6-C7 were affected. Three patients (1.9%) were discharged from hospital with continuous ventilation. Overall, 27.4% of all AIS A patients, 56% of all AIS B patients and 46.2% of all AIS C patients improved neurologically, with 17% of all patients being able to walk. CONCLUSIONS The consequences of a cervical spine injury after diving into shallow water are severe and lifelong. Functionally, patients may benefit from care in a specialised centre, both in the acute phase and during rehabilitation. The more incomplete the primary paralysis, the greater the possibility of neurological recovery.
Collapse
Affiliation(s)
- Markus Stuhr
- Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Medicine, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany.
| | - Birgitt Kowald
- Zentrum für Klinische Forschung, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Arndt P Schulz
- Zentrum für Klinische Forschung, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany; University of Luebeck, Medical Faculty, Luebeck, Germany
| | - Matthias Meyer
- University of Luebeck, Medical Faculty, Luebeck, Germany
| | - Sven Hirschfeld
- Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Ralf Böthig
- Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| | - Roland Thietje
- Spinal Cord Injury Center, BG Klinikum Hamburg, Bergedorfer Strasse 10, 21033 Hamburg, Germany
| |
Collapse
|
35
|
Singh S, Iyer RD, Rai A, GI S, Sharma D, Surana R. Biological Stabilisation vs Mechanical Fixation: Do We Always Require Instrumentation in Anterior Decompression Surgeries for Thoracolumbar Spinal Tuberculosis? Indian J Orthop 2023; 57:472-480. [PMID: 36825265 PMCID: PMC9941384 DOI: 10.1007/s43465-023-00827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 01/17/2023] [Indexed: 02/03/2023]
Abstract
Study Design A retrospective cohort study. Purpose To compare the outcomes of anterior decompression with bone grafting alone and anterior decompression with bone grafting and fixation. Methods 93 patients with minimum 2 year follow-up were included in the study. 50 patients had undergone anterior decompression with bone grafting without instrumentation (group 1) and 43 patients with instrumentation (group 2). Both groups were compared using their demographic data, vertebral level of involvement, neurological recovery and progression of kyphotic deformity. Results Demographic data and pre-operative parameters were comparable in both groups. The mean (SD) of pre-operative kyphotic angle (in degrees) in group 1 was 29° (8.47°) and in group 2 was 29.81° (9.51°). The mean loss of correction at follow-up was 9.6° for group 1 compared to 3.4° for group 2. The mean loss of correction in patients of group 1 involving upper thoracic spine was 5.6°. There was no significant difference between the two groups across different age groups. Conclusion Use of anterior instrumentation for decompression surgeries in cases of tubercular spine have shown significantly better results compared to strut grafting alone with respect to restricting the progression of kyphotic deformity at follow-up. Instrumentation may be avoided in patients older than 60 years of age and those involving the upper thoracic spine, more so if both of these co-exist. However, further studies are needed to make our patient selection more rational, so as to avoid the failures and complications of this morbid procedure. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-00827-4.
Collapse
Affiliation(s)
- Saurabh Singh
- Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh India
| | - R Dinesh Iyer
- Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu India
| | - Alok Rai
- Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, India
| | - Siddalingeshwara GI
- Department of Orthopaedics, Oxford Medical College and Research Centre, Bangalore, Karnataka India
| | - Divyansh Sharma
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Rishabh Surana
- Department of Orthopaedics, Fortis Hospital, Mohali, India
| |
Collapse
|
36
|
Cho SY, Jang BH, Seo JW, Kim SW, Lim KJ, Lee HY, Kim DJ. Transverse myelitis caused by herpes zoster following COVID-19 vaccination: A case report. World J Clin Cases 2023; 11:1419-1425. [PMID: 36926132 PMCID: PMC10013101 DOI: 10.12998/wjcc.v11.i6.1419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/17/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Transverse myelitis (TM) is characterized by sudden lower extremity progressive weakness and sensory impairment, and most patients have a history of advanced viral infection symptoms. A variety of disorders can cause TM in association with viral or nonviral infection, vascular, neoplasia, collagen vascular, and iatrogenic, such as vaccination. Vaccination has become common through the global implementation against coronavirus disease 2019 (COVID-19) and reported complications like herpes zoster (HZ) activation has increased.
CASE SUMMARY This is a 68-year-old woman who developed multiple pustules and scabs at the T6-T9 dermatome site 1 wk after vaccination with the COVID-19 vaccine (Oxford/ AstraZeneca ([ChAdOx1S{recombinant}]). The patient had a paraplegia aggravation 3 wk after HZ symptoms started. Spinal magnetic resonance imaging (MRI) showed transverse myelitis at the T6–T9 Level. Treatment was acyclovir with steroids combined with physical therapy. Her neurological function was slowly restored by Day 17.
CONCLUSION HZ developed after COVID-19 vaccination, which may lead to more severe complications. Therefore, HZ treatment itself should not be delayed. If neurological complications worsen after appropriate management, an immediate diagnostic procedure, such as magnetic resonance imaging and laboratory tests, will start and should treat the neurological complications.
Collapse
Affiliation(s)
- Su-Yeon Cho
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, South Korea
| | - Bo-Hyun Jang
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, South Korea
| | - Jun-Won Seo
- Department of Internal Medicine, Chosun University, College of Medicine, Gwangju 61453, South Korea
| | - Suk-Whee Kim
- Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju 61453, South Korea
| | - Kyung-Joon Lim
- Department of Anesthesiology and Pain Medicine, Chosun University, College of Medicine, Gwangju 61453, South Korea
| | - Hyun-Young Lee
- Department of Anesthesiology and Pain Medicine, Chosun University, College of Medicine, Gwangju 61453, South Korea
| | - Dong-Joon Kim
- Department of Anesthesiology and Pain Medicine, Chosun University, College of Medicine, Gwangju 61453, South Korea
| |
Collapse
|
37
|
Yun HY, Jung JA, Song WK, Kim SH, Kim O. Sacral interface pressure can be alleviated by repositioning with a small-angle change using an automated bed in patients with spinal cord injury. J Tissue Viability 2023:S0965-206X(23)00027-X. [PMID: 36894461 DOI: 10.1016/j.jtv.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/20/2023] [Accepted: 02/17/2023] [Indexed: 02/21/2023]
Abstract
AIM OF THE STUDY This study aimed to compare interface pressure and total contact area of the sacral region in different positions, including small-angle changes, in patients with spinal cord injury (SCI). Furthermore, we analyzed the clinical factors influencing pressure to identify the pressure injury (PI) high-risk group. MATERIALS AND METHODS An intervention was conducted for patients with paraplegia (n = 30) with SCI. In the first and second trials, interface pressure and total contact area of the sacral region were recorded from large- and small-angled positions using the automatic repositioning bed, which can change the angle of the back, lateral tilt, and knee. RESULTS Positions with back raised ≥45° showed significantly higher pressure on the sacrum than most other positions. The pressure and contact area differences were statistically insignificant for combinations of small-angled changes <30°. Additionally, the duration of injury (β = 0.51, p = 0.010) and neurological level of injury (NLI) (β = -0.47, p = 0.020) were significant independent predictors of average pressure. Similarly, the duration of injury (β = 0.64, p = 0.001), the Korean version of the spinal cord independence measure-III (β = -0.52, p = 0.017), and body mass index (BMI; β = -0.34, p = 0.041) were significant independent predictors of peak pressure. CONCLUSIONS For repositioning, combinations of small-angle changes <30° effectively reduce pressure on the sacral region in patients with SCI. Lower BMI, longer duration of injury, lower functioning score, and NLI ≥ T7 are predictors of high sacral pressures, which increase the risk for PI. Therefore, patients with these predictors require strict management.
Collapse
|
38
|
Kim DJ, Han S, Lim C. The Neuroprotective Effects of Ginsenoside Rd Pretreatment in a Rat Model of Spinal Cord Ischemia-Reperfusion Injury. Braz J Cardiovasc Surg 2023; 38:29-36. [PMID: 36112741 PMCID: PMC10010733 DOI: 10.21470/1678-9741-2021-0548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
INTRODUCTION Paraplegia may develop as a result of spinal cord ischemia-reperfusion injury in patients who underwent thoracoabdominal aortic surgery. The objective of this research is to determine the neuroprotective effects of ginsenoside Rd pretreatment in a rat model of spinal cord ischemia-reperfusion injury. METHODS Sprague-Dawley rats (n=36) were randomly assigned to three groups. The sham (n=12) and control (n=12) groups received normal saline orally. The Rd group (n=12) received ginsenoside Rd (100 mg/kg) orally 48 hours before the induction of spinal cord ischemia. Spinal cord ischemia was induced by aortic occlusion using a Fogarty balloon catheter in the Rd and control groups. A neurological assessment according to the motor deficit index and a histological evaluation of the spinal cord were performed. To evaluate the antioxidant activity of ginsenoside Rd, malondialdehyde levels and superoxide dismutase activity were determined. Further, the tissue levels of tumor necrosis factor-alpha and interleukin-1 beta were measured. RESULTS The Rd group showed significantly lower motor deficit index scores than did the control group throughout the entire experimental period (P<0.001). The Rd group demonstrated significantly greater numbers of normal motor neurons than did the control group (P=0.039). The Rd group exhibited decreased malondialdehyde levels (P<0.001) and increased superoxide dismutase activity (P=0.029) compared to the control group. Tumor necrosis factor-alpha and interleukin-1 beta tissue levels were significantly decreased in the Rd group (P<0.001). CONCLUSION Ginsenoside Rd pretreatment may be a promising treatment to prevent ischemia-reperfusion injury in patients who undergo thoracoabdominal aortic surgery.
Collapse
Affiliation(s)
- Dong Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Sunghee Han
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| |
Collapse
|
39
|
Fenton JM, King JA, McLeod CJ, Hoekstra SP, Finlayson G, Goosey-Tolfrey VL. A comparison of meal-related appetite, food reward and eating behaviour traits in people with and without spinal cord injury. Appetite 2023; 181:106384. [PMID: 36414146 DOI: 10.1016/j.appet.2022.106384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/20/2022]
Abstract
Persons with a spinal cord injury (SCI) are at a heightened risk of obesity. However, little is known about the effect of SCI on factors that influence energy intake. This study compared measures of food reward, eating behaviour traits, and appetite perceptions between adults with and without SCI. Twenty wheelchair dependent persons with chronic (>1 year) SCI (C1-T12) and twenty non-SCI individuals matched for BMI, age and sex participated. Following a familiarisation visit, participants consumed a breakfast meal, normalised for resting metabolic rate (RMR), and provided subjective appetite perceptions every 30 min for 4 h. Subsequently, energy intake was determined via an ad libitum lunch meal. Explicit liking, explicit wanting, implicit wanting and relative preference were assessed in a hungry and fed state via the Leeds Food Preference Questionnaire prior to and following the lunch meal. Eating behaviour traits were assessed via the Adult Eating Behaviour Questionnaire, Control of Eating Questionnaire, Reasons Individuals Stop Eating Questionnaire, and Three-Factor Eating Questionnaire Revised 18-item version. Sweet appeal bias was greater for explicit liking, explicit wanting, and relative preference in the group with SCI compared to the non-SCI group (p ≤ 0.024). The group with SCI also reported higher levels of cognitive restraint and satiety responsiveness (p ≤ 0.029). No group differences in postprandial appetite perceptions (p ≥ 0.690) or energy intake relative to RMR were seen (p = 0.358). However, the group with SCI demonstrated a trend toward a lower absolute energy intake (p = 0.063). In conclusion, food reward for sweet foods was greater in the group with SCI. Further, our findings suggest that acute appetite perceptions, including satiety profiles, are not different between persons with and without SCI.
Collapse
Affiliation(s)
- Jordan M Fenton
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, UK; Peter Harrison Centre for Disability Sport, Loughborough University, UK.
| | - James A King
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK.
| | - Chris J McLeod
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK.
| | - Sven P Hoekstra
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, UK; Peter Harrison Centre for Disability Sport, Loughborough University, UK.
| | - Graham Finlayson
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
| | - Victoria L Goosey-Tolfrey
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, UK; Peter Harrison Centre for Disability Sport, Loughborough University, UK.
| |
Collapse
|
40
|
Zhang JK, Alimadadi A, ReVeal M, Del Valle AJ, Patel M, O'Malley DS, Mercier P, Mattei TA. Litigation involving sports-related spinal injuries: a comprehensive review of reported legal claims in the United States in the past 70 years. Spine J 2023; 23:72-84. [PMID: 36028214 DOI: 10.1016/j.spinee.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT Sports-related spinal injuries can be catastrophic in nature. Athletes competing in collision sports (eg, football) may be particularly prone to injury given the high-impact nature of these activities. Due to the oftentimes profound impact of sports-related spinal injuries on health and quality-of-life, they are also associated with a substantial risk of litigation. However, no study to date has assessed litigation risks associated with sports-related spinal injuries. A better understanding of the risk factors surrounding these legal claims may provide insights into injury prevention and other strategies to minimize litigation risks. In addition, it may allow the spine surgeon to better recognize the health, socioeconomic, and legal challenges faced by this patient population. PURPOSE To provide a comprehensive assessment of reported legal claims involving sports-related spinal injuries, including a comparative analysis of legal outcomes between collision and non-collision sports. To discuss strategies to prevent sports-related spinal injuries and minimize litigation risks. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE Athletes experiencing spinal injuries during sports. OUTCOME MEASURES Outcomes included verdict outcome (defendant vs. plaintiff), legal claims, injuries sustained, clinical symptoms, and award payouts. METHODS The legal research database Westlaw Edge (Thomson Reuters) was queried for legal claims brought in the United States from 1950 to 2021 involving sports-related spinal injuries. Verdict or settlement outcomes were collected as well as award payouts, time to case closure, case year, and case location. Demographic data, including type of sport (ie collision vs. non-collision sport) and level of play were obtained. Legal claims, spinal injuries sustained, and clinical symptoms were also extracted. Furthermore, the nature of injury, injured spinal region, and treatment pursued were collected. Descriptive statistics were reported for all cases and independent-samples t-tests and chi-square tests were used to compare differences between collision and non-collision sports. RESULTS Of the 840 cases identified on initial search, 78 met our criteria for in-depth analysis. This yielded 62% (n=48) defendant verdicts, 32% (n=25) plaintiff verdicts, and 6% (n=5) settlements, with a median inflation-adjusted award of $780,000 (range: $5,480-$21,585,000) for all cases. The most common legal claim was negligent supervision (n=38, 46%), followed by premises liability (n=23, 28%), and workers' compensation/no fault litigation (n=10, 12%). The most common injuries sustained were vertebral fractures (n=34, 44%) followed by disc herniation (n=14, 18%). Most cases resulted in catastrophic neurological injury (n=37, 49%), either paraplegia (n=6, 8%) or quadriplegia (n=31, 41%), followed by chronic/refractory pain (n=32, 43%). Non-collision sport cases had a higher percentage of premises liability claims (41% vs. 11%, p=.006) and alleged chronic/refractory pain (53% vs. 28%, p=.04). Conversely, collision sport cases had a higher proportion of workers' compensation/no fault litigation (23% vs. 4%, p=.03) and cases involving disc herniation (29% vs. 9%, respectively; p=.04). CONCLUSION Sports-related spinal injuries are associated with multiple and complex health, socioeconomic, and legal consequences, with median inflation-adjusted award payouts nearing $800,000 per case. In our cohort, the most commonly cited legal claims were negligent supervision and premises liability, emphasizing the need for prevention guidelines for safe sports practice, especially in non-professional settings. Cases involving athletes participating in non-collision sports were significantly associated with claims citing chronic/refractory pain, highlighting the importance of long-term care in severely injured athletes.
Collapse
Affiliation(s)
- Justin K Zhang
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Alborz Alimadadi
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Matthew ReVeal
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Armando J Del Valle
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Mayur Patel
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Deborah S O'Malley
- Associate Professor, Saint Louis University School of Law, St, Louis, MO, 63104 USA
| | - Philippe Mercier
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA
| | - Tobias A Mattei
- Division of Neurological Surgery, Department of Neurosurgery, Saint Louis University School of Medicine, St, Louis, MO, 63104 USA.
| |
Collapse
|
41
|
Fink JK. The hereditary spastic paraplegias. Handb Clin Neurol 2023; 196:59-88. [PMID: 37620092 DOI: 10.1016/b978-0-323-98817-9.00022-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The hereditary spastic paraplegias (HSPs) are a group of more than 90 genetic disorders in which lower extremity spasticity and weakness are either the primary neurologic impairments ("uncomplicated HSP") or when accompanied by other neurologic deficits ("complicated HSP"), important features of the clinical syndrome. Various genetic types of HSP are inherited such as autosomal dominant, autosomal recessive, X-linked, and maternal (mitochondrial) traits. Symptoms that begin in early childhood may be nonprogressive and resemble spastic diplegic cerebral palsy. Symptoms that begin later, typically progress insidiously over a number of years. Genetic testing is able to confirm the diagnosis for many subjects. Insights from gene discovery indicate that abnormalities in diverse molecular processes underlie various forms of HSP, including disturbance in axon transport, endoplasmic reticulum morphogenesis, vesicle transport, lipid metabolism, and mitochondrial function. Pathologic studies in "uncomplicated" HSP have shown axon degeneration particularly involving the distal ends of corticospinal tracts and dorsal column fibers. Treatment is limited to symptom reduction including amelioration of spasticity, reducing urinary urgency, proactive physical therapy including strengthening, stretching, balance, and agility exercise.
Collapse
Affiliation(s)
- John K Fink
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States.
| |
Collapse
|
42
|
Wada T, Sako H, Kizu K, Tashima T, Takayama T, Miyamoto S. Endoscopic-assisted descending aortic replacement through a small intercostal incision: a case report. J Cardiothorac Surg 2022; 17:305. [PMID: 36510240 PMCID: PMC9746136 DOI: 10.1186/s13019-022-02059-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Descending aortic replacement often involves making large incisions; thus, it results in massive invasions. We report the case of a patient with dilated descending aorta treated using endoscopic-assisted descending aortic replacement with essentially minimal invasions. CASE PRESENTATION We performed endoscopic-assisted descending aortic replacement with a single incision involving six wounds by trocar puncturing on a 59-year-old man who was diagnosed with dilated descending aorta by stent graft-induced new entry. Subsequently, the patient was discharged on postoperative day 11 without any complications. CONCLUSIONS Despite minor incisions, our approach can be indicated to almost the same group of patients in whom the conventional approach can be performed. Our procedure involved a single incision of only 8 cm and six wounds by trocar puncturing. Thus, endoscopic-assisted surgery can be a useful option in descending aortic surgery.
Collapse
Affiliation(s)
- Takeshi Wada
- Department of Cardiovascular Surgery, Oita Oka Hospital, 3-7-11, Nishitsurusaki, Oita, 870-0192 Japan
| | - Hidenori Sako
- Department of Cardiovascular Surgery, Oita Oka Hospital, 3-7-11, Nishitsurusaki, Oita, 870-0192 Japan
| | - Kenya Kizu
- Department of Cardiovascular Surgery, Oita Oka Hospital, 3-7-11, Nishitsurusaki, Oita, 870-0192 Japan
| | - Takahiro Tashima
- Department of Cardiovascular Surgery, Oita Oka Hospital, 3-7-11, Nishitsurusaki, Oita, 870-0192 Japan
| | - Tetsushi Takayama
- Department of Cardiovascular Surgery, Oita Oka Hospital, 3-7-11, Nishitsurusaki, Oita, 870-0192 Japan
| | - Shinji Miyamoto
- grid.412337.00000 0004 0639 8726Department of Cardiovascular Surgery, Oita University Hospital, Oita, Japan
| |
Collapse
|
43
|
Mikami Y, Tinduh D, Lee K, Chotiyarnwong C, van der Scheer JW, Jung KS, Shinohara H, Narasinta I, Yoon SH, Kanjanapanang N, Sakai T, Kusumawardhani MK, Park J, Prachgosin P, Obata F, Utami DA, Laohasinnarong P, Wardhani IL, Limprasert S, Tajima F, Goosey-Tolfrey VL, Martin Ginis KA. Cultural validation and language translation of the scientific SCI exercise guidelines for use in Indonesia, Japan, Korea, and Thailand. J Spinal Cord Med 2022; 45:821-832. [PMID: 34228949 PMCID: PMC9661985 DOI: 10.1080/10790268.2021.1945857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
CONTEXT Indonesia, Japan, Korea, Thailand. OBJECTIVE To culturally validate and translate the Scientific Exercise Guidelines for Adults with Spinal Cord Injury (SEG-SCI) for use in four Asian countries. DESIGN Systematic Review. PARTICIPANTS N/A. METHODS A systematic review was conducted to identify all published English- and local-language studies conducted in Indonesia, Japan, Korea, and Thailand, testing the effects of exercise training interventions on fitness and cardiometabolic health in adults with acute or chronic SCI. Protocols and results from high-quality controlled studies were compared with the SEG-SCI. Forward and backward translation processes were used to translate the guidelines into Bahasa Indonesian, Japanese, Korean and Thai languages. RESULTS Fifteen studies met the review criteria. At least one study from each country implemented exercise prescriptions that met or exceeded the SEG-SCI. Two were controlled studies. In those two studies, relative to control conditions, participants in exercise conditions achieved significant improvements in fitness or cardiometabolic health outcomes only when the exercise intervention protocol met or exceeded the SEG-SCI. During the language translation processes, end-users confirmed that SEG-SCI language and terminology were clear. CONCLUSION Clinical researchers in Indonesia, Japan, Korea and Thailand have implemented exercise protocols that meet or exceed the SCI-SEG. Results of high-quality studies align with the SEG-SCI recommendations. Based on this evidence, we recommend that the SEG-SCI be adopted in these countries. The cultural validation and translation of the SEG-SCI is an important step towards establishing consistent SCI exercise prescriptions in research, clinical and community settings around the world.
Collapse
Affiliation(s)
- Yukio Mikami
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Damayanti Tinduh
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - KunHo Lee
- Department of Prescription and Rehabilitation of Exercise, Dankook University, Cheonan, Republic of Korea
| | - Chayaporn Chotiyarnwong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jan W. van der Scheer
- THIS Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - Kyung Su Jung
- Medical Center for Health Promotion and Sport Science, Wakayama Medical University, Wakayama, Japan
| | - Hiroshi Shinohara
- Faculty of Health Sciences, Aomori University of Health and Welfare, Aomori, Japan
| | - Inggar Narasinta
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Seung Hyun Yoon
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Napatpaphan Kanjanapanang
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Takafumi Sakai
- Department of Physical Therapy, Takarazuka University of Medical and Health Care, Takarazuka, Japan
| | - Martha K. Kusumawardhani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Jinho Park
- Department of Counseling, Health and Kinesiology, College of Education and Human Development, Texas A&M University-San Antonio, San Antonio, Texas, USA
| | - Pannika Prachgosin
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Futoshi Obata
- Department of Physical Therapy, Takarazuka University of Medical and Health Care, Takarazuka, Japan
| | - Ditaruni Asrina Utami
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Phairin Laohasinnarong
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Indrayuni Lukitra Wardhani
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Universitas Airlangga Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Siraprapa Limprasert
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan,Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - Victoria L. Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, UK
| | - Kathleen A. Martin Ginis
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, Canada,School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada,Centre for Chronic Disease Prevention and Management, Southern Medical Program, University of British Columbia, Kelowna, Canada,Correspondence to: Kathleen A. Martin Ginis. E-mail:
| |
Collapse
|
44
|
Jones C, Schnorenberg AJ, Garlanger K, Leonardis JM, Kortes S, Riebe J, Plesnik J, Lee K, Slavens BA. Biomechanical analysis of wheelchair athletes with paraplegia during cross-training exercises. J Spinal Cord Med 2022; 45:882-897. [PMID: 34100694 PMCID: PMC9662041 DOI: 10.1080/10790268.2021.1928868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT Extreme conditioning programs (ECPs), such as CrossFit®, are a relatively new method of fitness with rapid growth in individuals with paraplegia. However, it is unknown if wheelchair users are at an additional risk of musculoskeletal injury during these exercises. Biomechanical characterization is necessary to determine the safety and efficacy of ECPs as an exercise modality for wheelchair users with paraplegia. OBJECTIVE To characterize the three-dimensional (3-D) thorax and upper extremity joint kinematics of paraplegic wheelchair athletes during exercises commonly prescribed as part of ECPs. DESIGN Observational study. PARTICIPANTS Three male wheelchair athletes, average age of 37.1 ± 4.6 years, with spinal cord injury levels of T8, L2, and T10, with varying exercise experience. METHODS 3-D movement was acquired using motion capture during the performance of four exercises: battle ropes, sled pull, overhead press, and sledgehammer swing. A custom upper extremity inverse kinematics model was applied to compute 3-D joint angles. OUTCOME MEASURES 3-D peak thorax, glenohumeral, elbow, and wrist joint angles and ranges of motion (ROM), Visual Analog Scale (VAS), and Borg Scale of Perceived Exertion. RESULTS Large joint motions were required for the exercises, at times demanding extreme shoulder and/or wrist flexion and extension, abduction, and external rotation, which are concerning for injury risk in wheelchair users. Participants, however, were able to perform the exercises pain free. CONCLUSION These quantitative findings highlight that wheelchair athletes may be exposed to potentially injurious positions during common ECP exercises. These findings provide insight that may lead to improved clinical guidelines for prescription and training of exercise regimens, particularly involving ECPs, for wheelchair users.
Collapse
Affiliation(s)
- Carrie Jones
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alyssa J. Schnorenberg
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA,Correspondence to: Alyssa J. Schnorenberg, University of Wisconsin Milwaukee, Innovation Campus – Accelerator Building, Mobility Lab, Suite 131, 1225, Discovery Parkway, Wauwatosa, WI, USA; Ph: (414) 251-7746.
| | - Kristin Garlanger
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joshua M. Leonardis
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Sam Kortes
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Justin Riebe
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Justin Plesnik
- Body by Design, Brookfield, USA,Aqua-Endurance, Milwaukee, Wisconsin, USA
| | - Kenneth Lee
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brooke A. Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| |
Collapse
|
45
|
Sridharan K, Singh SR, Cherian KE, Kapoor N, Elizabeth J, John JA, Thomas N, Paul TV. Body composition and metabolic parameters in men with chronic traumatic paraplegia - A pilot study from India. J Spinal Cord Med 2022; 45:857-864. [PMID: 33705272 PMCID: PMC9661976 DOI: 10.1080/10790268.2021.1888021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To study body composition, measures of insulin resistance and dyslipidemia in Indian men with paraplegia as compared to age and body mass index (BMI) matched able-bodied men. DESIGN Cross sectional study. SETTING Departments of Physical Medicine and Rehabilitation and Endocrinology. PARTICIPANTS Males aged 18-45 years with chronic traumatic paraplegia versus age and BMI-matched able-bodied men. INTERVENTIONS None. MAIN OUTCOME MEASURES Measures of body composition such as total body fat, lean mass, regional adiposity using dual energy x-ray absorptiometry (DXA), metabolic profile and insulin resistance. RESULTS Subjects with paraplegia (n = 43), compared to controls (n = 36), had higher %Fat mass (FM) (25.5 (21.2-28.9) vs 20.2 (15.9-22.2); P < 0.01), lower trunk to leg ratio (0.66 (0.51-0.73) vs 0.87 (0.72-0.94); P < 0.01), lower lean mass index (14.38 (2.57) vs 17.80 (2.34); P < 0.01) and lower appendicular lean mass index (5.81 ± 1.26 vs 8.17 ± 1.12; P < 0.01). Fasting blood glucose (mg/dl) was higher (89.0(81.5-96.5) vs 80.0 (74.5-88.2); P < 0.01), Homeostasis model assessment of insulin resistance was higher (1.33 (1.03-2.12) vs 0.94 (0.52-1.78); P = 0.02), Quantitative insulin sensitivity check index (QUICKI) was lower (0.36 ± 0.04 vs 0.38 ± 0.05; P = 0.02) and HDL-C was lower (33.00 (30.00-42.75) vs 38.50 (33.00-43.25); P < 0.02) in cases compared to controls. QUICKI correlated positively with HDL-C and negatively with %FM, estimated VAT volume and TG. Trunk to leg ratio correlated positively with TG even after controlling for %FM. CONCLUSION Men with chronic paraplegia had lower lean mass, higher total and regional fat mass, increased insulin resistance and low HDL-C when compared with BMI-matched able-bodied controls. Both total and regional adiposity correlated with poor metabolic profile.
Collapse
Affiliation(s)
- Kalyani Sridharan
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Shipra Rachna Singh
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, India
| | - Kripa Elizabeth Cherian
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Jane Elizabeth
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, India
| | - Judy Ann John
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Thomas V. Paul
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India,Correspondence to: Dr. Thomas V. Paul, Dept. of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore (TN) - 632004, India; Ph: +91- 9566920379(M).
| |
Collapse
|
46
|
Gee CM, Kwon BK. Significance of spinal cord perfusion pressure following spinal cord injury: A systematic scoping review. J Clin Orthop Trauma 2022; 34:102024. [PMID: 36147378 PMCID: PMC9486559 DOI: 10.1016/j.jcot.2022.102024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/27/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
This scoping review systematically reviewed relevant research to summarize the literature addressing the significance of monitoring spinal cord perfusion pressure (SCPP) in acute traumatic spinal cord injury (SCI). The objectives of the review were to (1) examine the nature of research in the field of SCPP monitoring in SCI, (2) summarize the key research findings in the field, and (3) identify research gaps in the existing literature and future research priorities. Primary literature searches were conducted using databases (Medline and Embase) and expanded searches were conducted by reviewing the references of eligible articles and searches of Scopus, Web of Science core collection, Google Scholar, and conference abstracts. Relevant data were extracted from the studies and synthesis of findings was guided by the identification of patterns across studies to identify key themes and research gaps within the literature. Following primary and expanded searches, a total of 883 articles were screened. Seventy-three articles met the review inclusion criteria, including 34 original research articles. Other articles were categorized as conference abstracts, literature reviews, systematic reviews, letters to the editor, perspective articles, and editorials. Key themes relevant to the research question that emerged from the review included the relationship between SCPP and neurological recovery, the safety of monitoring pressures within the intrathecal space, and methods of intervention to enhance SCPP in the setting of acute traumatic SCI. Original research that aims to enhance SCPP by targeting increases in mean arterial pressure or reducing pressure in the intrathecal space is reviewed. Further discussion regarding where pressure within the intrathecal space should be measured is provided. Finally, we highlight research gaps in the literature such as determining the feasibility of invasive monitoring at smaller centers, the need for a better understanding of cerebrospinal fluid physiology following SCI, and novel pharmacological interventions to enhance SCPP in the setting of acute traumatic SCI. Ultimately, despite a growing body of literature on the significance of SCPP monitoring following SCI, there are still a number of important knowledge gaps that will require further investigation.
Collapse
Affiliation(s)
- Cameron M. Gee
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Canada
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Canada
| | - Brian K. Kwon
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Canada
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Canada
| |
Collapse
|
47
|
Nair MS, Kulkarni VN, Shyam AK. Combined Effect of Virtual Reality Training (VRT) and Conventional Therapy on Sitting Balance in Patients with Spinal Cord Injury (SCI): Randomized Control Trial. Neurol India 2022; 70:S245-S250. [PMID: 36412376 DOI: 10.4103/0028-3886.360934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Post spinal cord injury (SCI), sitting balance is considered a prerequisite for the effective performance of activities of daily living. Virtual Reality Training (VRT) may provide an interactive medium of rehabilitation, preventing a reduction in active participation of the patients while allowing for the training of sitting balance. Aim The aim of this study was to evaluate the effect of the addition of VRT to conventional therapy in improving sitting balance in persons with SCI. Subjects and Methods This was a single blinded randomized control trial conducted on 21 subjects with SCI (level of injury: D10 or below). They were randomly allocated into two groups; both groups received their routine exercise program. In addition, the intervention group, that is, Group B (n = 11) received 30 min of VRT in the seated position using Xbox-Kinect, while the conventional therapy group, that is, Group A (n = 10) received 30 min of additional conventional therapy to equalize the duration of the intervention (3 days/week, 4 weeks). The modified functional reach test and T-shirt test were measured at the beginning and at the end of 4 weeks. Results MFRT changes for forward (Group A: 1.7 ± 1.09 cm; Group B: 4.83 ± 2.95 cm), right lateral (Group A: 2.43 ± 2.81 cm, Group B: 5.08 ± 1.85 cm), left lateral (Group A: 3.05 ± 4.65 cm, Group B: 6.19 ± 1.51 cm) were statistically significant for Group B (P < 0.05). No significant difference was observed between the two groups for T-shirt test (P > 0.05). Conclusion VRT can be used as a part of a comprehensive rehabilitation program to improve sitting balance post-SCI.
Collapse
Affiliation(s)
- Manasa S Nair
- Department of Neuro Physiotherapy, Sancheti Institute of Orthopedics and Rehabilitation, Shivajinagar, Pune, Maharashtra, India
| | - Vivek N Kulkarni
- Department of Neuro Physiotherapy, Sancheti Institute of Orthopedics and Rehabilitation, Shivajinagar, Pune, Maharashtra, India
| | - Ashok K Shyam
- Department of Orthopaedics Surgery, Sancheti Institute of Orthopedics and Rehabilitation, Shivajinagar, Pune, Maharashtra, India
| |
Collapse
|
48
|
Rahyussalim AJ, Zufar MLL, Kurniwati T. A holistic approach for severe flexion contracture of bilateral hip, knee, and ankle joints in a neglected patient with prolonged knee-chest positioning on extreme undernourishment: a case report and review of the literature. J Med Case Rep 2022; 16:225. [PMID: 35610728 PMCID: PMC9128234 DOI: 10.1186/s13256-022-03439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 03/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background Flexion contracture in the lower extremity is a common finding in the patient with neuromusculoskeletal disorders. However, severe cases due to prolonged immobilization in knee–chest position are rarely established and remain underreported. This condition is associated with high morbidity and reduced quality of life, especially when it comes to neglected cases with missed injury and late presentation for adequate primary care and rehabilitative program. It remains a difficult challenge to treat, with no established treatment protocol. In addition, other factors related to psychological and socioeconomic conditions may interfere and aggravate the health state of such patients. Case presentation A 19-year-old Javanese man presented with flexion contracture of bilateral hip, knee, and ankle joints due to prolonged immobilization in knee–chest position for almost 2 years following a traffic accident and falling in the bathroom. The condition had persisted for the last 3 years due to irrecoverable condition and lack of awareness. In addition, the patient also presented with paraplegia at level L2–S1, dermatitis neglecta, multiple pressure ulcers, community-acquired pneumonia, and severe malnutrition. Prolonged and sustained passive stretching with serial plastering were performed in the patient. By the time of discharge, patient was able to move and ambulate using wheelchair. Progressive improvement of range of motion and good sitting balance were observed by 3-month follow-up. Conclusion A combination of surgery and rehabilitative care is required in the setting of severe flexion contracture. Passive prolonged stretching showed a better outcome and efficacy in the management of flexion contracture, whether the patient undergoes surgery or not. However, evaluation of residual muscle strength, changes in bone density and characteristic, and the patient’s general and comorbid conditions must always be considered when determining the best treatment of choice for each patient to achieve good outcome and result. A holistic approach with comprehensive assessment is important when treating such patients.
Collapse
Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central General Hospital and Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec. Senen, Kota Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10310, Indonesia.
| | - Muhammad Luqman Labib Zufar
- Department of Orthopaedic and Traumatology, Cipto Mangunkusumo National Central General Hospital and Faculty of Medicine, Universitas Indonesia, Jl. Pangeran Diponegoro No.71, RW.5, Kenari, Kec. Senen, Kota Jakarta Pusat, Daerah Khusus Ibukota, Jakarta, 10310, Indonesia
| | - Tri Kurniwati
- Stem Cell and Tissue Engineering, IMERI Universitas, Jakarta, Indonesia
| |
Collapse
|
49
|
Chiche L, Teissier J, Gelis A, Chammas M, Laffont I, Coulet B. Arthroplasty for weight-bearing shoulders. Orthop Traumatol Surg Res 2022; 108:103145. [PMID: 34780996 DOI: 10.1016/j.otsr.2021.103145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the shoulders, which become weight-bearing. Under these conditions, arthroplasty implants are subjected to large stresses, even though this indication is controversial in such a context. We hypothesized that joint replacement in weight-bearing shoulders will relieve pain and improve range of motion, with a positive impact on function and autonomy, without increasing the complication rate relative to the able-bodied population. MATERIALS AND METHODS This retrospective study involved 13 implants in 11 patients (4 total shoulder arthroplasty, 4 hemi-arthroplasty and 3 reverse shoulder arthroplasty) who had a mean follow-up of 33.7 ± 27 months (12-85 months). The clinical assessment included active and passive range of motion, pain, Constant score, and the Wheelchair User's Shoulder Pain Index (WUSPI). Radiographs were evaluated to look for signs of loosening and scapular notching. The patients' autonomy was evaluated through the number of transfers, means of locomotion (manual or electric wheelchair) and the functional independence measure (FIM). Two subgroups were defined based on the initial pathology: neurological shoulder or functional shoulder. RESULTS The 11 patients had a mean age of 64±19 years (23-85 years) and were all long-term wheelchair users (electrical or mechanical). The pain level on VAS decreased from 8±3 preoperatively to 4±2 postoperatively (p=0.003). The mean Constant score increased 90% from 22±11 preoperatively to 42±23 postoperatively (p=0.008). The WUSPI score decreased by 73% from 80±30 to 21±15 (p=0.001). The range of motion improved in the subgroup of patients with functional shoulders but not in the subgroup of patients with neurological shoulders. The means of locomotion was altered in five patients (63%) by the acquisition of an electric wheelchair, but with no significant change in the number of daily transfers. There were no radiographic signs of implant loosening at the final assessment. Two implants had to be revised: one anatomical prosthesis was converted to a reverse configuration because of a secondary rotator cuff rupture; one case of early infection required a two-stage implant change. DISCUSSION Joint replacement in weight-bearing shoulders is an effective medium-term solution for cuff tear arthropathy and glenohumeral OA, mainly for addressing pain, with slight improvements in range of motion, depending on the initial pathology. This intervention requires lifestyle adaptations such as changes in daily transfer practices and means of locomotion. LEVEL OF EVIDENCE IV, retrospective study.
Collapse
Affiliation(s)
- Léo Chiche
- Unité de chirurgie de la main et du membre supérieur, Hôpital Lapeyronie, CHRU De Montpellier, 371, avenue du Doyen Gaston Giraud, 3400 Montpellier, France.
| | - Jacques Teissier
- Unité de chirurgie du membre supérieur, Centre OrthoSud, 15, avenue du Pr Grasset, 34090 Montpellier, France
| | - Anthony Gelis
- Centre de rééducation Propara, 263, rue du Caducée, 34000 Montpellier, France
| | - Michel Chammas
- Unité de chirurgie de la main et du membre supérieur, Hôpital Lapeyronie, CHRU De Montpellier, 371, avenue du Doyen Gaston Giraud, 3400 Montpellier, France
| | - Isabelle Laffont
- Service de médecine physique et rééducation hôpital Lapeyronie, CHRU De Montpellier, 371, avenue du Doyen Gaston Giraud, 3400 Montpellier, France
| | - Bertrand Coulet
- Unité de chirurgie de la main et du membre supérieur, Hôpital Lapeyronie, CHRU De Montpellier, 371, avenue du Doyen Gaston Giraud, 3400 Montpellier, France
| |
Collapse
|
50
|
Shi X, Qi L, Du B, Yao X, Du X. Paraplegia secondary to disseminated mucormycosis: case report and literature review. BMC Infect Dis 2022; 22:405. [PMID: 35468738 PMCID: PMC9036692 DOI: 10.1186/s12879-022-07373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report a case of spine infection with mucormycosis that manifested signs of paraplegia in a patient suffering from disseminated mucormycosis. Timely and effective surgery was performed. A review of the literature is included. CASE PRESENTATION A patient with diabetic ketoacidosis complained of back pain and fatigue for one month, and his right lower extremity activity had been limited for 10 days. T4-T6 vertebral and paravertebral soft tissue-involved infections were identified by MRI, which were derived from right lung pneumonia. He underwent abscess debridement, spinal canal decompression, pedicle screw fixation and amphotericin B liposome injection. Histopathological examination revealed broad aseptate hyphae suggestive of invasive mucormycosis. There was improvement in neurological function after surgical and medical treatment. Three months after the surgery, the patient died of uncontrollable massive bleeding of the urinary system. Mucormycosis is characterized by rapid development and a high mortality rate. This case shows the significance of a multidisciplinary team in the diagnosis and treatment of patients with mucormycosis. In addition, orthopedic surgeons should design appropriate surgery plans for spine-involved mucormycosis patients. CONCLUSION This case present a patient with paraplegia caused by the spread of pulmonary mucormycosis to the vertebral and paravertebral soft tissue of levels T4-T6. After medical treatment, surgical debridement and internal fixation, the patient recovered well but later patient died of possible disease dissemination to the renal or urinary tract which resulted in massive haemorrhage.
Collapse
Affiliation(s)
- Xiangjun Shi
- Department of Hematology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.,School of Medicine, Tsinghua University, Beijing, China
| | - Lei Qi
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Boran Du
- Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Xingchen Yao
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xinru Du
- Department of Orthopaedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|