Complication Of Spinal Cord Injury Research Articles

Infectious diseases as complications following spinal cord injury

Background: Infectious complications in spinal cord injury (SCI) patients can increase the mortality and morbidity of the patients. The inability to do daily activity is the main cause of the occurrence of infectious complications. Good understanding and high awareness are needed to notice some infectious complications which are difficult to be diagnosed.
 Method: This paper is a literature review which was done by reviewing and searching journals with “infectious complication”, “spinal cord injury”, “infection” on the search engines. The authors found 52 articles are suitable to be composed as references for this paper.
 Outcome: Several infectious complications may occur following the incidence of SCI and have a lot of disadvantages. The causes of these infections are multifactorial. Urinary tract infection, infected pressure ulcer, pneumonia, and some other infectious diseases may appear as complications. Extra care in hygiene and sanitation is needed, besides, high awareness is needed to discover these complications.
 Conclusion: Monitoring post-SCI complications are complex and difficult. A high level of suspicion should be raised with frequent aseptic actions and procedures. Appropriate management including non-surgical or surgical procedures can be chosen to achieve the best outcomes. Early diagnosis and management are critical for the best treatment results.

Treatment of bilateral sacral insufficiency fractures with sacroplasty in a patient with motor complete tetraplegia

IntroductionOsteoporosis is a common secondary complication of spinal cord injury, with fragility fractures typically occurring in the lower body and management often is conservative.Case presentationWe present a 52-year-old male with chronic complete tetraplegia who presented to the emergency room with unremitting autonomic dysreflexia (AD). He was admitted for medical management of the AD when a source of the AD could not be identified. After an extensive workup, the patient was found to have bilateral sacral insufficiency fractures. He subsequently underwent sacroplasty with immediate and full resolution of AD symptoms and return to full premorbid function within 24 h.DiscussionPeople with chronic spinal cord injury (SCI) are at risk for spinal column fragility fractures in addition to lower extremity fractures. Vertebroplasty may be a safe option for treatment of insufficiency fractures in situations where conservative care may put people at risk for significant immobility-associated complications.

Combination of Botulinum Toxin and minocycline Ameliorates Neuropathic Pain Through Antioxidant Stress and Anti-Inflammation via Promoting SIRT1 Pathway.

Neuropathic pain (NP) is one of the intractable complications of spinal cord injury (SCI), with poor prognosis and seriously affects the quality of life of patients. This study aims to determine the treatment effect and mechanism of multimodal therapies in a rat model of SCI-induced NP by combining treatment with the anti-inflammatory agent minocycline (MC) and botulinum toxin (BoNT). The combined utilization alleviated SCI-induced NP and reduced apoptosis, inflammation, and oxidative stress of SCI by activating SIRT1 and dampening pAKT, P53, and p-NF-KB. BoNT with a concentration of 0.1 nm and MC with a concentration of 20 uM were selected for the experiment in the primary microglia and astrocytes treated with LPS. It was found that the combination of BoNT and MC obviously inhibits the inflammatory response and oxidative stress of glial cells, and notably activates SIRT1 and restrains pAKT, P53, and p-NF-KB. Therefore, in the treatment of SCI-induced NP, the combination of BoNT and MC markedly improves the therapeutic effect of NP by promoting the SIRT1 expression, thereby inactivating NF-KB, P53, and PI3K/AKT signaling pathway, inhibiting inflammation and oxidative stress as well as relieving SCI-induced NP.

Prospective Study to Evaluate the Incidence of Deep-Vein Thrombosis in Patients with Acute Traumatic Spinal Cord Injury

Introduction: Deep-vein thrombosis (DVT) is one of the precarious complications of spinal cord injury (SCI). The present study was aimed to determine the incidence of DVT in acute traumatic SCI in the Indian population, factors associated with DVT, and to evaluate the role of D-dimer and color Doppler in establishing the diagnosis. Patients and Methods: Fifty patients with acute SCI presenting to a tertiary care center within 48 h of injury were clinically evaluated for the level, extent, and severity of SCI according to the ASIA standards. The local examination for the assessment of DVT was conducted. D-dimer test and color Doppler for DVT were performed at initial presentation, on day 7 and 14, 1 month, 3 months, and 6 months. Results: Three patients developed DVT between 14 days to 1 month. Overall DVT incidence was found to be 6%. Neurological level (P < 0.05) and the severity of the deficit (P < 0.001) were found to be associated with DVT. Patients with DVT had significantly more thigh and calf circumference at 1 month. Significantly higher levels of D-dimer were observed right from initial presentations to 6 months. Color Doppler was positive in all the three cases of DVT. Conclusions: The incidence of DVT is low in SCI patients in India, but it is not a rare complication. The occurrence of DVT has a significant correlation with factors such as the level and severity of injury. Frequent clinical examinations including the thigh and calf circumference along with D-dimer level estimation are good screening indicators, and color Doppler is an effective tool for establishing a definitive diagnosis of DVT in SCI patients.

Neuromodulation as a basic platform for neuroprotection and repair after spinal cord injury.

Spinal cord injury (SCI) is one of the most challenging medical issues. Spasticity is a major complication of SCI. A combination of spinal cord stimulation, new methods of neuroprotection and biomedical cellular products provides fundamentally new options for SCI treatment and rehabilitation. The paper attempts to critically analyze the effectiveness of using these procedures for patients with SCI, suggesting a protocol for a step-by-step personalized treatment of SCI, based on continuity of modern conservative and surgical methods. The study argues the possibility of using neuromodulation as a basis for rehabilitating patients with SCI.

Commentary: The aggregation of marginal gains for spinal cord protection

Commentary: The aggregation of marginal gains for spinal cord protection

Serum CCL21 as a Potential Biomarker for Cognitive Impairment in Spinal Cord Injury

Objective Cognitive impairment is considered to be an important complication of spinal cord injury (SCI), but its underlying mechanism remains unclear. The purpose of this study is to explore whether serum CCL21 can be used as a potential biomarker of cognitive impairment in SCI. Methods In Neck-Shoulder and Lumbocrural Pain Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, hospitalized or treated acute SCI patients were included in the study as the SCI group (SCI). At the same time, a normal control group (NC) matching the age and sex of the SCI group was recruited in the outpatient clinic. Once the two groups were enrolled, their demographics and clinical characteristics were collected immediately. Enzyme-linked immunosorbent assay (ELISA) was used to detect serum CCL21 levels within 24 hours of admission. Three months later, the Montreal Cognitive Assessment (MoCA) was used to test the cognitive function of the population. Results A total of 84 SCI patients and 49 NC populations were eligible for inclusion in the study. There was no significant statistical difference in the demographics and clinical characteristics (age, gender, BMI, TG, LDL-C, FBG, SBP, and DBP) between the two groups (p > 0.05). Compared with the NC group, the SCI group had a higher serum CCL21 level (p < 0.001) and a lower MoCA score (p < 0.001). Serum CCL21 level in SCI was negatively correlated with MoCA score (p = 0.023). Multivariable analyses showed that serum CCL21 level is an independent prognostic factor of cognitive impairment in SCI. Conclusions MoCA score has a linear relationship with serum CCL21 quartile, and SCI cognitive function has a negative correlation with serum CCL21. Serum CCL21 is an independent risk factor for cognitive impairment after SCI.

LncRNA SNHG1 attenuates neuropathic pain following spinal cord injury by regulating CDK4 level.

Neuropathic pain (NP) is one of the most intractable complications of spinal cord injury (SCI). This study aims to explore the role of long non-coding RNA (lncRNA) SNHG1 in influencing SCI-induced NP. After establishment of the spinal nerve ligation (SNL) model in rats, spinal tissues were extracted. SNHG1 level in rat spinal tissues was determined by quantitative real-time polymerase chain reaction (qRT-PCR). The role of SNHG1 in the development of NP was explored by assessing paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) in model rats. The interaction between SNHG1 and CDK4 was explored by Luciferase assay and RIP (RNA-Binding Protein Immunoprecipitation). Enzyme-linked immunosorbent assay (ELISA) and qRT-PCR were conducted to determine inflammatory factor levels in rat spinal tissues. SNHG1 was upregulated in rats undergoing SNL. Knockdown of SNHG1 alleviated the development of NP and overexpression of SNHG1 was capable of inducing NP symptoms in uninjured rats. SNHG1 induced NP by directly regulating CDK4 level. SNHG1 is a novel target in the treatment of NP associated with neuroinflammation.

Histological and Biochemical Changes in Adult Male Rat Liver after Spinal Cord Injury with Evaluation of the Role of Granulocyte-Colony Stimulating Factor

ABSTRACT Spinal cord injury (SCI) is a devastating disease leading to motor disability. Metabolic dysfunction is another complication of SCI. Thus, we aimed to study the effect of SCI on the histological and biochemical structure of the liver in adult male rats and to delineate the role of post-injury administration of G-CSF. Thirty adult male Sprague-Dawley rats were assigned into three groups: Group I; control (18 rats subdivided equally into three subgroups), and 12 rats underwent SCI and were divided into an SCI group II and G-SCF-treated group III. Twenty-one days post-injury, liver sections were processed for light and electron microscopic examinations and immunohistochemical staining for PCNA and CD68 antibodies. The biochemical assay was carried out for detection of serum levels of ALT, AST, total proteins, albumin, total cholesterol, triglycerides, HDL-c, GSH and MDA. Liver tissue levels of GPx and MDA as well as semiquantitative RT-PCR analysis of hepatic cytokine expression were also conducted. In the SCI group, results showed liver tissue damage in the form of lipid infiltration, blood vessel congestion, vacuolated cells with apoptotic nuclei and increased collagen deposition. Increased CD68-positive macrophages and a decreased number of PCNA-positive cells was detected. Moreover, liver enzymes, total cholesterol and triglycerides were increased while serum albumin, total proteins and HDL-c were decreased in the SCI group. Oxidative stress and increased expression of inflammatory cytokines were detected. Administration of G-CSF induced significant liver improvement with retained liver function by anti-inflammatory, immune-modulatory and antioxidant mechanisms.

Respiratory function and respiratory complications in spinal cord injury: protocol for a prospective, multicentre cohort study in high-income countries

IntroductionPneumonia is one of the leading complications and causes of death after a spinal cord injury (SCI). After a cervical or thoracic lesion, impairment of the respiratory muscles decreases respiratory...

Current Insights Into the Pathology of Canine Intervertebral Disc Extrusion-Induced Spinal Cord Injury.

Spinal cord injury (SCI) in dogs is commonly attributed to intervertebral disc extrusion (IVDE). Over the last years substantial progress was made in the elucidation of factors contributing to the pathogenesis of this common canine disease. A detailed understanding of the underlying histopathological and molecular alterations in the lesioned spinal cord represents a prerequisite to translate knowledge on the time course of secondary injury processes into the clinical setting. This review summarizes the current state of knowledge of the underlying pathology of canine IVDE-related SCI. Pathological alterations in the spinal cord of dogs affected by IVDE-related SCI include early and persisting axonal damage and glial responses, dominated by phagocytic microglia/macrophages. These processes are paralleled by a pro-inflammatory microenvironment with dysregulation of cytokines and matrix metalloproteinases within the spinal cord. These data mirror findings from a clinical and therapeutic perspective and can be used to identify biomarkers that are able to more precisely predict the clinical outcome. The pathogenesis of progressive myelomalacia, a devastating complication of SCI in dogs, is not understood in detail so far; however, a fulminant and exaggerating secondary injury response with massive reactive oxygen species formation seems to be involved in this unique neuropathological entity. There are substantial gaps in the knowledge of pathological changes in IVDE with respect to more advanced and chronic lesions and the potential involvement of demyelination. Moreover, the role of microglia/macrophage polarization in IVDE-related SCI still remains to be investigated. A close collaboration of clinical neurologists and veterinary pathologists will help to facilitate an integrative approach to a more detailed understanding of the molecular pathogenesis of canine IVDE and thus to identify therapeutic targets.

Antibiotics with therapeutic effects on spinal cord injury: a review.

Accumulating evidence indicates that a considerable number of antibiotics exert anti-inflammatory and neuroprotective effects in different central and peripheral nervous system diseases including spinal cord injury (SCI). Both clinical and preclinical studies on SCI have found therapeutic effects of antibiotics from different families on SCI. These include macrolides, minocycline, β-lactams, and dapsone, all of which have been found to improve SCI sequels and complications. These antibiotics may target similar signaling pathways such as reducing inflammatory microglial activity, promoting autophagy, inhibiting neuronal apoptosis, and modulating the SCI-related mitochondrial dysfunction. In this review paper, we will discuss the mechanisms underlying therapeutic effects of these antibiotics on SCI, which not only could supply vital information for investigators but also guide clinicians to consider administering these antibiotics as part of a multimodal therapeutic approach for management of SCI and its complications.

Autonomic dysreflexia in spinal cord injury.

### What you need to know Autonomic dysreflexia is a potentially life threatening complication of spinal cord injury. It carries a mortality rate of 22%1 and increases the risk of stroke by 300% to 400%.2 Clinicians working in emergency or urgent care may not see patients with this condition often, but when they do, prompt recognition and treatment are required. This practice pointer gives a brief overview of autonomic dysreflexia and how to identify it. Autonomic dysreflexia is the product of dysregulation of the autonomic system, leading to an uncoordinated response to a noxious stimulus below the level of a spinal cord injury,2 usually in individuals with a spinal cord injury above the level of T6 (fig 1). It is three times more prevalent in those with complete spinal cord injury than in those with incomplete injury (91% versus 27%, respectively).3 Autonomic dysreflexia is clinically defined as an acute episode of systolic blood pressure elevated 25 mm Hg or above the patient’s normal measurements. …

A Primary Care Provider's Guide to Prevention and Management of Pressure Injury and Skin Breakdown in People With Spinal Cord Injury.

Skin breakdown, including burns and pressure injuries (PrIs), is a devastating complication of spinal cord injury (SCI). Chronic wounds place the person with SCI at high risk of infections, sepsis, and death. Skin health and breakdown is individual and multifactorial, thus prevention requires individualized education focused on patient preferences and goals. Assessment requires an accurate description of wound type/PrI stage, location, size, wound bed, wound margin, epithelialization, exudate, and peri-wound condition. PrIs should be staged using the National Pressure Injury Advisory Panel (NPIAP) staging system. Successful treatment requires optimal wound bed preparation, pressure off-loading, and access to surgical specialists if needed. Mattress and seating systems, pressure relief, skin microclimate, nutrition, and home supports should be optimized. To promote wound healing and aid prevention, identifiable causes need to be removed, risk factors improved, and wound care provided. Infection should be treated with input from infectious disease specialists. Consideration for specialized surgical management including flaps and primary closures should be coordinated with the interdisciplinary team to optimize outcomes. If comorbid conditions promote wound chronicity, a palliative rather than curative treatment plan may be needed.

Splenic sympathetic signaling contributes to acute neutrophil infiltration of the injured spinal cord

BackgroundAlterations in the immune system are a complication of spinal cord injury (SCI) and have been linked to an excessive sympathetic outflow to lymphoid organs. Still unknown is whether these peripheral immune changes also contribute for the deleterious inflammatory response mounted at the injured spinal cord.MethodsWe analyzed different molecular outputs of the splenic sympathetic signaling for the first 24 h after a thoracic compression SCI. We also analyzed the effect of ablating the splenic sympathetic signaling to the innate immune and inflammatory response at the spleen and spinal cord 24 h after injury.ResultsWe found that norepinephrine (NE) levels were already raised at this time-point. Low doses of NE stimulation of splenocytes in vitro mainly affected the neutrophils’ population promoting an increase in both frequency and numbers. Interestingly, the interruption of the sympathetic communication to the spleen, by ablating the splenic nerve, resulted in reduced frequencies and numbers of neutrophils both at the spleen and spinal cord 1 day post-injury.ConclusionCollectively, our data demonstrates that the splenic sympathetic signaling is involved in the infiltration of neutrophils after spinal cord injury. Our findings give new mechanistic insights into the dysfunctional regulation of the inflammatory response mounted at the injured spinal cord.

Inhibition of phosphodiesterase IV enzyme improves locomotor and sensory complications of spinal cord injury via altering microglial activity: Introduction of Roflumilast as an alternative therapy

Despite the great search for an effective approach to minimize secondary injury in spinal cord injury (SCI) setting, there have been limited advances. Roflumilast is a selective inhibitor of phosphodiesterase 4 with potent anti-inflammatory properties. Here, we sought to explore Roflumilast efficacy in the improvement of locomotor and sensory deficits of SCI. In an animal setting, 50 male rats were randomly assigned to five groups: an SCI group receiving Placebo, three SCI groups receiving Roflumilast at the doses of 0.25, 0.5, and 1 mg/kg prior to T9 vertebra laminectomy, and a sham-operated group. Locomotor, mechanical, and thermal activities were evaluated for 28 days. At the end of the study, spinal cord samples were taken to assess the relative ratio of microglial subtypes, including M1 and M2, histopathological changes, levels of pro-inflammatory (TNF-α and IL-1β) and anti-inflammatory (IL-10) biomarkers, and cAMP level. Repeated measure analysis revealed significant effect for time-treatment interaction on locomotion [F (24, 270) = 280.7, p < 0.001], thermal sensitivity [F (16, 180) = 4.35, p < 0.001], and mechanical sensitivity [F (16, 180) = 7.96, p < 0.001]. As expected, Roflumilast significantly increased the expression of spinal cAMP. H&E staining exhibited lesser histopathological disruptions in Roflumilast-treated rodents. We also observed a significant reduction in the M1/M2 ratio (p values < 0.001) as well as in pro-inflammatory biomarkers following the administration of Roflumilast to the injured rats. Furthermore, IL-10 level was increased in rodents receiving 1 mg/kg of the reagent. In conclusion, the increased spinal cAMP following Roflumilast therapy might attenuate neuroinflammation via altering microglial activity; therefore, it could be considered as an alternative therapeutic agent for SCI complications.

Comparing App-based and Lecture-based Methods of Sexual Satisfaction Education: A Randomized Controlled Trial

Background: Sexual dysfunction is one of the most common complications of spinal cord injury with potentially negative impacts on sexual satisfaction. Objectives: This study aimed to compare the effects of app-based and lecture-based sexual education on the sexual satisfaction of disabled men with spinal cord injury. Methods: A randomized clinical trial was conducted on disabled men with spinal cord injury in 2019. The participants were selected using a convenience sampling method from the Welfare Organization of Birjand city. A demographic form and Larson’s Sexual Satisfaction Questionnaire were completed before the intervention. Then, the participants were randomly assigned to two groups (app-based and lecture-based groups). In the app-based group, the sexual education content was prepared as an Android app that was accessible for the group participants for two months. Similar content was communicated to the lecture-based group in the form of lectures during ten 60- to 90-min sessions over two months. Six weeks after the end of the intervention, Larson’s Questionnaire was completed again for both groups. Data were analyzed using the Fisher’s exact test, Kolmogorov-Smirnov test, paired t-test, and independent t-test. The significance level was set at P &lt; 0.05. Results: In both groups, the mean scores of sexual satisfaction significantly increased after the intervention (P &lt; 0.05). Nevertheless, the mean change in the sexual satisfaction score was significantly more in the app-based group (18.16 ± 3.31) than in the lecture-based group (7.52 ± 4.59) (P &lt; 0.05). Conclusions: App-based sexual education can be more effective than lecture-based sexual education in improving the sexual satisfaction of disabled men with spinal cord injury.

Choice of osteotomy methods for old thoracolumbar osteoporotic fracture with kyphosis

To investigate the clinical outcome of single or double-segment pedicle subtraction osteotomy (PSO) for the treatment of old thoracolumbar osteoporotic compression fractures with kyphosis. The clinical data of 26 patients with old thoracolumbar osteoporotic compression fractures with kyphosis who underwent surgery from January 2015 to June 2017 were retrospectively analyzed. There were 12 males and 14 females, aged from 58 to 72 years old with an average of 65.6 years. The time interval from fracture to surgery was (8.2±1.5) years. According to different surgical methods, the patients were divided into single-segment PSO group (group A) and double-segment PSO group(groupB). The perioperative data, preoperative and postoperative imaging data and postoperative complications were recorded, and the Oswestry Disability Index (ODI) and visual analogue scale (VAS) were used before and after surgery to evaluate the clinical effect. All patients were followed up for 6-24 months with an average of 14.5 months. There was a statistically significant difference in operation time and intraoperative blood loss between the two groups (P<0.05). There was no significant difference in total drainage volume and length of hospital stay (P>0.05). The postoperative correction angle of the single segment PSO group was (33.3± 9.4) ° with the correction rate of 85.3% and the double segment PSO group was (41.0±13.5) ° with the correction rate of 92.7%, and there was statistical significance between two groups (P<0.05). There were no significant differences in postoperative lumbar lordosis (LL), sagittal vertical axis (SVA), and ODI, VAS between two groups (P>0.05). One case of cone injury occurred in the single-segment PSO group and recovered after treatment. There were no complications of spinal cord injury in the double segment group. Loose screws occurred during surgery in three patients in the single-segment PSO group and one patient in the double-segment PSO group (P<0.05). All 4 patients were re inserted with screws after using bone cement to reinforce the nail pathway. There were no complications such as anterior spinal vascular and nerve damage or osteotomy unfusion. Both single-segment PSO and double-segment PSO can achieve good orthopedic and clinical effects in the treatment of old thoracolumbar osteoporotic fractures with kyphosis. For patients with correction angles greater than 40° , the double-segment PSO provides a better correction angle and is safer, but it is with longer operation time and more intraoperative bleeding.

Pressure Ulcers in a Sample of Iraqi Patients with Spinal Cord Injury

Background: Pressure injury is the most common preventable secondary complication of spinal cord injury and may lead to serious. Aims of the study: To determine the prevalence, grade, number and most common sites of pressure ulcer in people with spinal cord injury. Patients and Method: This study carried out at Ibn Alkuff Spinal Cord Injury Rehabilitation Hospital, Baghdad, Iraq, during the period from 1st of November 2017 to the 1st of July 2018. A total sample of 100 patients was included in this descriptive cross-sectional study. Pressure ulcer was diagnosed by physical examination and graded according to the classification system for pressure ulcer by the European Pressure Ulcer Advisory Panel (EPUAP). Special scale was included in this study to assess spinal cord injury impairment (American spinal injury association scale (ASIA). Results: Forty patients were having a pressure ulcer. This study showed these pressure ulcers more frequent in ASIA score (A) followed by (B) and (C). The results showed no statistically significant association between age, gender, duration of spinal cord injury and causes of spinal cord injury in determining the presence of pressure ulcer (p=0.089, p=0.57, p=0.214 and p=0.57 respectively). Conclusions: Pressure ulcers are one of common secondary complication that occurs in 40% of Iraqi patients with spinal cord injury with more frequency in ASIA scale A and B spinal cord injury especially in sacral area and most of the patients presented with one ulcer only.

Is comorbidity related to the independence of patients with spinal cord injury?

Aim: Apart from the complications of spinal cord injury, some comorbidities in patients with this injury should be considered in the long term. In this study, we aimed to identify the comorbidities in patients with chronic spinal cord injury and the relationship of these comorbidities with the patients’ level of independence.Methods: This retrospective cohort study involved 40 patients who had spinal cord injury and were admitted to an inpatient rehabilitation program at our hospital between March 2014 and January 2016. The participants were evaluated in terms of age, height, weight, body mass index, place of residence, and marital status. Their type, level, and duration of injury were also assessed. ASIA Impairment Scale (AIS), Functional Independence Scale (FIM), Functional Ambulation Scale (FAS), Spinal Cord Independence Scale (SCIM), and Cumulative Illness Rating Scale (CIRS) were used to evaluate the patients.Results: The mean age of the 40 patients with chronic spinal cord injury was 41.83 (16.87) years. Their most common comorbidities were genitourinary (62.5%), lower gastrointestinal (50%), and ophthalmological–otolaryngologic problems (42.5%). No correlation was found between the CIRS scores and the SCIM Personal Care, Respiratory and Sphincter Management, Mobility, and the total SCIM scores of the participants. (P=0.949, P=0.469, P=0.452, P=0.521, respectively). By contrast, the FIM scores were correlated with the SCIM scores of the cases (P=0.014).Conclusion: The most common long-term comorbidities in patients with spinal cord injury were genitourinary, lower gastrointestinal, and ophthalmological–otolaryngologic problems. However, these comorbidities were not directly related to the patients’ ambulation and independence levels.