Management Of Spinal Cord Injury Patients Research Articles

Evaluation and management of neurogenic bladder after spinal cord injury: Current practice among physical medicine and rehabilitation specialists in Turkey.

Objectives This study aims to determine the current trends in evaluation and management of neurogenic bladder secondary to spinal cord injury (SCI) among Physical Medicine and Rehabilitation (PMR) specialists in Turkey. Materials and methods Between September 2013 and November 2013, a total of 100 PMR specialists from 18 different provinces of Turkey were included in the study. A 23-item questionnaire was developed to evaluate the current practice on assessment and follow-up of upper and lower urinary tract dysfunction. The questionnaire was delivered via e-mail to the participants routinely providing care for patients with SCI and all responses were obtained electronically. Results For surveillance of the upper urinary tract dysfunction, 93% of the participants preferred ultrasonography. A total of 59% of the participants favored an annual assessment and 36% preferred six-month intervals. Multichannel urodynamics, voiding cystourethrography combined with urodynamics, and video-urodynamics were preferred by 62%, 25%, and 10% of the participants, respectively for surveillance of the lower urinary tract. Urodynamic evaluation was performed annually by 51% of the participants. In patients with detrusor overactivity unresponsive to the combination of intermittent catheterization (IC) and anticholinergic agents, 66% preferred to increase the dose and 22% preferred to switch to another medication. For treatment of areflexic bladder, 78% preferred IC and 12% preferred the Credé' or Valsalva maneuvers. Treatment of asymptomatic bacteriuria was not favored in patients on IC and indwelling urethral catheter by 33% and 44% of the participants respectively. Totally, 84% participants preferred to administer antibiotics for 10 to 14 days for the treatment of symptomatic urinary tract infection. Conclusion Our study results indicate that there are some differences in the current practice of PMR specialists for surveillance and management of SCI patients with neurogenic bladder. These results also emphasize the need for development of guidelines and implementation of continuous medical education activities in this field.

Controversies in the Surgical Management of Spinal Cord Injuries

Traumatic spinal cord injury (SCI) affects over 200,000 people in the USA and is a major source of morbidity, mortality, and societal cost. Management of SCI includes several components. Acute management includes medical agents and surgical treatment that usually includes either all or a combination of reduction, decompression, and stabilization. Physical therapy and rehabilitation and late onset SCI problems also play a role. A review of the literature in regard to surgical management of SCI patients in the acute setting was undertaken. The controversy surrounding whether reduction is safe, or not, and whether prereduction magnetic resonance (MR) imaging to rule out traumatic disc herniation is essential is discussed. The controversial role of timing of surgical intervention and the choice of surgical approach in acute, incomplete, and acute traumatic SCI patients are reviewed. Surgical treatment is an essential tool in management of SCI patients and the controversy surrounding the timing of surgery remains unresolved. Presurgical reduction is considered safe and essential in the management of SCI with loss of alignment, at least as an initial step in the overall care of a SCI patient. Future prospective collection of outcome data that would suffice as evidence-based is recommended and necessary.

A Systematic Review of Intensive Cardiopulmonary Management after Spinal Cord Injury

Intensive cardiopulmonary management is frequently undertaken in patients with spinal cord injury (SCI), particularly due to the occurrence of neurogenic shock and ventilatory insufficiency and in an attempt to reduce secondary injury. We undertook a systematic review of the literature to examine the evidence that intensive care management improves outcome after SCI and to attempt to define key parameters for cardiopulmonary support/resuscitation. We review the literature in five areas: management of SCI patients in specialized centers, risk in SCI patients of cardiopulmonary complications, parameters for blood pressure and oxygenation/ventilation support following SCI, risk factors for cardiopulmonary insufficiency requiring ICU care after SCI, and preventative strategies to reduce the risks of cardiopulmonary complications in SCI patients. The literature supports that, in light of the significant incidence of cardiorespiratory complications, SCI patients should be managed in a monitored special care unit. There is weak evidence supporting the maintenance of MAP >85 mmHg for a period extending up to 1 week following SCI.

Spinal Cord Injury‐Induced Neurogenic Bladder

Spinal cord injury (SCI) is one of the most debilitating and devastating injuries to humans. Lower urinary tract dysfunction is of most concern in the management of SCI patients. Proper management depends on understanding the mechanisms underlying the development of neurogenic bladder. Suprasacral SCI induces detrusor areflexia and urine retention initially. The recovery of lower urinary tract function occurs several weeks later, but the voiding function deteriorates and manifests by hyperreflexia and incomplete voiding secondary to the simultaneous contraction of the detrusor and external urethral sphincter (detrusor–sphincter dyssynergia) during voiding. Electrophysiological and pharmacological studies of animals reveal that the recovery of lower urinary tract function relies on the plasticity of bladder afferent pathways. The Aδ afferents convey proprioception and initiate micturition reflex in intact cats and rats. Chronic SCI animals exhibit hyperreflexia during storage and incomplete expulsion during voiding. The Aδ afferent pathway is replaced by capsaicin‐sensitive C‐fiber afferents in chronic SCI cats. In chronic SCI rats, voiding is still mediated thru Aδ afferents. However, C‐fiber afferents modify bladder function and induce bladder hyperreflexia and detrusor–sphincter dyssynergia in chronic SCI rats. Thus, multiple factors have been implicated in the development of neurogenic bladder induced by SCI.

Practice patterns of Japanese physicians in urologic surveillance and management of spinal cord injury patients

Analysis of answers to a new questionnaire. To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan. Nationwide questionnaire survey to physicians in Japan. A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS). We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. For surveillance of the upper urinary tract (UUT), 239 (71.8%) respondents preferred abdominal ultrasound. Cystometry was performed routinely by 174 (52.3%) respondents for the evaluation of vesicourethral function. Cystoscopy was carried out in cases of hematuria (88.0%) and bladder stone (55.3%). Surveillance of the urinary tract was performed every year in 154 (46.2%). For detection of bladder cancer, which 119 (37.9%) respondents have experienced, 94.9% physicians perform cystoscopy, 76.3% urinary cytology, and 60.4% ultrasound. For initial treatment of detrusor-sphincter dyssynergia (DSD), 225 (69.2%) respondents chose alpha-blocker, and 94 (28.9%) chose clean intermittent catheterization (CIC) with/without anticholinergic agent(s). For initial treatment of overactive bladder, 245 (74.7%) chose anticholinergic agent(s) only and 63 (19.2%) chose anticholinergic agent(s) with CIC. For initial treatment of areflexic bladder, 233 (73.7%) chose CIC and 63 (19.9%) chose Credé maneuver or tapping. This survey shows that there are some differences in urological surveillance and management of SCI patients between Japan and the US. Reasons for the discrepancy should be examined.

MRI findings in spinal cord injury patients who have respiratory distress

The present study is an attempt to determine the prognostic capability of magnetic resonance imaging (MRI) in patients with a spinal cord injury (SCI) in the acute phase. The overall management of SCI patients is a prime consideration, and special precautions are required when the patient has respiratory distress. Twelve patients with a complete cervical injury accompanied by respiratory distress were examined by MRI, and a correlation of the MRI findings and the respiratory problems were investigated. In three cases with severe respiratory distress, the SCI was present above the C4-5 level, and MRI showed a high signal intensity at the upper C3. The severity of the respiratory failure was well correlated with the upper margin of the high signal intensity on T2-weighted images.