Non-traumatic Spinal Cord Research Articles

Clinical Prediction Rule Validation for Ambulation Outcome After Traumatic Spinal Cord Injury in a Spanish Population

Predicting the ability to walk after traumatic spinal cord injury is of utmost importance in the clinical setting. Nevertheless, only a small fraction of predictive models are evaluated on their performance by other authors using external data. The Dutch Clinical Prediction Rule for long-term walking ability was developed and validated using neurological assessments performed within 15 days postinjury. However, in reality, this assessment is most often performed between 11 and 55 days. When considering a longer time from injury to neurological assessments, the Dutch Clinical Prediction Rule has only been externally validated for patients after non-traumatic spinal cord injury. We aimed to validate the Dutch Clinical Prediction Rule with neurological assessment performed within 3-90 days after traumatic spinal cord injury, using (a) the Dutch Clinical Prediction Rule logistic regression coefficients (Equation 1); (b) the Dutch Clinical Prediction Rule weighted coefficients (Equation 2); and (c) the reestimated (using a Spanish population) weighted coefficients (Equation 3). We conducted a retrospective (STROBE-compliant) study involving 298 adults with traumatic spinal cord injury admitted to a hospital between 2010 and 2019 in Spain. The Spinal Cord Independence Measure item-12 was used for walking assessment. Using Equation 1, the model yielded 86.2% overall classification accuracy, 94.5% sensitivity, and 83.4% specificity (area under the curve [AUC] = 0.939, 95% confidence interval [CI]: 0.915-0.965; p < .001).Using Equation 2 yielded 86.2% overall classification accuracy, 93.2% sensitivity, and 83.9% specificity (AUC = 0.9392, 95% CI: 0.914-0.964; p < .001).Using Equation 3 yielded 86.9% overall classification accuracy, 68.9% sensitivity, and 92.8% specificity (AUC = 0.939, 95% CI: 0.914-0.964; p < .001). This study validates the Dutch Clinical Prediction Rule in a Spanish traumatic spinal cord injury population with assessments performed up to 90 days postinjury with similar performance, using the original coefficients and including a reestimation of the coefficients.

Management and outcome of spontaneous cervical epidural hematoma: Case report and review of the literature

Spontaneous spinal epidural hematomas are rare and potentially disabling neurological emergencies. Its lead to devastating neurologic outcomes and most patient does not recover completely. The clinical presentation is diverse and includes a severe acute attack, radiating pain at the back, interscapular, or neurological deficits. We report a case of a young woman, 24-year-old, that was admitted to our department for sudden non-traumatic cervical spinal cord compression syndrome (Type A of the American Spinal Cord Injury Association “ASIA A”) including intense cervical back pain, sensory loss, and tetraplegia. Her past medical history was unremarkable. The MRI confirmed a cervical mass responsible for the spinal cord compression and the emergent surgical intervention allow us to evacuate acute C3-C7 hematoma. The patient never recovers from the neurologic deficit despite the emergent management of her case followed by functional musculoskeletal rehabilitation for two years.

Traumatic versus non traumatic spinal cord injury: Characteristics and functional outcome in a Tunisian rehabilitation centre

Background: Understanding of the underlying mechanisms of Spinal cord injury (SCI) would help in the development of treatment strategies and enhance neurological recovery. Aim: The aim of this study was to describe clinical and demographic data of SCI in a physical medicine department and to compare neurological and functional outcome in Traumatic Spinal Cord Injury group (TSCI) and Non Traumatic Spinal Cord Injury group (NTSCI) during two years of follow up. Materials and methods: This study was conducted in a physical medicine and rehabilitation department of a tertiary hospital (January 2008-December 2014). Medical records of 177 patients with spinal cord injury (SCI) were reviewed. Two groups were defined: traumatic (TSCI) and non-traumatic (NTSCI) spinal cord injury. Characteristics and functional outcome were analyzed and compared. Results: Patients of NT group were significantly older. Most of injuries in both groups had a cervical level. ASIA scale scores and MIF scales were significantly higher in NT group at admission and after two years of follow up. The impairment was more remarkable in this group. Conclusions: Our study suggests that non traumatic SCI represent a considerable proportion of SCI rehabilitation admissions. Although different characteristics and injury patterns, functional outcomes maybe comparable to traumatic SCI. Key words: spinal cord injury, epidemiology, etiology, rehabilitation

Development of an ICF Core Set Based Instrument for Individuals with Non-traumatic Spinal Cord Injury

Introduction: The International Classification of Functioning, Disability and Health (ICF), describes the functioning and individuals with particular health condition and how context factors can modulate it. The nontraumatic spinal cord injury (NTSCI) has several effects on the functioning. The ICF Core Set for spinal cord injury (CSSCI) can be an innovative assessment of people with NTSCI functioning, but has not been applied in this context and there are no standardization proposals for its implementation. Objective: To develop a user-friendly instrument based in the International Classification of Functioning, Disability and Health core set for spinal cord injury (CSSCI) to operationalize functioning data of non-traumatic patients. Method: By studying, the particular uses of CSSCI categories to non-traumatic individuals, the researchers developed specific questions with richly described answer alternatives according with the descriptions of ICF qualifiers. For some categories, validated instruments were adapted, for some others new questions were formulated. Results: A questionnaire containing 43 sub-items was developed covering aspects of 9 body functions, 4 body structures, 21 activities and participation and 9 environmental factors. Health professional who tested it did not report difficulties to understand or apply the questionnaire, although it may time consuming. Conclusion: Besides proposing a method to develop ICF based questionnaires, this study developed a functional assessment tool that is very broad in the evaluation of functioning and adds the impact of environmental factors on the overall experience of disability.

A case of non-traumatic intramedullary spinal cord haemorrhage secondary to an arteriovenous malformation as a cause of painless myelopathy

A case of non-traumatic intramedullary spinal cord haemorrhage secondary to an arteriovenous malformation as a cause of painless myelopathy

Comparison of functional results in non-traumatic and traumatic spinal cord injury

Purpose. This study was conducted primarily to be a descriptive study about non-traumatic (NT) spinal cord injury (SCI) patients, in terms of their demographic and neurological features, and to investigate the complications and efficient results of rehabilitation in this group. The second aim of the study was to conduct a comparison between non-traumatic SCI patients and traumatic SCI patients.Materials and methods. The design was a retrospective study at a Physical Medicine and Rehabilitation Training and Research center. The study was carried out with 194 patients, of whom 63 had non-traumatic SCI and 131 had traumatic SCI. Main outcome measures were: Demographics, etiology, Functional Independent Measure score, and level of injury.Results. A total of 32.47% (n = 63) of the patients in the study had a non-traumatic SCI. In traumatic SCI group, the proportion of male patients were significantly more than the proportion of female patients (p = 0.002). Admission FIM score of non-traumatic SCI group was better than the traumatic SCI group (p = 0.004). The comparison of discharge FIM scores between traumatic SCI and non-traumatic SCI groups did not yield any significant results (p = 0.303). However, the comparison of FIM gain between the two groups showed a significant difference (p = 0.03). The most common complication in non-traumatic SCI group was urinary tract infection and this was observed in 25 patients (39.68%).Conclusions. The present study showed that there are certain differences between NT and traumatic SCI patients. Therefore, not all SCI patients should be considered to be falling under a single category, and should be divided into groups on the basis of the etiology of the injury. It is important to consider this information while developing the targets and planning of the rehabilitation program.

4-52-06 Non-traumatic spinal cord and root disorders

4-52-06 Non-traumatic spinal cord and root disorders

Is CNS trauma a prerequisite for the elongation of CNS axons into denervated peripheral nerve?

The demonstration that some central nervous system (CNS) axons can regenerate when provided with a suitable environment raises the possibility of new treatments for CNS injury. However, at present the conditions for optimal regeneration are not well understood. For example, the methods used in previous studies have entailed CNS trauma as part of the research protocol (e.g. that resulting from the implantation of peripheral nerve grafts), and so the role of neuronal or axonal injury in the regrowth observed has been difficult to establish. To determine whether such injury is necessary for the central reinnervation of denervated peripheral nerve, the L 5 dorsal root has been chronically denervated in rats by freeze-thawing its dorsal root ganglion (DRG), and the root has been left attached to either traumatized or non-traumatized spinal cord. The trauma induced was quite mild, and resulted from several vertical insertions of a fine needle. Two to 4 months later, retrogradely transported horseradish peroxidase (HRP) was used to label spinal neurons which sent axons into the denervated roots. HRP-labelled neurons were found in each of the spinal cords subjected to trauma, but no labelled neurons were observed in any of the non-traumatized cords. The number of HRP-labelled neurons in individual spinal cords was positively correlated with the degree of spinal cord trauma. We conclude first that the chronic and intimate presence of a denervated PNS tissue in continuity with the spinal cord is not, in itself, a sufficient stimulus to induced its reinnervation by CNS axons. Second, we conclude that under the conditions of this experiment CNS trauma is a prerequisite for the reinnervation of denervated peripheral nervous tissue by CNS axons.

Leukotriene B4 Release and Polymorphonuclear Cell Infiltration in Spinal Cord Injury

Activation of arachidonic acid occurs after spinal cord injury. Leukotriene B4 is a lipoxygenase metabolite of arachidonic acid. In a rat model of experimental spinal cord injury, we found that the leukotriene B4 content was less than the sensitivity of our assay (8 pg/mg of protein) in non-traumatized spinal cord. Leukotriene B4 was detectable in traumatized cord (mean +/- SE, 25 +/- 5 pg/mg of protein; n = 3). Release of leukotriene B4 from spinal cord slices into the incubation medium was also noted after trauma (9 +/- 1 pg/mg of protein; n = 12) and was enhanced by exposure of traumatized spinal cord slices to the calcium ionophore A23187 (375 +/- 43 pg/mg of protein; n = 12). The amount of leukotriene B4 released corresponded to the extent of post-traumatic polymorphonuclear cell infiltration determined by a myeloperoxidase assay. Results from this study suggest that the source of leukotriene B4 in spinal cord injury is infiltrating polymorphonuclear cells.