Non-traumatic Spinal Cord Lesions Research Articles

Reliability and validity of the international standards for neurological classification of spinal cord injury in patients with non-traumatic spinal cord lesions.

Prospective, observational study. The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) represent the gold standard for the assessment of patients with spinal cord injury (SCI) and their measurement properties have been evaluated in patients with traumatic lesions. Albeit the ISNCSCI are widely used also for the assessment and prognosis of patients with non-traumatic SCI, a validation of this grading system in this sample has never been performed. Therefore, the aim of this study is to evaluate the measurement properties of the ISNCSCI in a population of persons with non-traumatic SCI. Three Italian rehabilitation hospitals. The sample included 140 patients with non-traumatic SCI of different etiology, level and grade, for a total of 169 evaluations performed by two examiners. Cronbach's Alpha was used to evaluate the internal consistency of the ISNCSCI various components. The agreement between two examiners of each center in the definition of different components was used to assess the inter-rater reliability. The construct validity was evaluated through the correlation of the ISNCSCI with the Spinal Cord Independence Measure (SCIM). The ISNCSCI showed substantial internal consistency, and substantial inter-rater agreement for AIS grade, cumulative motor and sensory scores. The motor scores for upper and lower extremity showed fair to moderate correlation with SCIM self-care and motility subscores, respectively. The ISNCSCI total motor score correlated with the total SCIM score. Our study demonstrates that the ISNCSCI are a valid and reliable tool for the assessment of patients with non-traumatic SCI.

What can be achieved by using MR-DWI and ADC value in cases of intramedullary spinal cord lesions of non-traumatic causes?

BackgroundEarly diagnosis and management of intra medullary spinal cord lesions is crucial for improving the outcome. This can be achieved by adding DW-MRI to spinal imaging protocol. Patients & methodsA prospective study included 42 patients proved to have intramedullary SOLs of non-traumatic causes based on cMRI, were subjected to DWI and ADC value measurement. Our findings were correlated to the clinical outcome in non-neoplastic lesions and o the histopathological results in neoplastic lesions. Results20 cases of non-neoplastic lesions (group I) showed nonrestricted diffusion with variable increased ADC values (mean = 1.46 ± 0.35 × 103 mm2/s), except in cord acute ischemia which had restricted diffusion and reduced ADC value (mean = 0.85 ± 0.07 × 103 mm2/s). 22 cases of neoplastic lesions (group II) showed reduced ADC values (mean 1.05 ± 0.21 × 103 mm2/s), the lowest was in metastatic lesions (mean 0.75 ± 0.15 × 103 mm2/s) and medulloblastoma (mean 0.81 ± 0.09 × 103 mm2/s) while a diagnostic overlap occurred between astrocytoma and ependymoma (mean 1.19 ± 0.07, 1.1 ± 0.07 × 103 mm2/s respectively). A cut off value 1.25 × 103 mm2/s was found to differentiate between the two groups. ConclusionOptimum diagnosis for non-traumatic intra-medullary spinal cord lesions can be achieved by using DWI and ADC value measurement.

"Relationship between Modified Ashworth Scale and Alpha Motoneuron Excitabilityin Spinal Cord Lesions"

Background: Spasticity is one of the major neurological complications occurring in people with Spinal Cord Lesions due to loss of supra-spinal and spinal control over alpha motor neuron activity. Its accurate assessment is necessary for tailoring patient specific rehabilitation program. Clinical assessment is commonly done through Modified Ashworth Scale where in the examiner subjectively judges resistance to passive range of motion whereas, electrophysiological quantification of spasticity can be done through Hoffman’s Reflex which is an estimate of alpha motor neuron activity.Methods: This co-relational study establishes an association between MAS and H reflex in a sample of both traumatic and non-traumatic Spinal Cord lesion patients. A sample of 22 patients was obtained who were rated for MAS grades 0,1,1+,2 and 3 in bilateral gastro soleus and consequent H reflex elicitation was done.Results: Karl Pearson Correlation coefficient was calculated between MAS and H amplitude (r = 0.342, p<0.05); MAS and h latency (r = 0.013, p>0.05) ; MAS and H/M ratio (r=0.190 ,p>0.05).Conclusion: It was concluded that there exists a weak but significant correlation between MAS and H amplitude but non-significant relationship between MAS and H latency; MAS and H/M ratio.

Applicability, validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions

Purpose: To verify the applicability, reproducibility and validity of the SCIM III patients with non-traumatic spinal cord injury.Method: The cross-sectional study included 30 patients (66% females; 41.5 ± 14.7 yo) with non-traumatic spinal cord injury of any etiology. Subjects were subjected by computerized gait analysis and answered the Brazilian versions of SCIM III (0–100 points) and FIM™ (18–126 points) by two raters (A and B) at the same day and 1 week later (A).Results: The intraclass correlation coefficient for the use of SCIM III indicated appropriated intra- and inter-evaluator reproducibility (ICC = 0.9). Correlation between the SCIM III and the motor FIM™ was appropriate (r = 0.6; p = 0.0). SCIM III subscales and FIM™ domains correlated strongly for self-care (r = 0.8; p ≤ 0.001), moderately for transfers (r = 0.6; p = 0.0005) and locomotion (r = 0.6; p = 0.0006). SCIM III mobility subscale positively correlated with the cadence (r = 0.8; p ≤ 0.01), gait speed (r = 0.7; p ≤ 0.01) and step length (r = 0.6; p ≤ 0.01).Conclusions: SCIM III is a reproducible functional assessment instrument and capable of evaluating the level of independence of the individual with non-traumatic spinal cord injury. The SCIM III is more sensitive than the MIF™ for non-traumatic spastic paraplegic patients with higher levels of independence, particularly if they can walk independently. Linear gait parameters correlated with its mobility subscale.Implications for RehabilitationApplicability, validation and reproducibility of the Spinal Cord Independence Measure version III (SCIM III) in patients with non-traumatic spinal cord lesions.There are not many studies focused on patients with non-traumatic spinal cord lesion.Disability varies in severity, but frequently contributes to limitations in the activities of daily living (ADL) and participation.We do not find in the literature studies that assess the functionality of these individuals as comprehensive as ours.

Nontraumatic myelopathy at the University of Port Harcourt Teaching Hospital: Magnetic resonance imaging evaluation

Objective: The aim of the study is to evaluate the etiology of nontraumatic myelopathy on magnetic resonance imaging (MRI) with a view to highlight the most common causes. Materials and Methods: We retrospectively examined the images and reports of patients with nontraumatic spinal cord lesion who presented to the Radiology Department of University of Port Harcourt Teaching Hospital for MRI scan between 2007 and 2012. The following data were collected: age, gender, types of lesions, and location of lesions. Cases with incomplete information were eliminated and cases with conflicting image findings and reports were reviewed. Institutional ethics approval was not necessary for this retrospective study. The data were analyzed statistically using Statistical Package for the Social Sciences (SPSS) 14.0 window evaluation version. Results: Seventy-three patients satisfied the criteria for inclusion in the study. Of these patients, there were 21 females and 52 males giving a female-to-male ratio of 1:2.5. The mean age was 37 years (age range of 15-78 years). The age range of 51-60 years had the highest frequency of lesions, accounting for 29. 17%. Disc degenerative disease was found to rank the highest among the lesions seen on MRI, accounting for 46. 6%. Conclusion: MRI is useful in detecting and localizing the spinal cord lesion responsible for myelopathy. The finding in this study that the commonest cause of myelopathy is spondylosis has contributed to bringing into limelight the burden of degenerative spinal lesion in the environment and the need to provide adequate facilities for management of the condition.

Medication before and after a spinal cord lesion

To map the impact of spinal cord lesion (SCL) on medication. Registration of medication for 72 patients before SCL and at discharge from the Department for Spinal Cord Injuries. Department for Spinal Cord Injuries, East Denmark. The changes in medication for each Anatomical Therapeutic Chemical (ATC) Classification System group were registered for all patients, who were discharged from Department for Spinal Cord Injuries during 2010. The changes in medication per se were calculated for different parts of the population: non-traumatic, traumatic patients, men, women, paraplegia, tetraplegia, American Spinal Injury Association Impairment Scale (AIS) A, B or C, AIS D, age 0-45, 46-60 and 60+. In addition, comparisons of changes in medication were made between complementary parts of the population. The overall increase in medication after SCL was 3.29 times (P<0.001). Statistically significant increases were seen for most medicine categories. When studying subgroups of the population, the increase was most constantly seen for the medicine in the groups 'Alimentary tract and metabolism' and 'Nervous system'. The highest overall increases were seen in patients with AIS A, B and C compared with AIS D (P<0.05). There was no difference between traumatic and non-traumatic SCL, men and women, and younger compared with older patients. SCL elicits a general massive need for medicine. The relative increase is most pronounced for the more severely injured (AIS A, B and C). The increase in medication may have implications for side effects and for the economy of all involved.

Analysis of the Factors Influencing Functional Outcomes in Patients with Spinal Cord Injury

[Purpose] The extent of functional independence ultimately achieved by an individual patient will be influenced by a variety of medical and non-medical factors. [Subjects and Methods] this study included 419 patients with spinal cord lesions treated in the Clinic for Rehabilitation “Dr M. Zotovic”, Belgrade, Serbia, from January 2000 to December 2009. The patients were divided in two groups according to achievement of increase in Functional Independence Measure (FIM) score of more than 13 at discharge compared to admission. A variety of clinical variables were followed in both groups. [Results] one hundred twenty-one patients (28.9%) showed improvements in FIM score of ≤13, while 298 (71.1%) patients showed an increases in FIM score of >13 at discharge compared to admission. Better functional recovery was observed in patients with non-traumatic spinal cord lesions, lower neurological levels of the lesion (OR = 6.07), and in patients treated surgically, but the level of the spinal cord lesion was the most influential factor affecting outcome. [Conclusion] the patients with spinal cord lesions should not only be grouped by traumatic and non-traumatic lesions only, but also sub-categorized, according to the etiology, level of injury and treatment method.

Demographic characteristics and functional outcomes in patients with traumatic and nontraumatic spinal cord injuries

Spinal cord injuries (SCI) could be associated with a significant functional impairment in the areas of mobility, self-care, bowel and bladder emptying and sexuality. The aim of this study was to compare demographic characteristics and functional outcomes of nontraumatic and traumatic spinal cord injury patients. This study was designed as retrospective case series study. A detailed medical history including sex, age, mode of trauma, and clinical and radiological examination was taken for all patients. Hospital records were used to classify the patients according to the following: mechanism of injury, neurological level of injury, functional outcomes, associated injuries, method of treatment, secondary complications and length of stay. The following clinical scores were measured in the patients: American Spinal Injury Association standards (CASTA), Functional Independence Measure (FIM), and Modified Aschworth score (MAS). Out of totally 441 patients with spinal cord injury, 279 were traumatic patients (TSCI) and 162 nontraumatic patients (NTSCI); 322 men and 119 women. The mean age of the patients was 46.1 +/- 19.9 years. Traumatic and nontraumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower FIM score at admission and significantly better improvement in the FIM score at discharge. The two populations were discharged with similar functional outcome. The NTSCI patients in our study were younger, more frequently female, with less complications before rehabilitation and less frequently treated operatively than the TSCI patients. Hospital rehabilitation of the TSCI patients was longer than that of the NTSCI patients, but their functional gain from admission was also higher, so at discharge. Traumatic and nontraumatic spinal cord lesion patients achieved similar results in regard to neurological and functional status.

Neoplastic myelopathies and traumatic spinal cord lesions: an Italian comparison of functional and neurological outcomes

Although neoplastic spinal cord injuries (NSCIs) constitute ∼25% of all non-traumatic spinal cord lesions, patients with such pathologies are seldom, if ever, admitted to specialized centers; further, their rehabilitation typically is short because of the perception that rehabilitation prolongs hospital stays unnecessarily and is reserved only for patients with very good prognoses. This study is a retrospective analysis. The objective of this study is to evaluate the neurological and functional outcomes of patients with NSCIs compared with those of patients with traumatic spinal cord injury (TSCI). We evaluated 208 patients with TSCIs and 63 with NSCIs; using a matching cohorts procedure, 43 comparable couples were selected from each group. The measures used to assess these patients were the American Spinal Injury Association standards, the Barthel Index (BI), the Rivermead Mobility Index and the Walking Index for Spinal Cord Injury. In the general population, NSCI patients are older and have longer lesion-to-admission times and more incomplete lesions than TSCI patients. Therefore, the functional status at admission and outcomes differed between the groups. In the matching cohorts, TSCI patients had lower BI scores at admission than NSCI subjects. At discharge, the two groups had comparable functional outcomes. Neurological status was similar at admission and at discharge. Although they had slightly disparate functional levels at admission, NSCI and TSCI patients had the same outcomes at discharge. Our data suggest that in a selected cohort of NSCI patients, rehabilitation is as successful as that in TSCI subjects and allows most patients to be discharged instead of being institutionalized.

Traumatic and non-traumatic spinal cord lesions: an Italian comparison of neurological and functional outcomes

Retrospective study. To compare the rehabilitation outcomes of non-traumatic and traumatic spinal cord injury patients. Spinal cord unit of a rehabilitation hospital in Italy. In total, 380 patients at first rehabilitation stay after the lesion (144 traumatic patients and 236 non-traumatic patients; 244 men and 136 women; mean age 46.1±19.9 years; mean lesion to admission time 49.6±39.8 days). Not applicable. American Spinal Injury Association standards; Barthel index (BI), Rivermead mobility index and walking index for spinal cord injury. Poisson regression models with relative risks and 95% confidence intervals adjusted for the following confounders: age, sex, lesion level and Asia impairment. Models were stratified by age because a strong interaction between different variables and age was found. Traumatic and non-traumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower BI score at admission and significantly better improvement in the BI score by discharge. The two populations were discharged with similar functional outcome. No significant differences were found with regard to the others outcomes. In clinically stable patients, spinal cord injury etiology does not seem to affect the rehabilitative prognosis. At admission, traumatic patients show lower autonomy in daily life activities, probably because of the associated lesions that these patients often have. At discharge, traumatic and non-traumatic spinal cord lesion patients achieved similar results with regard to neurological and functional improvement.

Demographic characteristics after traumatic and non-traumatic spinal cord injury: a retrospective comparison study

Retrospective, 12-year case series. To compare neurological and functional outcomes, and complications of patients with traumatic vs non-traumatic spinal cord injury (SCI) after in-patient rehabilitation. In-patient rehabilitation unit of a tertiary research hospital. The sample consisted of 165 newly injured patients with traumatic and non-traumatic spinal cord lesions whose medical records were retrospectively reviewed. Demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) subgroup scores, length of stay and medical complications in both groups were compared. In all, 38 patients (23%) were non-traumatic and 127 patients (77%) were traumatic in etiology. Compared with patients with traumatic SCI (mean age 37.81±13.65 years), patients with non-traumatic SCI (mean age 53.97±14.48 years) were significantly older (P<0.05). Incomplete SCI was significantly higher in the non-traumatic group when compared with the traumatic group (P<0.001). In the non-traumatic group, admission motor FIM scores were significantly higher (28.29±16.04) than scores from the traumatic group (36.60±21.65; P=0.029); however, there was no significant difference in discharge motor FIM scores between the two groups (P=0.140). ASIA impairment scale scores were significantly higher in non-traumatic group both at admission and discharge (P=0.000 and P=0.000, respectively). The length of hospital stay was significantly shorter in the non-traumatic group (P=0.002). According to the results of this study, although patients with non-traumatic SCI had shorter length of stay and higher ASIA scores, there was no significant difference in functional outcomes between traumatic and non-traumatic SCI patients.

Non-traumatic spinal cord lesions: epidemiology, complications, neurological and functional outcome of rehabilitation

Prospective cross-sectional study. To study epidemiology, complication, neurological and functional outcome in non-traumatic spinal cord lesions (NTSCL) after inpatient rehabilitation. Neurological rehabilitation unit of a tertiary research hospital. Sixty-four patients (M/F=28:36) with NTSCL admitted from June 2005 to January 2008 for multidisciplinary rehabilitation. Epidemiology, medical complications during stay in rehabilitation, admission and discharge--Barthel Index (BI) and American Spinal Injury Association (ASIA) impairment scale for functional and neurological recovery, respectively, were recorded and analyzed. NTSCL constituted 60% (64 of 106) of the total SCL patients admitted for rehabilitation during the same period. Female patients outnumbered males (56.25%) in the study. Mean age, duration of illness and duration of stay in rehabilitation were 30.64+/-13.67 years (6-57), 7.09+/-9.15 months (1-48) and 55.75+/-40.91 days (14-193), respectively. The ratio of paraplegia and quadriplegia was 2:1. Forty-four patients (68.75%) had incomplete cord lesion according to the ASIA impairment scale. Spinal tumors (26.6%) were found to be the most common etiology, followed by Pott's spine (25%) and transverse myelitis (22%). Urinary tract infection was found to be the most common complication (50%), followed by spasticity (35.93%) and urinary incontinence (31.25%). The mean BI scores showed significant (P=0.000) functional recovery during rehabilitation using paired Student's t-test. The ASIA impairment scale showed significant neurological recovery (P=0.001) using the Wilcoxon non-parametric test. NTSCL constitute a significant proportion of overall SCL. Female population, paraplegia and incomplete cord lesions are more common among NTSCL in this study. Patients with NTSCL recover significantly both neurologically and functionally with rehabilitation intervention.

Hospital Care of Postacute Spinal Cord Lesion Patients in Italy

To define the clinical characteristics of hospital readmissions of subjects with spinal cord lesion. Prospective, multicenter, 2-yr survey in 32 spinal cord lesion centers in Italy. Readmitted traumatic or nontraumatic spinal cord lesion patients were included. Main outcome measures were number of readmissions, their causes, complications on admission, and length of stay. Out of 2070 total admissions of patients with spinal cord lesion, 1056 (51.0%) were readmissions. The median period between the onset of disease and readmission was 3.4 yrs. A program of functional gain was the main cause of readmission (33%). A pressure sore was reported in 20.6% of cases on readmission. Readmission for a program of functional gain was correlated to nontraumatic and incomplete lesions. Readmission necessary for clinical complications was correlated to traumatic spinal cord lesion and completeness of the lesion. A longer length of stay correlated with cause of readmission, admission to rehabilitation centers, and nontraumatic origin. Readmissions account for more than half of total admissions to centers for spinal cord lesion in Italy. The main burden is represented by a program of functional gain, pressure sores, and urological complications.

Traumatic vs non-traumatic spinal cord lesions: comparison of neurological and functional outcome after in-patient rehabilitation

Retrospective comparative study of 2 years duration. To compare neurological and functional outcome and length of stay of persons with traumatic vs non-traumatic spinal cord lesion (SCL) after in-patient rehabilitation. Neurological rehabilitation department of a tertiary research center in Bangalore, Karnataka, India. Seventy-six in-patients with spinal cord lesion: traumatic (38 patients, M/F=34:4) and non-traumatic (38 patients, M/F=16:22) were admitted for in-patient multidisciplinary neurorehabilitation. ASIA impairment scale, duration of stay (DOS), and admission and discharge--Barthel Index scores in both the groups were recorded, compared and analyzed. ASIA impairment scale scores were significantly higher in non-traumatic group both at admission and discharge (P=0.020 and 0.017), respectively, showing lesser impairment in non-traumatic group. DOS for rehabilitation was higher for traumatic group as compared to non-traumatic group (65.97+/-47.66 vs 60.68+/-45.69 days), although statistically not significant (P>0.05). Barthel Index scores were 28.68+/-17.15 vs 27.63+/-14.96 at admission and 54.21+/-25.10 vs 51.44+/-19.86 at discharge in traumatic and non-traumatic groups, respectively. All patients (n=76) showed significant improvement in Barthel Index (P=0.000), but no statistically significant difference (P>0.05) was recorded between the two groups, both at admission and at discharge. Orthoses was required significantly more frequently (P=0.043) in traumatic SCL group. The study showed that despite more impairment in persons with traumatic spinal cord lesion, there was statistically no significant difference in the length of stay and the functional outcome between persons with traumatic and non-traumatic spinal cord lesion after in-patient rehabilitation.

Quality of life and psychological problems in patients undergoing neurological rehabilitation

Aim:To assess the quality of life (QoL) and prevalence of psychological problems (PP) in patients with neurological illness, and their correlation with functional abilities.Materials and Methods:Prospective cross-sectional study conducted in the neurological rehabilitation unit of tertiary research hospital in 30 consecutive hospitalized patients (21 men), age 16-55 years (34.63±11.87).Outcome Measure:WHOQoL-BREF was used to assess QoL. The prevalence of PP was recorded using Hospital Anxiety Depression Scale (HADS) and General Health Questionnaire (GHQ-12). QoL and HADS scores were correlated with functional abilities using mean Barthel Index (BI) Score.Results:The duration of illness was three to 30 months (10.63±7.83) and their primary diagnoses were stroke 12, traumatic spinal cord injury seven and non-traumatic spinal cord lesion 11. Twenty-two patients qualified for GHQ-12 caseness, with 15 patients having distress (score ≥15) and seven having severe problem and psychological distress (score≥20). Twenty five patients had abnormal anxiety and 17 had abnormal depression on HADS (abnormal = 8-21), with moderate to severe anxiety and depression (scores≥11) in nine and three patients respectively. The mean WHOQoL-BREF transformed scores (on WHOQoL 0-100 scale) were (38.83±8.02), (50.76±9.79), (48.53±18.46) and (49.13±10.63) in physical, psychological, social, and environmental domains respectively. The social domain of QoL had significant correlation (P<.05) with functional abilities.Conclusion:Patients with neurological disorders requiring inpatient rehabilitation have impaired QoL that affects all domains of life. There is high prevalence of psychological problems, including anxiety and depression. The social domain of QoL adversely affected functional abilities, but the correlation between PP and functional abilities was insignificant.

The prevalence of neuropathic pain after non-traumatic spinal cord lesion

Retrospective register study. To investigate the predictive value of the following parameters for the development of neuropathic pain after non-traumatic spinal cord lesion: that is age at onset of spinal cord disease, gender, completeness of lesion, level of lesion, and aetiology. A unit for patients with post-acute traumatic and non-traumatic spinal cord lesions in the greater area of Stockholm, Sweden. All patients with non-traumatic spinal cord lesions visiting the unit between 1995 and 2000 were classified according to the following: that is neuropathic pain at or below lesion level according to IASP criteria, age at time of the onset of the spinal cord symptoms, injury level, complete/incomplete injury, and aetiology. Results were analysed with chi(2) - analysis and logistic regression. In total, 38% had neuropathic pain, 15% had pain predominantly at the level of lesion, and 23% predominantly below the level of lesion. Of those with pain, 67% reported that the pain affected daily life. Women reported neuropathic pain below the level of lesion more often (40%) than men (13%). The prevalence was particularly high (64%) for patients with malignant spinal cord diseases. Neither age at onset of the spinal cord symptoms, nor complete/incomplete injury nor injury level had significant influence on the prevalence. Neuropathic pain is common among patients with acquired non-traumatic spinal cord lesions regardless of aetiology, often causing severe problems in daily life.

Nontraumatic spinal cord lesions: a prospective study of medical complications during in-patient rehabilitation

Prospective study between 1st Jan 1995 and 31st Dec 1999. To document medical complications among subjects with Nontraumatic Spinal Cord Lesions (NTSCL) during in-patient rehabilitation. Bangalore, India. Persons with NTSCL admitted for in-patient rehabilitation were included in the study. Clinical evaluation was carried out according to The International Standards for Neurological and Functional classification of Spinal Cord Injury. Disability was quantified using Barthel index. All medical complications were documented. A total of 297 subjects (154 men and 143 women) with NTSCL were included. The number of medical complications in each patient varied from 0 to 17 (mean=6.1+/-3.7). Common complications seen were urinary tract infections (184), spasticity (169), pain (149), urinary incontinence (147), depression (114), respiratory tract infections (101), constipation (92), pressure ulcers (89), contractures (52) and sleep disturbance (43). The number of medical complications correlated positively with duration of stay (Pearson's correlation coefficient r=0.5, P<0.01) and negatively with Barthel Index at admission (r=-0.2, P<0.05) and at discharge (r=-0.2, P<0.05). Complications were more frequent among people with tetraplegia than those with paraplegia (P<0.001). Medical complications are frequent among subjects undergoing rehabilitation for NTSCL. Patients with severe disability at admission have more complications during rehabilitation. Conversely, individuals with more complications have greater disability at discharge.

Recovery of neurologic function following nontraumatic spinal cord lesions in Israel.

Retrospective cohort study. To assess neurologic recovery and the manner in which it is affected by various factors following nontraumatic spinal cord lesions (NTSCLs). NTSCLs comprise a considerable portion of spinal cord lesions. However, information about neurologic recovery in these lesions is scarce. The study sample included 1,085 patients with NTSCL treated between 1962 and 2000 at the premier referral hospital for rehabilitation in Israel. Demographic and clinical data were collected from hospital charts. The degree of neurologic recovery was determined by comparing each patient's Frankel grades of neurologic deficit at first admission to rehabilitation and at discharge from the same hospitalization. The study population was also compared with previously studied 250 patients with traumatic spinal cord lesions (TSCLs). Complete or substantial neurologic recovery (upgrade to Frankel Grade D or E) occurred during rehabilitation in 51% of patients who were Grade A, B, or C on admission, and in 57% of those who were Grade C. Neurologic recovery in NTSCL during rehabilitation was significantly affected by initial Frankel grade and by NTSCL etiology. Age had a borderline effect. Gender, lesion level, and the decade of rehabilitation did not affect recovery. Recovery rate was usually higher in NTSCLs than in TSCLs. The prognosis for neurologic recovery is affected mainly by SCL severity and etiology, and is usually better in NTSCLs than in TSCLs.

Survival after nontraumatic spinal cord lesions in Israel

Ronen J, Goldin D, Bluvshtein V, Fishel B, Gelernter I, Catz A. Survival after nontraumatic spinal cord lesions in Israel. Arch Phys Med Rehabil 2004;85:1499–502. Objective To assess survival in patients with nontraumatic spinal cord lesions (SCL). Design Retrospective cohort study. Setting Spinal department at a rehabilitation hospital in Israel. Participants Patients with nontraumatic SCL (N=1085) admitted between 1962 and 2000. Interventions Demographic, clinical, and mortality data were collected from hospital charts and from the Population Registry of the Israel Ministry of Internal Affairs. Main Outcome Measures Survival rates and mortality risk factors. Measures were estimated by using the product limit (Kaplan-Meier) method and the Cox model. Results Maximal survival time was 57 years. Median accumulated survival time was 24 years. Survival was significantly affected by lesion etiology, age, gender, severity of lesion, and recent decade of lesion onset; survival tended to be shorter in patients with higher level SCL. We found no significant difference between the effects of risk factors on mortality in nontraumatic SCL and traumatic SCL, other than the effect of age at lesion onset, which was a greater risk factor in the latter group. Conclusions The survival rate of patients with nontraumatic SCL has improved significantly in Israel in the last decade. The survival rates of a mixed nontraumatic SCL population are similar to those of traumatic SCL but may differ in specific etiologic age groups.

Spinal Cord Lesions Caused By Arteriovenous Malformation: Clinical Course And Risk Of Cancer

Purpose: Patients with nontraumatic myelopathy caused by arteriovenous malformation (AVM) are encountered in cohorts of traumatic myelopathy (SCI) patients. The study describes the clinical course of SCI secondary to AVM and compares the incidence of cancer with that in SCI patients.Participants: Twenty-three patients with AVM and 21 9 patients with SCI patients aged 50 years and older.Methods: The 2 groups were described by the character of paralysis and compared for the incidence of cancer in a retrospective review of records from the index year 1989.Results: Twenty-three patients with AVM became paralyzed, with onset from age 22 years to 85 years (mean, 53 years). The presenting symptoms were pain (usually back pain), paresthesias, and weakness. The clinical picture varied, with evolution of symptoms reported over a wide period ranging from minutes to 27 years (median, 6 months). Levels of the spinal cord damage were thoracic in 74% of the AVM group vs 40% for the SCI group, P = .004. For patients with AVM, grade of paralysis was American Spinal Injury Association D (some significant use of the legs) in 26% vs 16% for patients with SCI, P = .38. Nine patients with AVM (39%) developed cancer (skin, brain, blood, thyroid, liver, bladder, and prostate at age 66 ± 7 years) with an incidence of 5.92 cancers/100 patient years. Thirty-five patients with SCI (9%) had cancer (skin, blood, lung, bowel, bladder, and prostate, age 67 ± 5 years) develop at a rate of 1.70 cancers/100 patient years, 95% confidence interval = 1.89-6.51 for the difference, P = .001.Conclusion: Patients with nontraumatic spinal cord lesions caused by AVM often present with pain, may have a protracted clinical course, and have cancer develop more often than do those with traumatic SCI.