Spinal Injury Patients Research Articles

PMD54 Resource Utilisation Related to Catheter-associated Urinary Tract infections in Swedish Spinal injury Patients

To collect real-life data on costs and resource use, in order to understand the economic burden and treatment patterns of urinary tract infection (UTI) amongst people with spinal injury, who are in need of chronic, intermittent catheterisation. We used the CEBRxA database, which combines data from a public claims database for the South-West region of Sweden, comprising around 1.5 million individuals, with national Swedish registers on drug utilisation and mortality. We identified a population of spinal injury patients (ICD-10 S14.0, S24.0, S34.0, and T91.31) who in addition had received a diagnosis of neurogenic bladder (ICD-10 N31*), anytime during the years 2000 to 2009. UTIs were identified through the following ICD-10 codes: N11.0, N30*, N39.0*, N39.X*, N12.-P, and N30.-P. A cost per UTI was calculated through considering UTI-related care contacts that occurred within 14 days from each other (from 2005-07-01 onwards). We identified 295 spinal injury patients, with a mean age at index of 44 years, an average follow-up time of 6 years, and of which 79% were males. For 67% of the population we observed at least one UTI, which resulted in a care contact. Interestingly, a quarter of the population used prophylactic antibiotics (J01XX05), corresponding to an average of 235 DDDs per year, amongst users. A majority of UTIs were handled in primary care, while over 90% of costs were contributed by UTI-related hospitalisations. The mean cost per UTI was 43,500 SEK, while estimates varied considerably, with costs ranging from an average of 1,800 SEK for UTIs handled in primary care to 177,200 SEK for inpatient care. In a population of spinal injury patients, costs for catheter-associated urinary tract infections are to a large extent driven by outlier, expensive hospitalisation. There would be a large potential for cost savings if these hospitalisations could be avoided.

Factors influencing the quality of life of spouses of spinal cord injury patients

Objective To explore quality of life (QOL) of spouses of spinal cord injury patients,as well as its influencing factors.Methods Sixty-eight spouses of spinal cord injury patients were recruited as an observation group.At the same time,another 70 healthy married people who had no serious chronic diseases in the family but were matched in gender,age,occupation and education were chosen as a control group.The QOL of all the subjects in both groups was investigated by way of a questionnaire survey.The results of both groups were compared and factors that influenced their QOL were explored.Results The QOL of spouses of spinal cord injury patients,including total QOL ( 3.22 ± 0.37 ),physiological function ( 60.57 ± 14.22 ),psychological state ( 60.09 ± 8.06 ),social relations (63.37 ± 8.10 ) and the living environment (66.86 ± 11.26 ) were significantly lower than in the control group (4.62 ± 0.75 ; 82.48 ± 10.92 ; 86.02 ± 8.75 ; 85.94 ± 10.13 and 83.23 ± 9.54,respectively).The QOL of spouses of spinal cord injury patients was closely related to the patient's injury type,injury position,the treatment protocol,as well as their own gender,vocation and education.Conclusion The QOL of spouses of spinal cord injury patients is significantly lower than that of normal people,and closely related with the patients' injury type,injury position and treatment,as well as their own gender,vocation and education. Key words: Spinal cord injury; Spouses; Quality of life; Influence factors; Surveys

Are spine injuries sustained in battle truly different?

The severity and prognosis of combat-related injuries to the spine and spine injuries sustained unrelated to direct combat have not been previously compared. Differences may have implications on tactics, treatment strategies, and directions for future research. Compare the severity and prognosis of battle and nonbattle injuries to the spine. Retrospective study. American military personnel who were injured in a combat zone and whose medical data were abstracted in the Joint Theater Trauma Registry (JTTR). The JTTR was queried using International Statistical Classification of Diseases, Ninth Revision codes to identify all individuals who sustained battle and nonbattle injuries to the neck, back, spinal column, or spinal cord in Operation Iraqi Freedom or Operation Enduring Freedom from October 2001 to December 2009. Medical records of all identified servicemembers were individually reviewed. Demographic information, including sex, age, military rank, date of injury, and final disposition, was obtained for all patients. Spinal injuries were categorized according to anatomic location, associated neurologic involvement, precipitating mechanism of injury (MOI), and concomitant wounds. These data points were compared for the groups battle spine injuries (BSIs) and nonbattle spine injuries (NBSIs). Five hundred two servicemembers sustained a total of 1,834 battle injuries to the spinal column, including 1,687 fractures (92%), compared with 92 servicemembers sustaining 267 nonbattle spinal column injuries, with 241 (90%) fractures. Ninety-one BSI servicemembers (18% of patients) sustained spinal cord injuries (SCIs) with 41 (45%) complete SCIs, compared with 13 (14% of patients) nonbattle SCIs with six (46.2%) complete injuries (p=.92). The reported MOI for 335 BSI servicemembers (66.7%) was an explosion compared with one NBSI explosive injury. Eighty-four patients (17%) sustained gunshot wounds (GSWs) in battle compared with five (5.2%) nonbattle GSWs. Fifteen patients (3.0%) sustained a battle-related fall compared with 29 (30%) nonbattle-related falls. Battle spine injury servicemembers underwent significantly higher rates of surgical interventions (p<.0001), were injured by high-energy injury mechanisms at a significantly greater rate (p<.0001), and demonstrated a trend toward lower neurologic recovery rates after SCI (p=.16). Battle spine injury and NBSI are separate entities that may ultimately have disparate long-term prognoses. Nonbattle spine injury patients, although having similar MOIs compared with civilian spinal trauma, maintain a different patient demographic. Further research must be directed at accurately quantifying the long-term disabilities of all spine injuries sustained in a combat theater, whether they are the result of battle or not.

The effect of electrical stimulation of the pelvic floor combined with acupuncture on urinary dysfunction in spinal cord injury patients

Objective To observe the effect of electrical stimulation of the pelvic floor muscles (PES) combined with acupuncture on urinary dysfunction in patients with spinal cord injury (SCI). Methods Sixty-two patients with SCI were randomly divided into a treatment group ( n =31 ) and a control group ( n =31 ).All subjects received routine bladder function training and a drinking water schedule for 8 weeks.In addition,the treatment group was given PES 30-40 min/d 6 times/week and acupuncture for 30 min/d,6 times/week for the 8 weeks.Residual volume of urine was evaluated using ultrasound and a daily voiding diary.Uurodynamic examinations and catheter extraction were used to assess the urinary function pre- and post-treatment. Results No significant difference was found between the two groups before treatment,but after 8 weeks of treatment the residual volume of urine detected by ultrasound and voiding frequency were significantly lower in the treatment group than in the control group.First desire to urinate and maximal urinary bladder capacities in the treatment group were also significant higher than in the control group.The efficacy of treatment was also sustained significantly longer in the treatment group. Conclusion PES combined with acupuncture therapy is more effective than routine bladder function training for SCI patients with urinary dysfunction. Key words: Pelvic floor muscles; Electrical stimulation; Acupuncture; Spinal cord injury ; Urinary dysfunction

Analysis of radiation exposure to the orthopaedic trauma patient during their inpatient hospitalisation

PurposeThere has been considerable concern regarding radiation exposure to both the patient and treating surgeon and the possible risk of resulting malignancy. We sought to analyse the total effective dose of radiation that a cohort of orthopaedic trauma patients are exposed to during their inpatient hospitalisation and determine risk factors for greater exposure levels. MethodsFollowing approval from the Institution Review Board, a search was conducted of a level I trauma centre database for radiation exposures to patients over a 1 year period. Patients were included if they had an ICD-9 code from 805 to 828, indicating a fracture involving the trunk (805–811) or extremities (812–828). We compared the total effective radiation dose in various injury patterns as well as those considered to be polytrauma patients to those who were not according to their injury severity score (ISS). ResultsThe records of 1357 trauma patients were available for review. The average patient age was 40.6 years and the mean ISS was 14.1. The average effective radiation dose for all patients during their hospitalisation was 31.6mSv. There was a statistically significant difference in radiation exposure between patients with an ISS greater than 16 (48.6mSv) versus those with an ISS equal to or less than 16 (23.5mSv), p<0.001. Patients with spine trauma can be expected to get more than 15mSv more radiation than non-spine patients, p<0.001. Extremity injuries received the least amount of radiation, spine only patients were next, then finally spine and extremity injury patients had the greatest exposures. Having a spine fracture, a pelvic fracture, a chest wall injury, or a long bone fracture were all risk factors for having more than 20mSv of effective dose exposure. Patients under the age of 18 years did receive less radiation than the remainder of the cohort, p<0.001. ConclusionsThe average orthopaedic patient receives a total effective radiation dose of more than 30mSv, much greater than is considered acceptable as a recommended permissible annual dose by the International Commission on Radiological Protection (20mSv). These findings indicate that the average trauma patient (in particular those with polytrauma or fractures involving the spine, pelvis, chest wall, or long bones) is exposed to high levels of radiation during their inpatient hospitalisation. The treating physicians of such patients should take into consideration the large amounts of radiation their patients receive just during their initial hospitalisation, and be prudent with the ordering of imaging studies involving radiation exposure.

Urodynamic analysis on spinal cord injury patients with urinary voiding dysfunction

Objective To find the differences of bladder and urethra dysfunction between sacral spinal cord injury and Thoracolumbar spinal cord injury.Methods According to the criteria of inclusion and exclusion, we collected 30 patients in the study group.There were 22 males and 8 females, aged 17 -74 ( mean, 47 ) years, with duration between 7 - 36 ( mean, 18) months.There were nineteen cases of thoracolumbar spinal cord injury and 11 cases of sacral spinal cord injury in the study group.We conducted a retrospective analysis of the urodynamic data of the 30 patients in the group.They were divided into a sacral spinal cord injury group and a thoracolumbar spinal cord injury group according to the location of the site of injury.The urodynamic findings of the two groups were comparable.SPSS 16.0 was used to compare the differences between the groups by ANOVA/rank sum test.Results We measured the free flow rate parameters between thoracolumbar and sacral spinal cord injury groups.The maximum free flow rate was ( 13.0 ±5.1 ) vs ( 13.0 ±5.8) ml/s, the free flow rate at 2 s was (6.5 ±5.1 ) vs (6.9 ±6.4) ml/s, the mean free flow rate was (5.4± 2.4) vs ( 3.4 ± 0.5 ) ml/s, urine output volume was ( 279.1 ±131.1 ) vs (450.0 ± 26.6) ml and the residual urine volume was (209.5 ± 180.7 ) vs (434.0 ± 215.0) ml.The residual urine volume and urine output volume of sacral the spinal cord injury group was higher than the thoracic spinal cord injury group (P ＜ 0.05).We also measured the the cystometric parameters.The maximum urinary flow rate was (16.0±23.3) vs (7.1 ±3.3) ml/s, average flow rate was (4.6 ±2.3) vs (3.9 ± 2.3) ml/s, the flow rate after voiding 2 s was (4.6 ± 3.1 ) vs (2.2 ± 3.2) ml/s, urine output volume was (268.4 ± 113.9) vs ( 129.0 ± 97.9) ml, detrusor pressure of maximum flow rate was (58.8 ± 22.0) vs (56.5 ± 14.5) cm H2 O, flow rate of maximum detrusor pressure was (4.8 ± 2.0) vs (4.8 ± 4.4) ml/s,the maximum detrusor pressure was (68.0 ± 31.0) vs (54.6 ± 20.2) cm H2O and the average pressure of voiding period was (47.4 ±20.0) vs (42.6 ± 13.9) cm H2O.The urine output volume of the thoracolumbar spinal cord injury group was lower than sacral spinal cord injury group ( P ＜ 0.05 ).There were no significant differences in bladder sensation and coordination of bladder/urethra between the thoracolumbar spinal cord injury group and the sacral spinal cord injury group (P ＞ 0.05).The incidence of low compliance bladder in the thoracolumbar spinal cord injury patients (4/11) was higher than the sacral spinal injury group, the incidence of high compliance bladder in the sacral spinal cord injury patients (11/19) was higherthan the thoracolumbar group.Conclusions The urodynamics' difference between the sacral spinal cord injury group and thoracolumbar spinal cord injury group was observed in bladder compliance and bladder detrusor contractility changes.Relatively, the incidence of decreased detrusor contractility and high compliance bladder in sacral spinal cord injury patients was higher, and the cidence of detrusor hyperreflexia and low compliance bladder in thoracolumbar spinal cord injury patients was higher. Key words: Urodynamics; Spinal cord injury; Voiding dysfunction

Diagnosis of Soft-Tissue Masses

AJR 2011; 197:W365 0361–803X/11/1972–W365 © American Roentgen Ray Society Diagnosis of Soft-Tissue Masses We read with great interest the article by Subhawong et al. [1], “Soft-Tissue Masses and Masslike Conditions: What Does CT Add to Diagnosis and Management?” in the June 2010 issue of the AJR. As stated in the article, CT in combination with MRI is particularly useful for the evaluation of soft-tissue masses. In fact, CT may allow the detection of tiny calcifications as a key element in the early diagnosis of some soft-tissue masses, including myositis ossificans circumscripta (MOC) or paraosteoarthropathy (POA). However, it is noteworthy that sonography may allow the detection of the onset of mineralization before calcifications appear on radiographs or CT scans. Indeed, sonography is actually the most sensitive imaging modality for early diagnosis of the MOC zone phenomenon, in which a thin annular hyperechoic zone corresponds to the calcification area [2] (Fig. 1). Similarly, early sonographic assessment of patients with local signs of inflammation suggesting initial POA formation may permit a prompt and confident diagnosis as well [3] (Fig. 2). In both cases, hyperhemia can be observed contiguously on Doppler sonography. Using sonography for diagnosis may thus improve patient management: Nonsteroidal antiinflammatory agent therapy may stop the evolutionary process of POAs and MOC and prevent further heterotopic bone production [4]. Biopsy performance in acute and subacute MOC phases can yield falsepositive results in favor of malignancy owing to the malignant soft-tissue-like aspect at that time [5]. Because earlier diagnosis may permit earlier and more effective treatment and avoid useless biopsy, we think that sonography should be used as a first-choice diagnostic step in combination with MRI and CT to diagnose such soft-tissue masses. Alexis Lacout Centre d’Imagerie Medicale Centre Medico Chirugical (CMC)– groupe VITALIA Aurillac, France Pierre-Yves Marcy Antoine Lacassagne Cancer Research Institute Nice, France Robert Yves Carlier Hopital Raymond Poincare Service d’Imagerie Medicale Universite Paris Ile-de-France Ouest Garches, France DOI:10.2214/AJR.10.5203 WEB—This is a Web exclusive article.

Medical consultations and the sharing of medical images involving spinal injury over mobile phone networks

BackgroundThe transmission of medical images and other data over mobile phone networks may facilitate remote medical consultations between neurosurgeons and regional hospitals treating spinal injury patients. The aim of this study was to compare the efficacy of mobile phone consultations with standard hospital workstation consultations in spinal injury patients. MethodsThe images were exported over the Internet from surrounding local hospitals through the Picture Archiving and Communication System, in DICOM III format, to the central hospital server. The xVision browser was used to view the acquired images on a standard workstation. The data were also exported to the secured hospital Web server IIS60 and converted to JPEG format to enable remote physician access and consultation. The remote consulting physician connected to this server by mobile phone using the phone's Internet browser. A second physician, blind to the mobile phone results, evaluated the same images at a workstation in the hospital. The results of the mobile phone consultations were compared with the results from standard workstation consultations. ResultsThere was no difference in the quality of spinal computed tomographic/magnetic resonance images viewed on the phone screen compared with on the workstation. More importantly, the final diagnoses made by mobile phone did not differ from those made by workstation consultations. A transfer to the department of neurosurgery was required after consultation in 11 patients. ConclusionMobile phone consultations for patients with spinal injuries was as effective as workstation consultations. Mobile phone consultations can increase the expertise available to regional hospitals, which are often the first responders to medical emergencies.

Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study

This is a European cohort study on predictors of spinal injury in adult (≥16 years) major trauma patients, using prospectively collected data of the Trauma Audit and Research Network from 1988 to 2009. Predictors for spinal fractures/dislocations or spinal cord injury were determined using univariate and multivariate logistic regression analysis. 250,584 patients were analysed. 24,000 patients (9.6%) sustained spinal fractures/dislocations alone and 4,489 (1.8%) sustained spinal cord injury with or without fractures/dislocations. Spinal injury patients had a median age of 44.5 years (IQR = 28.8–64.0) and Injury Severity Score of 9 (IQR = 4–17). 64.9% were male. 45% of patients suffered associated injuries to other body regions. Age <45 years (≥45 years OR 0.83–0.94), Glasgow Coma Score (GCS) 3–8 (OR 1.10, 95% CI 1.02–1.19), falls >2 m (OR 4.17, 95% CI 3.98–4.37), sports injuries (OR 2.79, 95% CI 2.41–3.23) and road traffic collisions (RTCs) (OR 1.91, 95% CI 1.83–2.00) were predictors for spinal fractures/dislocations. Age <45 years (≥45 years OR 0.78–0.90), male gender (female OR 0.78, 95% CI 0.72–0.85), GCS <15 (OR 1.36–1.93), associated chest injury (OR 1.10, 95% CI 1.01–1.20), sports injuries (OR 3.98, 95% CI 3.04–5.21), falls >2 m (OR 3.60, 95% CI 3.21–4.04), RTCs (OR 2.20, 95% CI 1.96–2.46) and shooting (OR 1.91, 95% CI 1.21–3.00) were predictors for spinal cord injury. Multilevel injury was found in 10.4% of fractures/dislocations and in 1.3% of cord injury patients. As spinal trauma occurred in >10% of major trauma patients, aggressive evaluation of the spine is warranted, especially, in males, patients <45 years, with a GCS <15, concomitant chest injury and/or dangerous injury mechanisms (falls >2 m, sports injuries, RTCs and shooting). Diagnostic imaging of the whole spine and a diligent search for associated injuries are substantial.Electronic supplementary materialThe online version of this article (doi:10.1007/s00586-011-1866-7) contains supplementary material, which is available to authorized users.

Management of the bladder in traumatic injuries of the spinal cord during the First World War and its implications for the current practice of urology

What's known on the subject? and What does the study add? Prior to the First World War, traumatic injuries to the spinal cord rapidly led to death from severe infections of the bladder. During the Second World War, Ludwig Guttmann resurrected the use of intermittent catheterisation at Stoke Mandeville Hospital, by meticulous attention to detail and was so successful, that this method was introduced into general urological practice. Historical review of the management of the bladder in patients with spinal injuries. Spinal injury patients--literature review--personal experience at Stoke Mandeville Hospital. Review of the different methods of catheterisation from the 19th century to today. Methods learned from the management of the bladder of spinal injuries patients were adopted into mainstream urology.

(A121) Relation of Dopamine Dependent Hypotension with Outcome in Cervical Spine Injury Patients

BackgroundIt is believed that dopamine resistance sets in within 72–92 hours following therapy. However, in the authors' experience, spinal cord injury patients may require dopamine to maintain blood pressure over several weeks.ObjectivesThis study aims to: (1) assess the incidence and duration of of dopamine dependence in cervical cord injury patients; and (2) find the relation (if any) of dopamine dependent hypotension with outcome of spinal cord injured patients.MethodsThis was a prospective, observational study carried out over 2-month period in the neurosurgery intensive care unit (ICU) at JPN Apex Trauma Centre, AIIMS. All cervical spine injury patients who had hypotension during the hospital stay were included in the study. History, clinical findings, requirement of ionotropic support, management, and outcome were recorded for all enrolled subjects.ResultsDuring the study period 48 patients were admitted with cervical spine injury in the ICU. Of these, 26 patients (54%) had hypotension and were constituted the study group. Eleven patients had complete spinal cord injury (power 0/5) and 15 patients had incomplete spinal cord injury. Twenty-four patients were on ventilator support and two were on oxygen masks. The mean dose of dopamine which the patient receives during the treatment was 7.5 mcg/kg/min with the maximum and minimum doses of 20mcg/kg/min and 2 mcg/kg/min. The mean duration of dopamine support was 17 days (Range 6–48 days). Eight patients (31%) required intermittent dopamine support and 18 patients (70%) required continuous support. The in-hospital mortality was 61% (n = 16). Mortality was significantly lower in patients who received intermittent ionotropic support as compared to those who required continuous ionotropic support (p &lt; 0.01).ConclusionThe patients with spinal cord injury are dependent on dopamine throughout their recovery period. The patients who required intermittent ionotropic support had significant better outcome compared to those who required continuous ionotropic support.

1036 PROFESSOR LUDWIG GUTTMANN-TRANSFORMING THE UROLOGICAL CARE OF SPINAL INJURED PATIENTS

INTRODUCTION AND OBJECTIVES: In 1944 the life expectancy for a patient with spinal cord injury was three months. Pressure sores and urinary infections accounted for the majority of deaths. Guttmann’s early understanding of the neuropathic bladder revolutionised the care of these patients, establishing principles that are universally practiced today. METHODS: A hand search of original material at the Wilfred Stokes Library in Stoke Mandeville was carried out and relevant books and papers obtained. Additional information was obtained from The Poppa Guttmann Recognition and Celebration Project and by contacting patients who were under his care. RESULTS: Ludwig Guttmann was born in July 1899 in Tost, Germany. He volunteered at a hospital after school and came into contact with spine-injured coal miners whose prognoses were invariably poor. During his early years in the UK he published work on the management of spinal injuries patients. The British Government, anticipating an increase of such patients due to the war, opened the Stoke Mandeville Spinal Injuries Centre and appointed Guttmann as director in 1944. Guttmann recognised the importance of bladder drainage and advocated no touch intermittent catheterisation (NTIC). Leading authorities at the time advocated the technique of cutaneous vesicostomy for spinal patients and dismissed NTIC as certain to lead to disaster. Guttmann opposed this view and presented the complications of cutaneous vesicostomy. He understood that indwelling catheters and foreign bodies became colonised with bacteria and demonstrated that NTIC maintained the sterility of urine and reduced the complications of bladder calculi and fistulae. Guttmann published research regarding autonomic reflexes upon bladder distension in spinal-injured patients. His observations were meticulous, describing the reflexes in patients with various levels of spinal injury. Guttmann’s practice extended to the holistic care of his patients and he worked hard to overcome the prejudices that were strongly held against his patients. He recognised that sport and work could help with rehabilitation and he established the Stoke Mandeville Games which later became the Paralympics. Under his supervision, the spinal injuries centre expanded to 200 beds and remains a centre of excellence for care of these patients today. CONCLUSIONS: The vision and determination of Prof. Guttmann in the care of spinal injuries patients revolutionised their care and established firm principles which are widely used today. He recognised the importance of bladder management but also the wider holistic care of his patients.

Clinical Predictors Of Cervical Spine Injury In Patients

Clinical Predictors Of Cervical Spine Injury In Patients

Non-operative management is superior to surgical stabilization in spine injury patients with complete neurological deficits: A perspective study from a developing world country, Pakistan

Background:Surgical stabilization of injured spine in patients with complete spinal cord injury is a common practice despite the lack of strong evidence supporting it. The aim of this study is to compare clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view.Methods:A detailed analysis of patients with traumatic spine injury and complete deficits admitted at the Aga Khan University Hospital, Pakistan, from January 2004 till January 2010 was carried out. All patients presenting within 14 days of injury were divided in two groups, those who underwent stabilization procedures and those who were managed non-operatively. The two groups were compared with the endpoints being time to rehabilitation, length of hospital stay, 30 day morbidity/mortality, cost of treatment, and status at follow up.Results:Fifty-four patients fulfilled the inclusion criteria and half of these were operated. On comparing endpoints, patients in the operative group took longer time to rehabilitation (P-value = 0.002); had longer hospital stay (P-value = 0.006) which included longer length of stay in special care unit (P-value = 0.002) as well as intensive care unit (P-value = 0.004); and were associated with more complications, especially those related to infections (P-value = 0.002). The mean cost of treatment was also significantly higher in the operative group (USD 6,500) as compared to non-operative group (USD 1490) (P-value < 0.001).Conclusion:We recommend that patients with complete SCI should be managed non-operatively with a provision of surgery only if their rehabilitation is impeded due to pain or deformity.

Clinical character of spinal injury in patients with massive spinal ankylosis

Clinical character of spinal injury in patients with massive spinal ankylosis

Empowering and Assisting Natural Human Mobility: The Simbiosis Walker

This paper presents the complete development of the Simbiosis Smart Walker. The device is equipped with a set of sensor subsystems to acquire user-machine interaction forces and the temporal evolution of user's feet during gait. The authors present an adaptive filtering technique used for the identification and separation of different components found on the human-machine interaction forces. This technique allowed isolating the components related with the navigational commands and developing a Fuzzy logic controller to guide the device. The Smart Walker was clinically validated at the Spinal Cord Injury Hospital of Toledo - Spain, presenting great acceptability by spinal chord injury patients and clinical staff.

Diaphragmatic pacemaker as an alternative to mechanical ventilation in patients with cervical spinal injury

ObjectiveTo verify that the diaphragmatic pacemaker is a form of respiratory support that can be used to replace a volumetric respirator in cervical spinal injury patients with cervical spinal lesion and diaphragmatic paralysis by means of its comparison with the traditional volumetric respirator. DesignRetrospective study of a prospective database and age-matched case control study. SettingIntensive Care Unit and Intermediate Care Respiratory Unit, Paraplegics National Hospital, Toledo (Spain). PatientsWe collected data on all patients discharged from the Hospital with permanent respiratory support by volumetric respirator or diaphragmatic pacemaker during a follow-up period of 25 years. Personal interviews were conducted to evaluate health-related qualify of life. Comparison and survival tests were used for statistical comparisons. InterventionsQuality of life questionnaire. Main variablesThe main variables collected were demographic data, hospital stay, mortality, family reintegration and health-related quality of life. ResultsWe evaluated the clinical records of 101 patients, 37 in the pacemaker-group and 64 in the volumetric respirator-group. Our results show that ICU admission duration and hospitalization as well as family reintegration, without significant differences, with a tendency to greater survival in pacemaker patients (18.18 versus 9.67 years by the Kaplan-Meier method, p<0.001). However, this difference becomes non-significant (p=0.06) after adjustment of the groups by age. Furthermore, better quality of life was found in the same patients with pacemakers in terms of security, communication, sociability, comfort and mobility in the patients. ConclusionsDiaphragmatic pacemaker ventilation is an effective alternative to mechanical ventilation with similar efficacy that improve quality of life in patients with severe respiratory failure due to cervical spinal cord injury.

Marcapasos diafragmático como alternativa a la ventilación mecánica en el paciente con lesión medular cervical

Objective To verify that the diaphragmatic pacemaker is a form of respiratory support that can be used to replace a volumetric respirator in cervical spinal injury patients with cervical spinal lesion and diaphragmatic paralysis by means of its comparison with the traditional volumetric respirator. Design Retrospective study of a prospective database and age-matched case-control study. Setting Intensive Care Unit and Intermediate Care Respiratory Unit, Paraplegics National Hospital, Toledo (Spain). Patients We collected data on all patients discharged from the Hospital with permanent respiratory support by volumetric respirator or diaphragmatic pacemaker during a follow-up period of 25 years. Personal interviews were conducted to evaluate health-related quality of life. Comparison and survival tests were used for statistical comparisons. Interventions Quality of life questionnaire. Main variables The main variables collected were demographic data, hospital stay, mortality, family reintegration and health-related quality of life. Results We evaluated the clinical records of 101 patients, 37 in the pacemaker-group and 64 in the volumetric respirator-group. Our results show that ICU admission duration and hospitalization as well as family reintegration, without significant differences, with a tendency to greater survival in pacemaker patients (18.18 versus 9.67 years by the Kaplan-Meier method, p < 0.001). However, this difference becomes non-significant (p = 0.06) after adjustment of the groups by age. Furthermore, better quality of life was found in these same patients with pacemakers in terms of security, communication, sociability, comfort and mobility in the patients. Conclusions Diaphragmatic pacemaker ventilation is an effective alternative to mechanical ventilation with similar efficacy that improve quality of life in patients with severe respiratory failure due to cervical spinal cord injury.

Acute Abdominal Pain in Spinal Cord Injury Patient Induced by Indwelling Urethral Catheter Placed into the Right Ureter through the Ureteral Orifice: A casereport

Diagnosis of acute abdomen in spinal cord injury (SCI) patients remains challenging. Classic peritoneal signs, such as rigid abdomen, rebounding pain and abdominal muscle guarding may be not reliable. It is still an important cause of morbidity and mortality in patients with SCI. A 45-year-old woman with SCI and 7th and 8th thoracic vertebrae fractures suffered from lower abdominal pain, fever and chills for three days. Physical examination revealed diffuse abdominal tenderness with muscle guarding. Laboratory studies showed severe leukocytosis and mild pyuria. Abdominal contrast-enhanced computed tomography scans (CTS) revealed a urinary catheter, which had been accidentally inserted into the right ureter through the ureteral orifice. Abdominal pain improved dramatically after the urinary catheter was replaced. We suggest further workup for possible causes of acute abdominal pain in SCI patients presenting with symptoms such as vomiting, vague abdominal pain, abdominal distension, spasms and cramps. Early investigation with abdominal X-ray, ultrasound, computed tomography scan or diagnostic video laparotomy may prevent delays in diagnosis and improvement of outcome.

Epidemiology of non-disaster spinal injuries at a spine unit.

To describe the demography, types of injuries and their management in all non-disaster spinal injury patients admitted to the Spine Unit of a tertiary care hospital in Pakistan from 2001-2008. Case series. Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, from April 2001 to December 2008. Data of all new non-disaster spinal injury patient admissions, kept in a custom-built database at Spine Unit, was analyzed. Demography, type of injuries and their management was described in percentages. Five hundred and twenty one non-disaster patients were selected out of a total 671 new admissions with spinal injuries. Mean age was 39.1 years and 77% were males. Mechanisms of injury included; fall in 62% and road traffic accidents in 32%. Fracture dislocations and burst fractures were equally distributed (36% each). Most of the injuries (43.6%) were at T11-L1 level. Forty three percent patients had complete spinal cord injury (SCI), 33% had incomplete SCI and 24% did not have any SCI. Eight patients had concomitant spinal injury at a different level. Twelve percent patients had associated other major injuries. Seventy percent patients were treated surgically. Average follow-up was for 4 years. Non-disaster spinal injury was frequent in young males usually due to fall or road traffic accident. It involved fracture dislocation or burst fracture at T11-L1, level in most cases requiring surgical treatment.