Sustained Spinal Cord Injuries Research Articles

Vaginal delivery is safely achieved in pregnancies complicated by spinal cord injury: a retrospective 25-year observational study of pregnancy outcomes in a national spinal injuries centre

BackgroundWomen with spinal cord injuries (SCI) represent a high risk population during pregnancy with comparatively few studies in the literature regarding their management and pregnancy outcomes, due to the relative rarity of the condition. Our objective was to assess pregnancy outcomes in women with spinal cord injury.MethodsWe performed a retrospective observational study of pregnancy outcomes by reviewing maternity records of all pregnant women with SCI attending the National Spinal Injury Centre at Buckinghamshire NHS Trust between 1991 and 2016. The outcome measures were Maternal demographic data, antenatal complications, method of anaesthetic, intrapartum data (gestation at delivery, onset of labour, mode of delivery, indication for obstetric intervention) and neonatal outcomes (low birth weight, stillbirth, neonatal death).ResultsFifty women with a total of 68 pregnancies were identified. Five patients sustained SCI during pregnancy and the remaining 63 pregnancies were conceived at least 1 year after SCI, of which 45 pregnancies had a SCI at T10 or above (73%) and 23 pregnancies at T11 or below (27%). The most common antenatal complications in SCI patients were worsening of spasms (38%) and urinary tract infection (24%). Preterm delivery occurred in 18% of women. Vaginal delivery was achieved in 77% of pregnancies, including 14% instrumental delivery rate and 23% Caesarean delivery rate.ConclusionsOur findings support the current evidence that pregnancy outcomes are generally successful and that vaginal delivery can be safely achieved in the majority of women, independent of the level of SCI.

Systematic scoping review protocol for clinical prediction rules (CPRs) in the management of patients with spinal cord injuries

IntroductionThe upsurge in the use of clinical prediction models in general medical practice is a result of evidence-based practice. However, the total number of clinical prediction rules (CPRs) currently being...

Medical and surgical management of acute spinal injury during pregnancy: A case series in a third-world country.

Background:There is scant literature describing the management of acute spinal injury in pregnant patients. Here, we report our experience with five cases of pregnant patients including three females who suffered acute traumatic spinal cord injuries (SCIs).Methods:This retrospective study evaluated five pregnant women presenting with traumatic spinal injuries over a 16-month period. All were assessed using the International Standards for Neurological Classification of Spinal Cord Injury Patients and the American Spine Injury Association Impairment Scale (AIS).Results:Three patients sustained SCIs: two cervical spine (C4 AIS-A and C5 AIS-B) and one thoracolumbar junction fracture dislocation (T11 AIS-A). Two patients required surgical stabilization during pregnancy, with one undergoing surgery after delivery. All three patients subsequently delivered healthy newborns. The remaining two patients without neurologic deficits at admission were treated conservatively; one had a healthy child, whereas the other patient aborted the baby due to the initial trauma.Conclusions:Our study demonstrates that the same surgical principals may be applied to pregnant women as to routine patients with SCIs. Further studies with greater patient data should be performed to better develop significant guidelines for the management of pregnant patients with spinal injuries.

Locally manufactured wheelchairs in Tanzania - are users satisfied?

The government of Tanzania created opportunity for the production of wheelchairs that would be appropriate to the local needs and environment. The study assessed the extent to which the wheelchairs met the activity and participation needs of the users, as well as the users' level of satisfaction with the provision, repair and maintenance of these wheelchairs. A descriptive cross-sectional analytical design was utilized to collect data through the administration of a questionnaire among 75 adult wheelchair users. Participants had used wheelchairs for an average period of 9.3 years. Most participants (61%) had sustained spinal cord injuries, and used three-wheeler chairs (76%). More than 90% reported that their wheelchairs positively influenced their activity and participation needs, and 85% were satisfied with their ability to carry out daily activities. Participants expressed satisfaction with the durability of the wheelchairs (89%), and the professional services received (71%), but not with follow-up services (77%). There was difference in satisfaction with features of 3-wheeler and 4-wheeler rigid chairs (p=0.030). The wheelchairs positively impacted participants' activity and participation needs. Participants were sat isfied with the features of the wheelchairs but not with follow-up services. The concerns of dissatisfied users should be addressed.

Closed therapy of thoracic and lumbar vertebral body fractures in trauma patients.

Background:The failure rate for the closed/non-surgical treatment of thoracic and lumbar vertebral body fractures (TLVBF) in trauma patients has not been adequately evaluated utilizing computed tomography (CT) studies.Methods:From 2007 to 2008, consecutive trauma patients, who met inclusion criteria, with a CT diagnosis of acute TLVBF undergoing closed treatment were assessed. The failure rates for closed therapy, at 3 months post-trauma, were defined by progressive deformity, vertebral body collapse, or symptomatic/asymptomatic pseudarthrosis. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification was utilized to classify the fractures (groups A1 and non-A1 fractures) and were successively followed with CT studies.Results:There were 54 patients with 91 fractures included in the study; 66 were A1 fractures, and 25 were non-A1 fractures. All had rigid bracing applied with flat and upright X-ray films performed to rule out instability. None had sustained spinal cord injuries. Thirteen patients (24%) failed closed therapy [e.g. 13 failed fractures (14%) out of 91 total fractures]. Five failed radiographically only (asymptomatic), and eight failed radiographically and clinically (symptomatic). A1 fractures had a 4.5% failure rate, while non-A1 fractures failed at a rate of 40%.Conclusion:Failure of closed therapy for TLVBF in the trauma population is not insignificant. Non-A1 fractures had a much higher failure rate when compared to A1 fractures. We recommend close follow-up particularly of non-A1 fractures treated in closed fashion using successive CT studies.

Mary Riddoch (1901-1966), an extraordinary tale of survival.

In 1934 Mary Riddoch sustained a traumatic spinal injury as a result of a road traffic accident. Although a few surviving servicemen from the First World War have been recorded, this is the first account of a female paraplegic patient surviving a traumatic spinal injury. Her personal circumstances greatly contributed to her long survival: she was a qualified doctor, she was the sister of George Riddoch the neurologist who treated soldiers who had sustained spinal cord injuries during the First World War, and she was fortunate to have benefited from the dedicated care of nurse Dorothy Fiddes. Her great-nephew, Graeme Riddoch, is one of the authors of this paper and his recollections provide a unique perspective to this case report.

Understanding post-traumatic growth following pediatric-onset spinal cord injury: the critical role of coping strategies for facilitating positive psychological outcomes

The aim of this study was to explore positive psychological growth in individuals who had sustained spinal cord injuries (SCIs) in childhood, and to identify factors correlating with such growth. Data were drawn from ongoing research aimed at assessing the long-term outcomes of pediatric-onset SCIs in adults. Participants were assessed using measures of demographics, coping ability, post-traumatic growth, life satisfaction, happiness, and mental health. The study sample included 161 adults with a mean age of 33 years and 2 months (SD 7y 3mo, range 19-50y). The participants had sustained SCIs between the ages of 7 years and 18 years (mean 14y 10mo, SD 2y 6mo) and were injured for an average of 17 years and 9 months (SD 7y 7mo, range 1-36y). Sixty-four percent of participants were male, 81% were white, 63% had tetraplegia, and 70% had complete injuries. The vast majority of participants (99%) recognized that at least one positive change had occurred in their life as a result of their SCI. Post-traumatic growth was significantly associated with behavioral (r=0.29, p<0.001) and cognitive (r=0.39, p<0.001) coping strategies, as well as with increased life satisfaction (r=0.18, p=0.024) and happiness (r=0.27, p=0.001), but was unrelated to psychological distress. Additional analyses indicated that post-traumatic growth mediated effects of cognitive coping on happiness, but not on life satisfaction. The majority of individuals with pediatric-onset SCIs experienced positive psychological growth. Coping strategies are crucial to this growth process.

Sensitivity analysis of a novel five-degrees-of-freedom user command controller in people with spinal cord injury and non-injured for full upper extremity neuroprosthesis, wearable powered orthoses and prosthetics.

Sensitivity analysis for a user command controller monitoring head position for artificial control of the proximal upper limb was performed. The controller was evaluated by having subjects complete target matching tasks manipulating a simulated on-screen hand representation to investigate the effects of target location and target speed on performance. Sixteen subjects took part in the study, 11 of whom had sustained cervical spinal cord injuries. The subjects were able to control the on-screen hand with overall low sensitivity of performance with the controller to target position in its five-degrees-of-freedom. The optimal speed was found to be a compromise between low speed and high accuracy but longer completion time and fast speed for short completion time with lower accuracy. The results demonstrated the robustness of the controller across a population of non-injured subjects and those with tetraplegia.

EXTREME SPORT AND RECONSTRUCTION OF IDENTITY IN PERSONS WITH SPINAL CORD INJURIES (SCI)

This study aims to explore the meaning extreme sport have to the reconstruction of identity in persons who have sustained spinal cord injuries (SCI). Psychological well- being in persons with spinal cord injury is of crucial matter. Suicide rate in persons with SCI are reported to be three times higher than the average population. This study have a qualitative design with a phenomenological approach, where 4 extreme skiers, recruited from the WY All Mountain Ski Camp in Jackson Hole, Wyoming, USA where interviewed. Data triangulation consists of 5 additional sources of data, instructor interview, voluntary assistant interview, field journal, including reflexive research diary, and pilot interview. Data where analyzed by color-coding to identify reoccurring themes. Findings show a consistent loss of identity among participants and the need for recovery was prominent. However, the risk factor specifically in extreme sport cannot say to significantly affect the reconstruction of identity in persons with SCI. Other elements than the risk factor show significance for identity reconstruction, such as social aspects and professional identity. Sports play a highly important role in the process of identity reconstruction, as to regain their normal self, pre injury. Nevertheless, considering all participants of this study obsess an adventurous personality with background in risky activities, and the need to regain the same activities as engaged in pre injury is crucial for the identity reconstruction, one can say extreme sport does affect the identity reconstruction in the participants.

Güney Batı Nijerya\'da Osobongo şehrinde ticari motosikletlerin karıştığı trafik kazalarının mortalite ve morbidite paternleri

Introduction: Motorcycle accidents occur frequently in this part of the world as a result of interface between the agent, the host and its environment resulting in fatal consequences. The objective of this study is to assess mortality and morbidity pattern accrued to road traffic accidents from commercial motorcycles in Osogbo metropolis in south western Nigeria. Methods: This is a retrospective, analytical study of morbidity and mortality pattern among commercial motorcycle riders managed at Ladoke Akintola University of Technology Teaching Hospital in Osogbo in southwestern Nigeria. Case notes of one hundred and eleven commercial motorcyclists who had road traffic accident between May 2002 and April 2005 were reviewed for mortality and morbidity related data. These secondary data was analyzed using the EPI Info software. Results: Mean age of the commercial motorcyclists was 33.3(+1.4) years and all were males. Fifty-six (50.4%) were married, 48(43.2%) had below secondary level education while 42(37.8%) were strictly commercial and professional motorcyclists. A total of 12 (10.8%) of victims eventually died while 99 (89.2%) remained alive. Among survivors, 32 (32.4%) were deformed while 67 (67.6%) were not. Pattern of injuries sustained by victims include limb fracture 63(56.8%); head injury 48 (43.2%), bruises 48 (43.2%), loss of consciousness 36(32.4), limb dislocations in 5(4.5%) while 3(2.7%) sustained spinal cord injuries. Conclusions: Morbidities and mortalities associated with motorcycle road traffic accidents are common. There is a need for all concerned stakeholders to take adequate steps towards reduction and prevention of occurrences or mortality and morbidity among this group.

Military penetrating spine injuries compared with blunt

The nature of blunt and penetrating injuries to the spine and spinal column in a military combat setting has been poorly documented in the literature. To date, no study has attempted to characterize and compare blunt and penetrating spine injuries sustained by American servicemembers. The purpose of this study was to compare the military penetrating spine injuries with blunt spine injuries in the current military conflicts. Retrospective study. All American military servicemembers who have been injured while deployed in Iraq (Operation Iraqi Freedom) and Afghanistan (Operation Enduring Freedom) whose medical data have been entered into the Joint Theater Trauma Registry (JTTR). The JTTR was queried for all American servicemembers sustaining an injury to the spinal column or spinal cord while deployed in Iraq or Afghanistan. These data were manually reviewed for relevant information regarding demographics, mechanism of injury, surgical intervention, and neurologic injury. A total of 598 servicemembers sustained injuries to the spine or spinal cord. Isolated blunt injuries were recorded in 396 (66%) servicemembers and 165 (28%) sustained isolating penetrating injuries. Thirty servicemembers (5%) sustained combined blunt and penetrating injuries to the spine. The most commonly documented injuries were transverse process fractures, compression fractures, and burst fractures in the blunt-injured servicemembers versus transverse process fractures, lamina fractures, and spinous process fractures in those injured with a penetrating injury. One hundred four (17%) servicemembers sustained spinal cord injuries, comprising 10% of blunt injuries and 38% of penetrating injuries (p<.0001). Twenty-eight percent (28%) of blunt-injured servicemembers underwent a surgical procedure compared with 41% of those injured by penetrating mechanisms (p=.4). Sixty percent (n=12/20) of blunt-injured servicemembers experienced a neurologic improvement after surgical intervention at follow-up compared with 43% of servicemembers (n=10/23) who underwent a surgical intervention after a penetrating trauma (p=.28). Explosions accounted for 58% of blunt injuries and 47% of penetrating injuries, whereas motor vehicle collisions accounted for 40% of blunt injuries and 2% of penetrating injuries. Concomitant injuries to the abdomen, chest, and head were common in both groups. Blunt and penetrating injuries to the spinal column and spinal cord occur frequently in the current conflicts in Iraq and Afghanistan. Penetrating injuries result in significantly higher rates of spinal cord injury and trend toward increased rates of operative interventions and decreased neurologic improvement at follow-up.

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.

Anxiety and depression in children and adolescents with spinal cord injuries

Aim To determine the levels of anxiety and depression in young people with spinal cord injuries (SCI) and their associated factors and outcomes. Method Children and adolescents aged 7 to 17 years at interview who had sustained SCI at least 1 year before the study were assessed using the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Pediatric Quality of Life Inventory, the Children's Assessment of Participation and Enjoyment, and a demographic questionnaire designed for the study. Results The 118 participants (61 males, 57 females) had a mean age of 12 years 4 months, SD 3 y 1 mo, range 7-17 y. Mean age at injury was 5 years 11 months, SD 4 y 11 m, range 0-16 y; 89 participants (75%) had paraplegia and 29 (25%) had tetraplegia. Fifty-seven (52%) had complete injuries and 52 (48%) had incomplete injuries according to the American Spinal Injury Association impairment scale. Thirteen participants (13%) reported significant symptoms of anxiety, and seven (6%) reported significant levels of depression, which were comparable to the normative population. Age, race, and sex were not associated with anxiety or depression, but participants with shorter duration of injury were more likely to be anxious, and those with less functional independence were more likely to be depressed. Only one dimension of participation was associated with anxiety and depression, but all aspects of quality of life were decreased among those with anxiety or depression. Interpretation The levels of anxiety and depression in young people with SCI are comparable to the normative range. When anxiety and depression occur they are associated with reduced levels of quality of life.

Association of C-reactive protein and insulin resistance in patients with chronic spinal cord injury

To study the association between C-reactive protein levels and insulin resistance in patients with spinal cord injury. Cross-sectional study. Forty-two subjects who had sustained spinal cord injuries at least 6 months before enrollment. Circulating glucose, insulin and C-reactive protein levels were measured after 12 hours' fasting. The homeo-stasis model insulin resistance index was used to evaluate insulin resistance. Insulin resistance and C-reactive protein levels were compared between complete/incomplete patients and between paraplegic/tetraplegic patients. The subjects were then divided into 3 groups (C-reactive protein levels < 1, 1-3, > 3 mg/l) to compare insulin resistance. Eighteen (43%) subjects had C-reactive protein levels > 3 mg/l. The C-reactive protein levels and insulin resistance did not significantly differ between complete/incomplete or between paraplegic/tetraplegic subjects. However, insulin resistance in the high C-reactive protein group (>3 mg/l) differed significantly from that of the other 2 groups, and there was a significant correlation between C-reactive protein and insulin resistance, with r=0.7745. Most young and middle-aged patients with chronic spinal cord injury with high C-reactive protein levels also have high insulin resistance, and their C-reactive protein levels have well correlated with insulin resistance.

Depression in Adults Who Sustained Spinal Cord Injuries as Children or Adolescents

Study design: Interview survey.Objective: To assess depression in adults with pediatric–onset spinal cord injuries (SCI) and to determine demographic and injury–related factors, and outcomes associated with depression, and to determine which other outcomes are associated with depression.Methods: Subjects were adults with pediatric-onset SCI who sustained SCI at age =18 years and were interviewed at age =24 years. This is part of a longitudinal study for which there were 864 eligible participants; 353 (41%) were interviewed. Of these, 232 were assessed for depression. A telephone interview was conducted that included a structured questionnaire and standardized measures (Functional Independence Measure, Craig Handicap Assessment and Reporting Technique, Short-Form 12 measure of healthrelated quality of life, Satisfaction with Life Scale, and Patient Health Questionnaire–9 to screen for depression).Results: Twenty–seven percent reported depressive symptoms ranging from mild to severe, and 7% reported having suicidal thoughts within the last 2 weeks, and 3= reported symptoms consistent with probable major depressive disorder (MDD). Depression was not significantly associated with any demographic factors but it was associated with incomplete injury (P = 0.013). Depression was also associated with many participation outcomes, health–related quality of life, life satisfaction, and medical complications.Conclusions: Depression is a significant problem among adults with pediatric–onset SCI and is associated with poorer outcomes and lower quality of life. These findings should be addressed as clinicians prepare children and adolescents with SCI to transition to adulthood

Death anxiety as a predictor of future time orientation among individuals with spinal cord injuries

Purpose: The purpose of this study was to examine therelationship between death anxiety and future time orientationamong individuals who sustained spinal cord injuries (SCI). Methods: Participants were 317 individuals with SCI, of whom57.4% were US veterans. Data were obtained by means ofmailed questionnaires and included responses to the DeathAnxiety Scale (DAS), the Future Time Orientation (FTOS)measure, as well as information on participants’ personal anddisability-related characteristics. Results: A hierarchical multiple regression analysis wasconducted to examine the influence of a set of demographicvariables, followed by a set of disability-related variables, andfinally two factorially-derived measures of death anxiety(denial of death and distressed awareness of death) on futuretime orientation. Two disability-related variables (pain leveland existence of pressure ulcers) and one of the two deathanxiety measures (distressed awareness of death) significantlypredicted future time orientation. A post-hoc analysis, addingdepression as a predictor, was also significant, indicating thatan increased level of depression uniquely contributed to atruncated future time orientation. Conclusions: Distressed anxiety and depression may be importantfactors affecting goals and plans of people with SCI.Future research should attempt to clarify the intricaterelationships among negative affectivity, future time orientation,and psychosocial adaptation to SCI.

Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics.

Diagnosing and managing cervical spine trauma in head-injured patients is problematic due to an altered level of consciousness in such individuals. The reported incidence of cervical spine trauma in head-injured patients has generally ranged from 4 to 8%. In this retrospective study the authors sought to define the incidence of cervical injury in association with moderate or severe brain injury, emphasizing the identification of high-risk patients. The study included 447 consecutive moderately (209 cases) or severely (238 cases) head injured patients who underwent evaluation at two Level 1 trauma centers over a 40-month period. Of the 447 patients, 24 (5.4%) suffered a cervical spine injury (17 men and seven women; mean age 39 years; median Glasgow Coma Scale [GCS] score of 6, range 3-14). Of these 24 patients, 14 (58.3%) sustained spinal cord injuries (SCIs), 14 sustained injuries in the occiput-C3 region, and 10 underwent a stabilization procedure. Of the 14 patients with SCIs, nine experienced an early hypotensive and/or hypoxic insult. Regarding the mechanism of injury, cervical injuries occurred in 21 (8.2%) of 256 patients involved in motor vehicle accidents (MVAs), either as passengers or pedestrians, compared with three (1.6%) of 191 patients with non-MVA-associated trauma (p < 0.01). In the subset of 131 MVA passengers, 13 (9.9%) sustained cervical injuries. Patients with an initial GCS score less than or equal to 8 were more likely to sustain a cervical injury than those with a score higher than 8 (odds ratio [OR] 2.77, 95% confidence interval [CI] = 1.11-7.73) and were more likely to sustain a cervical SCI (OR 5.5, 95% CI 1.22-24.85). At 6 months or more postinjury, functional neurological recovery had occurred in nine patients (37.5%) and eight (33.3%) had died. Head-injured patients sustaining MVA-related trauma and those with an initial GCS score less than or equal to 8 are at highest risk for concomitant cervical spine injury. A disproportionate number of these patients sustain high cervical injuries, the majority of which are mechanically unstable and involve an SCI. The development of safer and more rapid means of determining cervical spine integrity should remain a high priority in the care of head-injured patients.

Causes and outcomes of pediatric injuries occurring at school.

This study examines the causes and outcomes of injuries occurring at school and highlights the need for injury prevention strategies. Descriptive statistics were applied to data from a national pediatric trauma database on 1,558 K-12 graders injured at school severely enough to require hospitalization. Factors analyzed included age, gender, cause, place, time, injured body regions, use of hospital resources, in-hospital fatality rate, and functional limitations. Most injuries were unintentional (89.7%) and occurred mostly to children 10-14 years old. Almost half occurred in recreational areas. Falls and sports were the most frequent causes, but the pattern varied by grade and gender. Most children sustained injuries to the extremities (41.3%) or to the head (39.2%). Two percent sustained spinal cord injuries, mainly from sports. Eight children died, and 43.6% developed one or more functional limitations. Frequent, severe, and costly injuries should be the focus of school safety policies, and a mix of injury prevention strategies should be applied.

Menstruation and Pediatric Spinal Cord Injury

Menstrual characteristics were studied in young women who sustained spinal cord injuries (SCI) prior to puberty or in early adolescence. Subjects were 37 females who were injured prior to age 16 years and who were at least 10 years old at the time of interview; 22 were injured prior to menarche and 15 after menarche. Average age of menarche for females injured before puberty was 12.3 years which is similar to their mothers (mean 12.6 years) and to patients injured after menarche (mean 12.0 years). Of 15 females injured after menarche, seven reported no interruption in menses while eight had interruptions ranging from one to seven months. No significant menstrual problems were noted in either group. This information about menstruation should be included in sexuality teaching of parents and patients when an SCI occurs to a child or adolescent. (J Spinal Cord Med 1997; 20:56-59)

Current advances in magnetic resonance imaging (MRI) in spinal cord trauma: review article.

Magnetic resonance (MR) images of 87 patients who had sustained spinal cord injuries during the past 2 years, were analyzed and compared with the corresponding clinical, surgical, and in some cases pathological findings. In addition to the standard MR imaging techniques applied in the spinal cord injuries, we also introduced some recent MRI technical achievements which are anticipated to improve diagnostic accuracy and broaden clinical application of this modality with regard to the spinal cord trauma. The recent technical advancements that we used include image enhancement, fat tissue signal suppression, three-dimensional (3-D) imaging, and magnetic resonance angiography (MRA). The reviewed post traumatic changes disclosed in these MR images were classified in 4 categories: acute, subacute, chronic, and the injury's sequelae. The essential properties of the 4 new imaging advancements are considered in relationship to the gain in diagnostic improvement of MRI of the 4 phases of patients with spinal cord trauma.