Traumatic Spinal Cord Injury Group Research Articles

Nontraumatic spinal cord injury: Incidence, epidemiology, and functional outcome

Objectives: To identify and compare the incidence, demographics, neurologic presentation, and functional outcome of individuals with nontraumatic spinal cord injury (SCI) to individuals with traumatic SCI. Design: A 5-year prospective study. Setting: Level I trauma center of a Regional SCI Model System. Patients: Two hundred twenty adult SCI admissions. Main Outcome Measures: Demographics, etiology, level and completeness of injury, Functional Independent Measure (FIM) scores. Results: Of SCI admissions, 39% were nontraumatic in etiology (spinal stenosis, 54%; tumor, 26%). Compared to subjects with traumatic SCI, those individuals with nontraumatic SCI were significantly ( p < .01) older and were more likely married, female, and retired. Injury characteristics revealed significantly more paraplegia and incomplete SCI within the nontraumatic SCI group ( p < .01). Both nontraumatic and traumatic SCI individuals had significant FIM changes from rehabilitation admission to discharge ( p < .01). Those with tetraplegia-incomplete nontraumatic SCI had significantly higher admission motor FIM scores and shorter rehabilitation length of stay than in the traumatic group ( p < .05). Paraplegic-complete and paraplegic-incomplete nontraumatic SCI subjects had lower discharge motor FIM scores, FIM change, and FIM efficiency than those with traumatic SCI. Similar discharge-to-home rates were noted in both nontraumatic and traumatic SCI groups. Conclusions: These data suggest that individuals with non-traumatic SCI represent a significant proportion of SCI rehabilitation admissions and, although differing from those with traumatic SCI in demographic and injury patterns, can achieve similar functional outcomes.

Clinical presentations, medical complications, and functional outcomes of individuals with gunshot wound-induced spinal cord injury.

Gunshot wounds are currently the second leading cause of spinal cord injury in the United States, and coexisting injuries or complications accompanying penetrating wounds often increase patient morbidity. A review of 217 traumatic spinal cord injury rehabilitation admissions to a tertiary care hospital during a 5-yr period revealed 49 individuals (23%) with gunshot wound-induced spinal cord injury. A single bullet entry site was seen in 54%, whereas 17% had greater than 3 sites of entry. Common (>25%) sites of bullet entry included the back, abdomen, neck, and chest. Common gunshot wound-related medical complications included pain (54%), infections (40%), pneumothorax (24%), nonspinal fractures (22%), colonic perforation (17%), cerebrospinal fluid leak (10%), and retroperitoneal hematoma (10%). When compared with nonviolence-related traumatic spinal cord injury (motor vehicle accidents and falls), patients with gunshot wound-induced spinal cord injury were significantly more frequently (P < 0.01) younger, non-Caucasian, unmarried, and unemployed. Injury characteristics revealed significantly (P < 0.01) more paraplegia and complete spinal cord injury within the gunshot wound-induced spinal cord injury group. Gunshot wound-induced spinal cord injury and nonviolent traumatic spinal cord injury groups had similar lengths of stay, Functional Independence Measure scores, and discharge to home rates. This article adds to the growing body of literature examining clinical, medical, and functional outcome characteristics of individuals with spinal cord injury secondary to violence-related cause.

Comparison of Rehabilitation Outcomes in Violent Versus Non-violent Traumatic SCI

This paper represents the results of a cohort study comparing functional outcomes of individuals with violent and non-violent traumatic spinal cord injury (SCI) following inpatient rehabilitation. Twenty-seven consecutive patients with a diagnosis of traumatic SCI of violent etiology (gunshot wound, stabbing or assault) and 27 patients with non-violent etiology (motor vehicle accident and falls) were matched for neurological level of injury and classification. Demographic comparison of violent versus non-violent groups revealed mean age 30 versus 39, gender 93 percent versus 78 percent male, race 89 percent versus 59 percent non-white, 74 percent versus 41 percent unmarried and 56 percent versus 22 percent unemployed, respectively. Violent and non-violent traumatic SCI groups had similar lengths of stay, admission and discharge functional independent measures (FIM), FIM improvement, payor sources, hospital charges and discharge to home rates. Despite the differences noted in the demographics of violent and non-violent traumatic SCI, these two matched groups achieved similar functional outcomes and discharge disposition following inpatient rehabilitation. (J Spinal Cord Med 1998;21:32-36)

Metastatic and Traumatic Spinal Cord Injury: Acute Rehabilitation Outcome, Post-Discharge Placement, and One Year Survival

Paraplegia following metastatic spinal damage is associated with specific problems that require expert attention and management. Out of 744 consecutive admissions to a Spinal Cord Injury Unit, the acute rehabilitation outcomes, the post-discharge place ments, and the one-year survival rates of twenty patients with metastatic spinal cord lesions (MSCL) were compared to twenty-four patients with traumatic spinal cord injury (TSCI) in the same age range and level of neurologic injury.The rehabilitation outcome was measured using the Functional Independence Mea sure scores, the efficiency and the efficacy scores, and the length of stay in the inpatient rehabilitation unit.Although the average FIM scores at admission were higher in the MSCL group (70 vs. 65.63), their discharge FIM scores were lower than in the TSCI group (88.28 vs. 96.1). The efficacy score was significantly worse in the MSCL group ( p = .01) and there was no significant difference in efficiency between both groups.The median length of stay w...