| 1. |
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| 2. |
- Aito, S, et al.
(författare)
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Spinal cord injuries due to diving accidents
- 2005
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Ingår i: Spinal cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 43:2, s. 109-116
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Tidskriftsartikel (refereegranskat)
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| 3. |
- Alexander, M S, et al.
(författare)
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International standards to document remaining autonomic function after spinal cord injury.
- 2008
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 47:1, s. 36-43
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Experts opinions consensus. OBJECTIVE: To develop a common strategy to document remaining autonomic neurologic function following spinal cord injury (SCI). BACKGROUND AND RATIONALE: The impact of a specific SCI on a person's neurologic function is generally described through use of the International Standards for the Neurological Classification of SCI. These standards document the remaining motor and sensory function that a person may have; however, they do not provide information about the status of a person's autonomic function. METHODS: Based on this deficiency, the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) commissioned a group of international experts to develop a common strategy to document the remaining autonomic neurologic function. RESULTS: Four subgroups were commissioned: bladder, bowel, sexual function and general autonomic function. On-line communication was followed by numerous face to face meetings. The information was then presented in a summary format at a course on Measurement in Spinal Cord Injury, held on June 24, 2006. Subsequent to this it was revised online by the committee members, posted on the websites of both ASIA and ISCoS for comment and re-revised through webcasts. Topics include an overview of autonomic anatomy, classification of cardiovascular, respiratory, sudomotor and thermoregulatory function, bladder, bowel and sexual function. CONCLUSION:This document describes a new system to document the impact of SCI on autonomic function. Based upon current knowledge of the neuroanatomy of autonomic function this paper provides a framework with which to communicate the effects of specific spinal cord injuries on cardiovascular, broncho-pulmonary, sudomotor, bladder, bowel and sexual function.
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| 4. |
- Anderson, K. D., et al.
(författare)
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Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury
- 2009
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Ingår i: Spinal Cord. - 1362-4393. ; 47:4, s. 334-8
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Secure, web-based survey. OBJECTIVES: To determine how quadriplegics in the US view tendon transfer surgeries (TTS) and what activities of daily living (ADL) involving arm/hand function are important in improving quality of life (QoL). SETTING: World wide web. METHODS: Individuals >or=18 years of age living with a cervical spinal cord injury (SCI). Participants obtained a pass code to enter a secure website and answered survey questions. A total of 137 participants completed the survey. RESULTS: Two-thirds of participants had injury levels between C4/5 and C5/6. Over 90% felt that improving their arm/hand function would improve their QoL. ADL that were ranked most important to regain were dressing, feeding, transferring in/out of bed, and handwriting. Less than half of the participants had never been told about TTS and only 9% had ever had TTS. Nearly 80% reported that they would be willing to spend 2-3 months being less independent, while recovering from surgery, to ultimately become more independent. Over 75% reported that the ideal time preferred to have TTS, if chosen, would be within 5 years post-injury. CONCLUSION: Regaining arm and hand function is of primary importance to individuals with cervical SCI, in particular, to increase independence in multiple ADL. There is a critical need in the US to improve awareness of TTS as a viable option for improving arm/hand function in some people. This information needs to be provided early after injury so that informed choices can be made within the first 5 years.
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| 5. |
- Augutis, M, et al.
(författare)
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Pediatric spinal cord injury in a subset of European countries.
- 2006
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 44:2, s. 106-12
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Postal survey.SETTING: A total of 19 countries in Europe.OBJECTIVES: Firstly, to collect information about incidence and systems of care for pediatric spinal cord injury (pedSCI); including prevention, initial care and follow-up in a subset of European countries. Secondly, to initiate a network of involved professionals for exchange of information and development of research and care programs.METHODS: A short semi-structured questionnaire was sent to respondents working with spinal cord injury (SCI) in 19 countries in Europe.RESULTS: Only in Portugal and Sweden, is the incidence of pedSCI (fatal injuries included) established, that is 27 children/million children/year and 4.6 children/million children/year, respectively. For the other countries, the estimated incidence of pedSCI (nonfatal injuries) varied from 0.9 to 21.2 children/million children/year in the age group of 0-14 years. Although the incidence varies considerably, pedSCI is rare throughout Europe. The management differs between the countries depending on the age of the child and the local organization of health care.CONCLUSIONS: The survey confirms that pedSCI is rare. In order to establish high-quality standardized care, further integration of knowledge in this area is needed throughout Europe. The contacts initiated by this survey may be used to create an international network serving as a reference for health professionals, researchers and families, thereby possibly alleviating some of the unwanted variations of care identified in this study.
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| 6. |
- Bennegård, Gun-Marie, et al.
(författare)
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Higher glucose uptake in paralysed spastic leg.
- 2008
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 46:2, s. 103-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Insulin resistance and diabetes mellitus have been reported in the spinal cord injured (SCI). The group exhibits risk factors, as decreased physical activity, as well as episodes of stimulation of sympathetic nervous system below the level of lesion known to stimulate lipolysis, which in turn could induce insulin resistance. However, data are inconsistent, which might indicate the presence of protective mechanisms. OBJECTIVE: To investigate the glucose uptake in spastic paralysed SCI legs compared to able-bodied. To investigate regional differences between glucose handling in the arm and leg. STUDY DESIGN: Experimental controlled study. SETTINGS: Institution of Clinical Neuroscience and Physiology, Spinal Injures Unit, Sahlgrens University Hospital, Goteborg, Sweden. METHODS: Nine SCI subjects (2 C7, 7 T1-T4 ASIA A: 8, ASIA B: 1) were compared to 10 weight- and age-matched controls. Plasma flow in arm and leg was analysed by venous occlusion strain gauge plethysmography, and plasma derived from artery and veins in the arm and leg was analysed for glucose, insulin and lactate during fasting resting conditions. RESULTS: Glucose uptake was higher in SCI legs compared to controls. There was no difference in insulin uptake or lactate production. Plasma flow was higher in SCI legs compared to controls. Controls showed a higher glucose uptake and lactate production in arm than leg. CONCLUSIONS: Spasticity may counteract the risk of diabetes by inducing an insulin-independent glucose uptake. The regional difference in metabolism in able-bodied make it hazardous to do generalizations to whole body metabolism from arm or leg measurements.
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| 7. |
- Bodin, Per, et al.
(författare)
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Effects of abdominal binding on breathing patterns during breathing exercises in persons with tetraplegia
- 2005
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 43, s. 117-122
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Cross-sectional, experimental. Objectives: To investigate and compare static lung volumes and breathing patterns in persons with a cervical spinal cord lesion during breathing at rest, ordinary deep breathing, positive expiratory pressure (PEP) and inspiratory resistance-positive expiratory pressure (IR-PEP) with and without an abdominal binder (AB). Setting: The outpatient clinic at the Spinal Unit at Sahlgrenska University Hospital, Göteborg, Sweden. Method: The study group consisted of 20 persons with complete cervical cord lesion at C5–C8 level. Breathing patterns and static lung volumes with and without an AB were measured using a body plethysmograph. Results: With an AB, static lung volumes decreased, vital capacity increased, breathing patterns changed only marginally and functional residual capacity remained unchanged during PEP and IR-PEP. Conclusion: Evidence supporting the general use of an AB to prevent respiratory complications by means of respiratory training is questionable. However, the interindividual variation in our results indicates that we cannot rule out that some patients may benefit from the treatment. Sponsorship: This work was supported by grants from the Memorial Foundation of the Swedish Association of registered Physiotherapists and the Association of Cancer and Road Accident Victims, Sweden.
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| 8. |
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| 9. |
- Dahlgren, A, et al.
(författare)
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Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale.
- 2007
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 45:7, s. 475-84
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cross-sectional study. OBJECTIVES: (1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale. SETTING: Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS: Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale. RESULTS: Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items. CONCLUSION: The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.
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| 10. |
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| 11. |
- Divanoglou, A, et al.
(författare)
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Incidence of traumatic spinal cord injury in Thessaloniki, Greece and Stockholm, Sweden : a prospective population-based study.
- 2009
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 47:11, s. 796-801
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Prospective population-based open-ended study. This paper is part of the Stockholm-Thessaloniki Acute Traumatic Spinal Cord Injury Study.OBJECTIVES: To calculate incidence and evaluate the epidemiological profile of the incident population with traumatic spinal cord injury (TSCI).SETTINGS: The greater Thessaloniki region in Greece and the greater Stockholm region in Sweden.METHODS: TSCI individuals, older than 15 years of age, who had survived the first 7 days post-trauma, were identified through an active surveillance system. The forms of the Nordic Spinal Cord Injury Registry were used.RESULTS: 87 individuals were injured in the greater Thessaloniki and 49 in the greater Stockholm region. Annual crude incidence was 33.6 per million for Thessaloniki and 19.5 per million for the Stockholm region. The leading causes of injury for the Thessaloniki region were transportation accidents (51%) and falls (37%), and those for the Stockholm region were falls (47%) and transportation accidents (23%). A significantly larger number of individuals of the Thessaloniki group were injured in transportation accidents. There was no significant difference between regions with regard to the type of resulting impairment.CONCLUSIONS: Incidence of TSCI was considerably higher in the Thessaloniki region as compared with that in the Stockholm region, probably chiefly reflecting differences in preventative measures with regard to driving.
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| 12. |
- Forslund, E B, et al.
(författare)
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Transfer from table to wheelchair in men and women with spinal cord injury : coordination of body movement and arm forces
- 2007
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 45:1, s. 41-48
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A complex set-up was used to investigate kinematics and ground reaction forces.SETTING: Motor Control and Physical Therapy Research Laboratory, Neurotec Department, Karolinska Institutet, Huddinge, Sweden.OBJECTIVE: To investigate how men and women with spinal cord injury (SCI) perform transfers from table to wheelchair with regard to timing and magnitude of force generation beneath the hands and associated body movements.METHODS: A total of 13 subjects (seven men, six women) with thoracic SCI. Kinematics of body movement were recorded (Elite 2000 system) simultaneously with the signals from three force plates (AMTI) placed beneath the buttocks and hands. Temporal and spatial parameters regarding head, trunk and trailing arm displacement, loading amplitudes and loading torque directions of both hands were analyzed for each trial and subject and compared between genders.RESULTS: Men and women used similar amplitudes of head bending and forward displacement of the trailing shoulder, while female subjects had significantly larger trunk rotation. Both genders applied significantly more weight on the trailing hand. Differences between genders were seen in direction and timing of peak torque beneath the hands.CONCLUSIONS: The forces beneath the trailing hand were larger than those in the leading, if there is weakness or pain in one arm, this arm should be selected as the leading. To avoid excessive load on the arms, technical aids and environmental factors should be very well adapted.SPONSORSHIP: This project was funded by the Swedish Research Council and the Health Care Science Committee of Karolinska Institutet.
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| 13. |
- Hanna-Mitchell, Ann T, et al.
(författare)
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The impact of neurotrophin-3 on the dorsal root transitional zone following injury
- 2008
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Ingår i: Spinal Cord. - 1362-4393 .- 1476-5624. ; 46:12, s. 804-810
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Morphological and Stereological assessment of the dorsal root transitional zone (DRTZ) following complete crush injury, using light microscopy (LM) and transmission electron microscopy (TEM).Objectives: To assess the effect of exogenous neurotrophin-3 (NT-3) on the response of glial cells and axons to dorsal root damage.Setting: Department of Anatomy, University College Cork, Ireland and Department of Physiology, UMDS, University of London, UK.Methods: Cervical roots (C6-8) from rats which had undergone dorsal root crush axotomy 1 week earlier, in the presence (n = 3) and absence (n = 3) of NT-3, were processed for LM and TEM.Results: Unmyelinated axon number and size was greater in the DRTZ proximal ( Central Nervous System; CNS) and distal ( Peripheral Nervous System; PNS) compartments of NT-3-treated tissue. NT-3 was associated with a reduced astrocytic response, an increase in the proportion of oligodendrocytic tissue and a possible inhibition or delay of microglial activation. Disrupted-myelin volume in the DRTZ PNS and CNS compartments of treated tissue was lower, than in control tissue. In the PNS compartment, NT-3 treatment increased phagocyte and blood vessel numbers. It decreased myelinating activity, as sheath thickness was significantly lower and may also account for the noted lower Schwann cell and organelle volume in the test group.Conclusions: Our observations suggest that NT-3 interacts with non-neuronal tissue to facilitate the regenerative effort of damaged axons. This may be as a consequence of a direct action or indirectly mediated by modulation of non-neuronal responses to injury.
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| 14. |
- Johansson, C, et al.
(författare)
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Validity and responsiveness of the spinal cord index of function: an instrument on activity level.
- 2009
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC.
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:To evaluate the validity and responsiveness of the Spinal Cord Index of Function (SIF), a new instrument on activity level, measuring the ability to perform various transfers in non-walking patients with a spinal cord lesion.Settings:Spinal Injuries Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.Methods:Twenty-nine patients with a spinal cord lesion classified as grade A, B or C according to the American Spinal Injury Association/International Medical Society of paraplegia classification were included. Each patient was evaluated from the acute phase until discharge, every second week, by their physiotherapist, according to SIF and the Swedish physiotherapy clinical outcome variables (S-COVS). To determine validity, Spearman's rho correlation coefficient was calculated between the total scores of SIF and S-COVS, and the determination coefficient was calculated. Responsiveness was determined by computing effect sizes.Results:Spearman's correlation between SIF and S-COVS was 0.933 and the determination coefficient was 0.87. The effect size for SIF was 9.1.Conclusion:The results of the study prove that SIF is a valid and sensitive instrument, which will be useful for physiotherapists in goal-planning programs and in evaluating progress during a patient's rehabilitation. SIF could also be used in research and in evaluating the patient's functional ability at follow-ups.Spinal Cord advance online publication, 16 June 2009; doi:10.1038/sc.2009.57.
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| 15. |
- Kreuter, Margareta, 1947, et al.
(författare)
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Health and quality of life of persons with spinal cord lesion in Australia and Sweden
- 2005
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 43, s. 1123-1129
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Tidskriftsartikel (refereegranskat)abstract
- A cross sectional questionnaire study of 89 Australian and 71 Swedish spinal cord injured persons. The demonstrated health related quality of life profiles in spinal cord injured persons showed that valid measures can provide new information of clinical value beyond the self-evident physical and practical restrictions due to the injury. Illustrative comparisons between Australia and Sweden may extend our knowledge about areas where the spinal cord injured persons themselves are the logical experts, for example, maintenance of personal roles, social interaction and emotional well-being.
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| 16. |
- Lawton, G, et al.
(författare)
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Cross-cultural validity of FIM in spinal cord injury.
- 2006
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 44:12, s. 746-52
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To analyse cross-culture validity of the Functional Independence Measure (FIM) in patients with a spinal cord injury using a modern psychometric approach. SETTINGS: A total of 19 rehabilitation facilities from four countries in Europe. PARTICIPANTS: A total of 647 patients at admission, median age 46 years, 69% male. METHODS: Data from the FIM, collected on inpatient admission, was fitted to the Rasch model. A detailed analysis of scoring functions of the seven categories of the FIM items was undertaken before to testing fit to the model. Categories were rescored where necessary. Fit to the model was assessed initially within country, and then in the pooled data. Analysis of differential item functioning (DIF) was undertaken in the pooled data for each of the FIM motor and social cognitive scales, respectively. Final fit to the model was tested for breach of local independence by principle components analysis (PCA). RESULTS: The present scoring system for the FIM motor and cognitive scales, that is a seven category scale, was found to be invalid, necessitating extensive rescoring. Following this, DIF was found in a number of items within the motor scale, requiring a complex solution of splitting items by country to allow for the valid pooling of data. Five country-specific items could not be retained within this solution. The FIM cognitive scale fitted the Rasch model after rescoring, but there was a substantial ceiling effect. CONCLUSIONS: Data from the FIM motor scale for patients with spinal cord injury should not be pooled in its raw form, or compared from country to country. Only after fit to the Rasch model and necessary adjustments could such a comparison be made, but with a loss of clinical important items. The FIM cognitive scale works well following rescoring, and data may be pooled, but many patients were at the maximum score.
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| 17. |
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| 18. |
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| 19. |
- Nordgren, Camilla
(författare)
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On the need of validating inpatient registers.
- 2008
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1476-5624 .- 1362-4393. ; 46, s. 748-752
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Tidskriftsartikel (refereegranskat)abstract
- Study design:Register study.Objectives:To design and implement a validation process to check the completeness of the Hospital Discharge Register (HDR) held by the Swedish National Board of Health and Welfare.Setting:Sweden.Methods:An accurate traumatic spinal cord injury prevalence group (n=495) was acquired from the Swedish Spinalis Clinic. A register control was performed on the group by raising three questions to check the validity of the HDR: Is an inpatient stay registered in association with the injury date? Is the reported first length of stay plausible, given the level and extent of injury? Are all the anticipated care and/or rehabilitation providers represented in the HDR?Results:For 62% (of 413 cases) the first registered hospitalization date correlated with the injury date. For the other 38%, hospitalization was reported to start between 2 and 8651 days after injury. Considering the level and extent of injury, individuals were reported to have unrealistically short initial hospitalization. The prevalence group visited 42 different hospitals and 47 clinics. Five rehabilitation clinics, though, were not reported.Conclusions:The HDR is a valuable source when conducting epidemiological and health services research. However, using the register without any validation process could, as detected in the investigated diagnosis group, lead to a severe underestimation of the inpatient usage. The study showed that systematic errors could be detected by means of extensive knowledge of the diagnosis group.Spinal Cord advance online publication, 13 May 2008; doi:10.1038/sc.2008.42.
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| 20. |
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| 21. |
- Osteråker, A-L, et al.
(författare)
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Indicators of psychological distress in postacute spinal cord injured individuals.
- 2005
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 43:4, s. 223-9
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Consecutive inclusion of spinal cord injured patients admitted for postacute rehabilitation from June 2000 to January 2002.OBJECTIVE: Assessment of prevalence of indicators of psychological distress in the subacute and early chronic stages after acute-onset spinal cord injury (SCI).SETTING: A Swedish rehabilitation center.METHODS: In all, 36 patients participated. Psychological assessment was obtained at admission, discharge and 6 months follow-up by psychological measures based on the DSM-IV (ie Beck's Depression Inventory, SPIFA, SCID-screen, AUDIT) and clinical interview. Ongoing psychotropic medication was noted.RESULTS: Clinical depression was infrequent. However, ongoing psychotropic medication was common, possibly indicating a relatively high incidence of underlying depressive and anxiety disorders. In all, 25% of the sample showed indicators of high alcohol consumption. Few patients had a previously diagnosed personality disorder. By contrast, there was frequent occurrence of personality traits outside normal ranges.CONCLUSION: Medication of psychological problems commonly occurs after SCI, especially for depression and anxiety. There are indications of alcohol overconsumption in a substantial minority of SCI patients. The study raises the question of whether suppression of psychological symptoms by drug therapy is the optimal treatment of such problems in a rehabilitation process.
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| 22. |
- Pazooki, David, 1958, et al.
(författare)
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Continent cutaneous urinary diversion in patients with spinal cord injury.
- 2006
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 44:1, s. 19-23
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Retrospective study. OBJECTIVE: To examine the functional results and effect on quality of life of continent cutaneous urinary diversion in spinal cord injured patients. SETTING: Department of Urology, Sahlgrenska University Hospital, Göteborg, Sweden. SUBJECTS: A total of 10 patients with spinal cord injury (SCI). METHOD: The patients were operated on with an ileal reservoir (Kock reservoir or T-pouch), Cr-EDTA clearance was determined preoperatively and at follow-up. The patients answered a questionnaire concerning reservoir function, various activities and quality of life. The patient charts were reviewed. RESULTS: One patient died of pulmonary embolism 3 years after surgery. Two patients were reoperated on for reservoir perforation. All patients were satisfied/very satisfied with their reservoirs. Half of them reported improved ability to perform various activities. Eight out of nine patients reported improved quality of life. CONCLUSION: For a selected group of patients with SCI, continent cutaneous urinary diversion provides successful outcome with improved quality of life.
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| 23. |
- Reinke, M, et al.
(författare)
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Brown-Séquard syndrome caused by a high velocity gunshot injury: a case report.
- 2007
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Ingår i: Spinal cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 45:8, s. 579-82
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Tidskriftsartikel (refereegranskat)abstract
- Case report.To present an unusual traumatic neurologic pathology caused by gunshot injury.Spine unit of Department of Trauma and Orthopaedic Surgery, University Medical School, Charité - Campus Benjamin Franklin, Berlin, Germany.A 35-year-old male sustained a gunshot injury from a machine gun. The projectile caused a fracture of the left pedicle of Th10. The spinal cord was indirectly damaged by cavitation that caused a Brown-Séquard syndrome (BSS). After a microscopically assisted posterior revision at T9/10 with removal of bullet and bone fragments from the spinal canal and debridement of the bullet cavity via extended fenestrectomy the patient gained his motor function back. The sensory deficit remained unchanged.BSS can be caused by bullet-related injury of the spinal canal with no direct damage of neural structures. The initial treatment is always based on the total injury pattern. Possible spinal cord injuries are only clarified after restitution of vital functions. Decompression of neural structures in shotgun injury is indicated in incomplete paraplegia, injury of intra-abdominal hollow organs or high velocity bullet wounds. Through debridement and decompression of neural structures and chronic damage caused by foreign body granulomas can be prevented. Secondary destabilization of the spine should be avoided.
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| 24. |
- Robinson, Yohan, 1977, et al.
(författare)
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Spinal extradural meningeal cyst with spinal stenosis.
- 2006
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Ingår i: Spinal cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 44:7, s. 457-60
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Tidskriftsartikel (refereegranskat)abstract
- Case report.To present a rare pathology causing a common disease.Spine unit of the orthopaedic surgery department of a university hospital in Berlin/Germany.A 39-year-old female with an intraspinal extradural arachnoid cyst of the lumbar spine presented with intermittent radiating lumbar pain. The magnetic resonance imaging (MRI) showed a dorsal spinal extradural arachnoid cyst at L3/4. After wide laminotomy L3, operative cyst resection and stabilisation at L3/4 by posterior lumbar interbody fusion (PLIF), major symptom relief occurred.Spinal extradural arachnoid cysts are a rare entity causing low back pain and intermittent radicular syndromes. They can be caused by arachnoid herniation through dural weak spots which are hereditary or occur after trauma. A ball-valve mechanism promotes growth. The main diagnostic tool for spinal extradural cysts is the MRI scan. Additionally, myelography is helpful to demonstrate fluid communication. Complete surgical removal of the cyst should be attempted to reduce risk of recurrence. If extensive decompression is needed for the surgical approach causing segmental instability, interbody fusion is recommended. The outcome depends on age, duration and degree of neurological damage.
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| 25. |
- Rutberg, Lena, et al.
(författare)
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Amenorrhoea in newly spinal cord injured women: an effect of hyperprolactinaemia?
- 2008
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 46:3, s. 189-191
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Prospective, single centre study. OBJECTIVES: Previous studies have suggested a relationship between stress reaction and elevated levels of prolactine. The aim of the present study was to investigate if there was a relationship between s-prolactine and menstrual cycle status following spinal cord injury (SCI). SETTING: Spinal Cord Injury Unit, Göteborg, Sweden. METHODS: S-prolactine and menstrual cycle status were investigated in 16 consecutive women with SCI, treated at the SCI Unit, Sahlgrens University Hospital, Göteborg, Sweden. Level of injury ranged from C1 to L5, ASIA A-D. Mean age at injury was 45 years (range 20-79). RESULTS: S-Prolactine showed a mean value of 741 mIU/l (standard deviation (s.d.): 625; 95% confidence interval (CI): 435-1788 mIU/l, reference value <400 mIU/l). When dividing the group according to fertility status we found hyperprolactinaemia in the women who were in childbearing age (n=9): mean value 1050 mIU/l (s.d.: 678; 95% CI: 607-1493 mIU/ml), whereas it was normal in the group in menopause (n=7): mean value 343 mIU/l (s.d.: 185, 95% CI: 206-480 mIU/l) (P<0.01 when comparing groups). The group that developed amenorrhoea showed the highest values of s-prolactine. All values but one was normalised 3-6 months later. CONCLUSION: Amenorrhoea following SCI is correlated to level of s-prolactine. We found no correlation between level of s-prolactine and level or degree of injury.
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| 26. |
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| 27. |
- Vaidyanathan, S, et al.
(författare)
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Recurrent vesical calculi, hypercalciuria, and biochemical evidence of increased bone resorption in an adult male with paraplegia due to spinal cord injury: is there a role for intermittent oral disodium etidronate therapy for prevention of calcium phosphate bladder stones?
- 2005
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 43:5, s. 269-277
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Clinical case report with comments by colleagues from Sweden, Poland, Spain, Brazil, Japan, Belgium and Switzerland. Objectives: To discuss the role of disodium etidronate therapy for prevention of calcium phosphate vesical calculi in persons with spinal cord injury, who have hypercalciuria and biochemical evidence of increased bone resorption. Setting: Regional Spinal Injuries Centre, Southport, UK. Methods: A 21-year-old male sustained paraplegia (T-10; ASIA scale: A) in a road traffic accident in June 2001. He had an indwelling urethral catheter until the end of August 2001, when he started self-catheterisation. He developed bladder stones and electrohydraulic lithotripsy (EHL) was performed in May 2002. All stone fragments were removed. Recurrence of vesical calculi was noted in October 2002. These stones were fragmented by lithoclast lithotripsy in two sessions, in December 2002 and February 2003; all stone fragments were removed at the end of the second session. This patient reverted to indwelling catheter drainage when vesical calculi recurred. In September 2003, X-ray of the abdomen showed recurrence of vesical calculi. By February 2004, the stones had increased in size and number. EHL of vesical calculi was again performed in April 2004. Complete clearance was achieved. Results: A 24-h urinalysis detected hypercalciuria – 18.7 mmol/day (reference range: 2.5–7.5). Biochemical analysis of vesical calculus revealed calcium phosphate (85%) and magnesium ammonium phosphate (15%). Plasma C-terminal telopeptide (CTX) was increased – 1.06 ng/ml (reference range: 0.1–0.5 ng/ml). Free deoxypyridinoline/creatinine ratio (fDPD/Cr) in urine was also increased – 20.2 (reference range: 2.3–5.4). In April 2004, this patient was prescribed disodium etidronate 400 mg day. Nearly 3 months after commencing therapy with etidronate, plasma CTX decreased to 0.87 ng/ml. fDPD/Cr in urine also decreased to 12.4. After 4 months of etidronate therapy, 24-h urinary calcium excretion had decreased to 6.1 mmol/day. Conclusion: Etidronate (400 mg daily) is a very effective inhibitor of calcium phosphate crystallisation. Etidronate decreased urinary excretion of calcium, an important factor in prevention of calcium phosphate bladder stones. Etidronate therapy is not a substitute for other well-established methods for prevention of vesical calculi in spinal cord injury patients, for example, large fluid intake, avoiding long-term catheter drainage. Intermittent therapy with etidronate may be considered in selected patients, in whom hypercalciuria persists after instituting nonpharmacological therapy for an adequate period, for example, early mobilisation, weight-bearing exercises, and functional electrical stimulation. However, possible side effects of etidronate, and the fact that etidronate is not licensed in United Kingdom for prevention of urolithiasis, should be borne in mind.
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| 28. |
- Werhagen, L., et al.
(författare)
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The prevalence of neuropathic pain after non-traumatic spinal cord lesion
- 2007
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 45:9, s. 609-615
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Retrospective register study. Objective: 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. Setting: A unit for patients with post-acute traumatic and non-traumatic spinal cord lesions in the greater area of Stockholm, Sweden. Method: 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 χ 2 - analysis and logistic regression. Results: 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. Conclusion: Neuropathic pain is common among patients with acquired non-traumatic spinal cord lesions regardless of aetiology, often causing severe problems in daily life.
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