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ObjectiveTo explore the application of Brain and Spinal Injury Center (BASIC) score in evaluation of traumatic cervical spinal cord injury. MethodsFrom January, 2015 to December, 2021, 175 patients with traumatic cervical spinal cord injury in Beijing Bo'ai Hospital were analyzed. Gender, age, cause of injury, injury mechanism and American Spinal Injury Association Impairment Scale (AIS) grade were collected. The sagittal and axial T2 weighted imaging (T2WI) of the patients were evaluated with BASIC score, single/multi-segment injury, and with/without intramedullary hemorrhage. According to the injury mechanism, the patients were divided into two groups: with fracture/fracture dislocation (n = 92) and without fracture and dislocation (n = 83). The baseline demographic indicators and T2WI evaluation indicators were compared between the two groups, and the relationship between AIS grade and BASIC score, intramedullary hemorrhage, single/multi-segment injury were investigated. ResultsThere were significant differences in gender, age and AIS grade, BASIC score, and the rates of inntramedullary hemorrhage and single segment injury of T2WI between two groups (t = -10.276, χ2 > 8.703, P < 0.01); however, no difference was found in the cause of injury (P > 0.05). The AIS grade was significantly correlated with the BASIC score (r = 0.790, P < 0.001). There was significant difference in AIS grade between intramedullary hemorrhage or not, and single/multi-segment injury (χ2 > 5.516, P < 0.05). ConclusionThe BASIC score of T2WI is a predictor of the severity of spinal cord injury after traumatic cervical spinal cord injury, and is different with the injury mechanisms.
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ObjectiveTo observe the characteristics of gait symmetry and its influencing factors in patients with incomplete spinal cord injury (ISCI). MethodsFrom May, 2018 to November, 2021, 34 patients with ISCI in Beijing Bo'ai Hospital were divided into symmetrical injury of lower limb (SI) group and asymmetrical injury of lower limb (ASI) group according to the lower extremities motor score (LEMS). Three dimensional motion acquisition system and plantar pressure acquisition system were used for gait test. The symmetry indexes of step length, stance time and swing time were caculated. ResultsThe symmetry indexes of step length, stance time and swing time were significant lower in SI group than in ASI group (|t| > 2.619, P < 0.01). Stance time and swing time significantly correlated to the difference of bilateral LEMS in ASI group (r > 0.468, P < 0.01). Discriminant analysis showed that gait parameter equations were different for patients with different symmetry of lower limb injuries. ConclusionThe symmetry of lower limb motor function impacts gait symmetry for patients with ISCI, especially the difference value of bilateral total LEMS. Gait parameters can be used to determine the symmetry of lower limb injury in patients with ISCI.
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ObjectiveTo investigate the changes of bone mineral density of distal femur and proximal tibia in patients with spinal cord injury. MethodsNine inpatients with spinal cord injury in Beijing Bo'ai Hospital for rehabilitation from November, 2018 to January, 2021 were recruited. The bone mineral density of distal femur, proximal tibia, total hip and femoral neck at admission and six months after admission was measured. ResultsCompared with the results of admission, the bone mineral density of distal femur, proximal tibia, total hip and femoral neck decreased significantly six months after admission (∣Z∣ > 2.265, P < 0.01). The percentage of decreased bone mineral density in the femoral neck was inversely correlated with the lower extremity movement score at the second measurement (r = -0.515, P = 0.035). ConclusionWithin one year after the onset of spinal cord injury, the bone mineral density of distal femur and proximal tibia decreases.
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@#Objective To explore the prevention for hip dysplasia after pediatric spinal cord injury. Methods From March, 2017, the families of 47 children with spinal cord injury accepted education for preventing improper posture of sitting and sleeping and other interventions, and 23 of them were followed up for three months or more. Results New hip dislocation was found in one child, and 18 children developed almost normally in hip, the other four children with old hip dislocation did not worsen.Conclusion Intervention in time may prevent the hip dislocation in children with spinal cord injury.
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Objective To retrospectively analyze the lower extremity deep vein thrombosis prevention in patients with spinal cord injury (SCI). Methods A total of 115 SCI patients in our department from April to May, 2015 were included. The clinical symptoms, lower limb deep vein ultrasonic testing, laboratory examination were collected to analyze the occurrence, prevention measures, the thrombus location and management of deep venous thrombosis (DVT) in lower limbs. Results Forty-three patients had thromboprophylaxis in other hospitals before admission, and 105 patients in our department after admission, in which, nine cases were with clinical symptoms in other hospitals and three cases in our department. No pulmonary embolism occurred in them. There was no significant difference in most laboratory index-es between patients with DVT and without DVT in lower limbs (P>0.05). Five patients were with DVT in lower limbs in 43 patients who had thromboprophylaxis, and four cases in 72 patients who did not have thromboprophylaxis. No relationship was found between thrombo-prophylaxis and DVT in lower limbs (χ2=0.663, P=0.415). Five patients were with DVT in lower limbs in 53 patients with complete SCI, and four cases in 59 patients with incomplete SCI. No relationship was found between the severity of SCI and DVT in lower limbs in other hospitals (χ2=0.028, P=0.867). Conclusion DVT in lower limbs could be also occurred in patients who accepted thromboprophylaxis. Labo-ratory indexes are inadequate for the prediction and diagnosis specificity of DVT in lower limbs.
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Objective To compare the apparent diffusion coefficients (ADC) between healthy people and patients with early cervical spi-nal cord injury (SCI). Methods 18 patients with early cervical SCI and 5 healthy controls were examined with MRI T1WI, T2WI and DWI, and the ADC values and ADC maps were obtained. Results and Conclusion ADC values were less in the patients than in the healthy con-trols, and the cut-off point was 800.0×10-6 mm2/s. ADC values also reduced in some patients without obvious abnormal MRI finds.
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Objective To investigate the correlation between Semmes-Weinstein monofilament test and light touch exam of international standard for spinal cord injury (SCI). Methods 84 inpatients with SCI were assessed with Semmes-Weinstein monofilament test and light touch exam of international standard to determine the SCI level. The results were recorded as right-side and left-side of the body respective-ly. Results The normal tactual level of monofilament test and the normal light touch level of International Standard of Spinal Cord Injury (ISSCI) was consistent in 36%result to the unilateral level of SCI. For the 45 cases with ASIA A injury, 71%of the key points below the SCI level lost the tactual sensation in monofilament test, and 84%lost in light touch exam of ISSCI. Conclusion The result of monofilament test is poorly consistent with light touch exam of SCI, which may result from tactile sensitization after SCI. It is recommended to combine these exam in practices.
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@#Objective To investigate the correlation between Semmes-Weinstein monofilament test and light touch exam of international standard for spinal cord injury (SCI). Methods 84 inpatients with SCI were assessed with Semmes-Weinstein monofilament test and light touch exam of international standard to determine the SCI level. The results were recorded as right-side and left-side of the body respectively. Results The normal tactual level of monofilament test and the normal light touch level of International Standard of Spinal Cord Injury (ISSCI) was consistent in 36% result to the unilateral level of SCI. For the 45 cases with ASIA A injury, 71% of the key points below the SCI level lost the tactual sensation in monofilament test, and 84% lost in light touch exam of ISSCI. Conclusion The result of monofilament test is poorly consistent with light touch exam of SCI, which may result from tactile sensitization after SCI. It is recommended to combine these exam in practices.
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@#Objective To compare the apparent diffusion coefficients (ADC) between healthy people and patients with early cervical spi nal cord injury (SCI). Methods 18 patients with early cervical SCI and 5 healthy controls were examined with MRI T1WI, T2WI and DWI, and the ADC values and ADC maps were obtained. Results and Conclusion ADC values were less in the patients than in the healthy con trols, and the cut-off point was 800.0×10-6 mm2/s. ADC values also reduced in some patients without obvious abnormal MRI finds.
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@#Study design Survey of expert opinion, feedback and final consensus. Objective To describe the development and the variables included in the International Spinal Cord Injury (SCI) Spinal Interventions and Surgical Procedures Basic Data set. Setting International working group. Methods A committee of experts was established to select and define data elements. The data set was then disseminated to the appropriate committees and organizations for comments. All suggested revisions were considered and both the International Spinal Cord Society and the American Spinal Injury Association endorsed the final version. Results The data set consists of nine variables: (1) Intervention/ Procedure Date and start time (2) Non-surgical bed rest and external immobilization, (3) Spinal intervention-closed manipulation and/or reduction of spinal elements, (4) Surgical procedure-approach, (5) Date and time of the completion of the intervention or surgical closure; (6) Surgical procedure-open reduction, (7) Surgical procedure-direct decompression of neural elements, and (8 and 9) Surgical procedure- stabilization and fusion (spinal segment number and level). All variables are coded using numbers or characters. Each spinal intervention and procedure is coded (variables 1 through 7) and the spinal segment level is described (variables 8 and 9). Sample clinical cases were developed to illustrate how to complete it. Conclusion The International SCI Spinal Interventions and Surgical Procedures Basic Data Set was developed to facilitate comparisons of spinal interventions and surgical procedures among studies, centers and countries.
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@#Objective To study the modification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) worksheet (2013 version) and the significance for clinical practice. Methods The latest English version of ISNCSCI worksheet- 2013 was compared with the previous version to find the advantages of current version and analyze its significance according to the experience from using the worksheet-2011. Results 11 modifications were found in ISNCSCI-2013, in which some were just discrimination, some were for emphasis, and the others were detailing. Conclusion The ASIA International Standards Committee made prudent modifications according to the practical experience of the ISNCSCI-2011 to make the worksheet more scientific and clear for recording. The modification will be more beneficial to record and determine the evaluation results of neurological examination of spinal cord injury in clinical practice.
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@#Study design Survey of expert opinion, feedback and final consensus. Objective To describe the development and the variables included in the International Spinal Cord Injury (SCI) Spinal Interventions and Surgical Procedures Basic Data set. Setting International working group. Methods A committee of experts was established to select and define data elements. The data set was then disseminated to the appropriate committees and organizations for comments. All suggested revisions were considered and both the International Spinal Cord Society and the American Spinal Injury Association endorsed the final version. Results The data set consists of nine variables: (1) Intervention/ Procedure Date and start time (2) Non-surgical bed rest and external immobilization, (3) Spinal intervention-closed manipulation and/or reduction of spinal elements, (4) Surgical procedure-approach, (5) Date and time of the completion of the intervention or surgical closure; (6) Surgical procedure-open reduction, (7) Surgical procedure-direct decompression of neural elements, and (8 and 9) Surgical procedure- stabilization and fusion (spinal segment number and level). All variables are coded using numbers or characters. Each spinal intervention and procedure is coded (variables 1 through 7) and the spinal segment level is described (variables 8 and 9). Sample clinical cases were developed to illustrate how to complete it. Conclusion The International SCI Spinal Interventions and Surgical Procedures Basic Data Set was developed to facilitate comparisons of spinal interventions and surgical procedures among studies, centers and countries.
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Objective To investigate the application of International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) in China. Methods A retrospective review was performed and the articles were identified in Chinese National Knowledge Infra-structure (CNKI), Wanfang data and CqVip data from January 2012 to January 2015. The articles were searched by words Spinal Cord Inju-ry, Paraplegia and Tetraplegia. Results The usage rate of ISNCSCI was 46.6%in domestic, and they were 60.7%, 47.8%and 35.3%in de-partments of rehabilitation, spinal surgery and orthopedics, respectively. Conclusion ISNCSCI is not widely used in spinal cord injury re-search in China, so it is important to raise the awareness and promote the use of ISNCSCI.
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Objective To study the modification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) worksheet (2013 version) and the significance for clinical practice. Methods The latest English version of ISNCSCI work-sheet-2013 was compared with the previous version to find the advantages of current version and analyze its significance according to the ex-perience from using the worksheet-2011. Results 11 modifications were found in ISNCSCI-2013, in which some were just discrimination, some were for emphasis, and the others were detailing. Conclusion The ASIA International Standards Committee made prudent modifica-tions according to the practical experience of the ISNCSCI-2011 to make the worksheet more scientific and clear for recording. The modifi-cation will be more beneficial to record and determine the evaluation results of neurological examination of spinal cord injury in clinical practice.
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Objective To observe the relationship between spinal cord cystic degeneration, spinal cord movement improvement and ap-parent diffusion coefficient (ADC) values after early cervical spinal cord injury. Methods 18 patients with early cervical spinal cord injury were examined with MRI T1WI, T2WI and diffusion weighted imaging (DWI). Then ADC values and ADC maps were obtained. Their ASIA motor scores were also recorded. The relationship between spinal cord cystic degeneration and spinal cord movement improvement and ADC values was analyzed. Results ADC values were lower in those with cystic degeneration than without cystic degeneration in early cervi-cal spinal cord injury, and the cut-off point was 700×10-6 mm2/s. ADC values were positively correlated with age. The movement improve-ment did not obviously correlate with ADC values. Conclusion ADC values of early cervical spinal cord injury are less than 700×10-6 mm2/s when cystic degeneration happened. Motor function recovery of patients with early cervical spinal cord injury cannot be estimated by mea-suring ADC values.
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@#Collection of information on spinal column injury is very important for the diagnosis and treatment of individuals with spinal cord lesions. The purpose of the Spinal Column Injury Basic Data Set for spinal cord injury individuals is to standardize the collection and reporting of a minimal amount of information on the spinal column injury in daily practice. By studying and using the International Spinal Cord Injury Spinal Column Injury Basic Data Set, it is helpful to standardize and unify the collection of information on spinal column injury of patients with spinal cord injury in our country and afford evidence to the relevant treatments. The process used to develop the International Spinal Cord Injury Spinal Column Injury Basic Data Set, a description of the data elements and examples of cases illustrating how the data is coded is described in this paper.
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@#There is autonomic nerve dysfunction after cervical spinal cord injury. Fluctuation of blood pressure and heart rate was found as orthostatic hypotension and bradycardia.
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@#Objective To observe the relationship between spinal cord cystic degeneration, spinal cord movement improvement and apparent diffusion coefficient (ADC) values after early cervical spinal cord injury. Methods 18 patients with early cervical spinal cord injury were examined with MRI T1WI, T2WI and diffusion weighted imaging (DWI). Then ADC values and ADC maps were obtained. Their ASIA motor scores were also recorded. The relationship between spinal cord cystic degeneration and spinal cord movement improvement and ADC values was analyzed. Results ADC values were lower in those with cystic degeneration than without cystic degeneration in early cervical spinal cord injury, and the cut-off point was 700×10-6 mm2/s. ADC values were positively correlated with age. The movement improvement did not obviously correlate with ADC values. Conclusion ADC values of early cervical spinal cord injury are less than 700×10-6 mm2/s when cystic degeneration happened. Motor function recovery of patients with early cervical spinal cord injury cannot be estimated by measuring ADC values.
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@#Objective To investigate the effect of combination of baclofen, tizanidine and eperisone on moderate or severe spasticity after spinal cord injury. Methods 18 inpatients with moderate (n=2) or severe (n=16) spasticity after spinal cord injury were treated with combination of 2 or 3 kinds of drugs for 2 months, and followed up for at least 4 months with modified Ashworth scale (MAS). Their blood pressure, blood and urine routine, liver and kidney function were observed. Results Among the 16 cases of severe spasticity (MAS≥3), MAS reduced 3 grades in 3 cases, 2 grades in 12 cases, 1 grade in 1 case, with alleviation of phantom pain. For the cases of moderate spasticity (MAS=2), the MAS reduced 1 grade with alleviation of phantom pain. Slightly drowsiness was observed in 2 cases. No hepatic or renal dysfunctions was found. Conclusion Combination of baclofen, tizanidine and eperisone is effective on moderate or severe spasticity after spinal cord injury with limited side-effects.
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@# Objective To explore correlative factors with rehabilitation outcomes in spinal cord injury (SCI). Methods 226 patients were reviewed. Results Rehabilitation outcomes did not correlated with sex, occupation, and education, but correlated with the time of rehabilitation intervention, complications, hospital costs, injury severity and injury segment. Conclusion The time of rehabilitation intervention, complications, hospital costs, injury severity and injury segment are main factors related with rehabilitation outcomes of patients with SCI.