Determination of Neurological Impairment Level in Thoracic SpinalCord Injuries using Dermatomal Somatosensory Evoked Potentials

OBJECTIVE: To determine sensory levels of injury using dermatomal somatosensory evoked potentials (SEPs) and compare with the neurological level of injury determined by ASIA standard in patients with thoracic spinal cord injury. METHOD: By stimulating segmental thoracic dermatomes, cortical SEPs were studied in nine spinal cord injured patients from T2 to T12 (9 men, mean age 41.8) and 20 normal adult men (mean age, 28.3). The SEP studies were performed bilaterally. RESULTS: In eight cases (44%) of the paraplegics tested, the neurological level of injury by dermatomal SEPs was same compared to the level of injury assessed by ASIA standard. In 15 cases (83%), there were no or one level difference of the level of injury between the levels by SEPs and ASIA standard. CONCLUSION: This study suggests that dermatomal SEP can be a useful tool in determination of the neurological level of injury in patients with thoracic spinal cord injury.

Ambulation of Spina Bifida Patients

OBJECTIVE: To investigate the ambulatory status and its contributing factors in eighty one patients with spina bifida, and to obtain informations about the actual state and the problems of their orthotic uses for the lower limbs. METHOD: Eighty one spina bifida patients above thirty months of age who registered to the Myelomeningocele Clinic of Seoul National University Hospital were investigated through the telephone interviews and the retrospective reviews of the medical records by a physiatrist. RESULTS: About one half of 81 spina bifida patients had problems in their ambulation. It was significantly influenced by the neurological level, the type of spina bifida, the contractures and deformities of the lower limbs, and presence of hydrocephalus. The deformity of hip and the neurological level were revealed to be the most important factors contributing to their state of ambulation by the multiple linear logistic analysis(p<0.01). Forty patients had used the lower limb orthoses of which the ankle-foot-orthosis was most frequently used. The satisfaction and compliance of the patients, however, were not high and the most common complaint of the parents was a skin wound from the use of orthoses. CONCLUSION: The neurological level and the deformity of hip were the two most important contributing factors to the ambulation of the spina bifida patients. Early detection of the neurological level and an adequate prescription of the lower limb orthoses should be stressed for the management of ambulation in spina bifida patients.