Vulnerabilidad del adulto mayor con lesión cervical traumática

Fundamento: los adultos mayores sufren caídas que producen complicaciones traumáticas, dentro de estas se encuentra el trauma raquimedular que produce una alta tasa de discapacidad y mortalidad. Objetivo: exponer factores pronósticos que repercuten en el adulto mayor con lesión espinal cervical traumática. Métodos: se realizó un estudio de corte transversal sobre 42 pacientes geriátricos diagnosticados con trauma raquimedular cervical atendidos en Camagüey, desde 2019 hasta el 2022. Se analizaron las variables siguientes: datos demográficos, tipo de accidente, nivel de la lesión, complicaciones médicas, terapia utilizada y como variable dependiente la mortalidad. Resultados: se observó un predominio de los pacientes entre 60 a 74 años. El análisis estadístico sobre las probabilidades de fallecer mostró que ante un evento cervical traumático los pacientes con ventilación mecánica asistida, complicaciones médicas, nivel de severidad de la lesión (ASIA A o B) que sufrieron un accidente de tránsito tuvieron mayor riesgo de morir que los que no se encontraban en estos grupos. El nivel de dependencia social del grupo estuvo entre moderado y severo. Conclusiones: el envejecimiento poblacional requiere del desarrollo de terapias especializadas, donde se tomen en cuenta las características morfofisiológicas de este grupo que permitirá mejor recuperación funcional y una calidad de vida adecuada.

Foundation older adults suffer falls that produce traumatic complications, among which is spinal cord trauma with a high rate of disability and mortality. Objective to set out the prognostic factors that affect the elderly with traumatic cervical spinal injury. Methods: a cross-sectional study was carried out with 42 geriatric patients diagnosed with spinal cord trauma treated in Camagüey, from 2019 to 2022. The research consisted of a stage for the collection of demographic data, the type of accident, the level of injury, medical complications, the therapy used and another where the statistical processing was carried out where the mortality variable was considered as dependent. Results: a predominance of patients between 60 and 74 years of age was observed. The statistical analysis on the probabilities of dying showed that in a traumatic cervical event, patients with assisted mechanical ventilation, medical complications, injury severity level (ASIA A or B) who suffered a traffic accident had a higher risk of dying than those who were not in these groups. The level of social dependence of the group was between moderate and severe. Conclusions: population aging requires the development of specialized therapies, where the morphophysiological characteristics of this group are taken into account, which will allow better functional recovery and an adequate quality of life.

Improving Effect of Modified Buyang Huanwutang Combined with Electroacupuncture on Traumatic Spinal Cord Injury due to Qi Deficiency and Blood Stasis / 中国实验方剂学杂志

Objective:To observe the clinical efficacy of modified Buyang Huanwutang combined with electroacupuncture （EA） in the treatment of traumatic spinal cord injury （TSCI） due to Qi deficiency and blood stasis. Method:Eighty-seven TSCI patients who met the inclusion requirements were randomly divided into an observation group （<italic>n</italic>=44） and a control group （<italic>n</italic>=43）. On the basis of comprehensive western medical treatments， patients in the control group were further provided with Wuwei Tongshuan oral liquid，10 mL per time，three times per day， while those in the observation group received modified Buyang Huanwutang，one bag per day，for 12 consecutive weeks. Besides， EA was performed in both groups in the same way， once per day， six times per week， for six weeks in total. The American Spinal Injury Association （ASIA） motor score， modified Barthel index （MBI），visual analog scale （VAS） pain score，Berg balance scale （BBS） score，modified Ashworth scale （MAS） score， spinal cord independence measure-Ⅲ（SCIM-Ⅲ） score， lower limb range of motion （ROM）， and Qi deficiency and blood stasis syndrome score before and after treatment were evaluated， followed by the recording of the occurrence of complications during treatment. The brain-derived nerve growth factor （BDNF）， nerve growth factor （NGF）， vascular endothelial growth factor （VEGF）， neurotrophic factor-3 （NT-3）， malondialdehyde （MDA） and superoxide dismutase （SOD） levels before and after treatment were determined. Result:The motor， light touch， needling sensation， MBI， and BBS scores of the observation group were higher than those of the control group （<italic>P</italic><0.01）， while the AS and MAS scores were lower（<italic>P</italic><0.01）. The angles of adductor and straight leg raising in the observation group were greater than those of the control group （<italic>P</italic><0.01），but the Qi deficiency and blood stasis syndrome score was lower（<italic>P</italic><0.01）. Both the scores of self-care， respiration， and sphincter management in SCIM-Ⅲ and the total score in the observation group were elevated as compared with those of the control group （<italic>P</italic><0.01）. The cumulative incidence of complications in the observation group was 34.09%，significantly lower than 55.81% in the control group （<italic>χ</italic>²=4.149，<italic>P</italic><0.05）. Compared with the control group， the observation group exhibited remarkably increased BDNF， NGF， VEGF， NT-3， and SOD （<italic>P</italic><0.01） and decreased MDA （<italic>P</italic><0.01）. Conclusion:Modified Buyang Huanwutang combined with EA is effective in alleviating spinal cord injury， promoting neural functional recovery， improving independence in activities of daily living， reducing the incidence of complications of patients with TSCI， which may be related to the amelioration of ischemia and hypoxia， inhibition of lipid peroxidation， and acceleration of nerve cell repair and regeneration.

Estudo e prevalência de bexiga neurogênica em pessoas com lesão medular traumática e não traumática no Brasil / Study and prevalence of neurogenic bladder in users with traumatic and non-traumatic spinal cord injury in Brazil

A bexiga neurogênica, frequentemente associada à lesão medular de causa traumática e não traumática, é uma disfunção vesical decorrente de alterações no sistema nervoso. Este estudo investigou e analisou a bexiga neurogênica, sua prevalência e manejo em pessoas com diagnóstico de lesão medular traumática (LMT) e não traumática (LMNT) em uma rede de hospitais de reabilitação. Tratou-se de um estudo quantitativo, transversal, exploratório, descritivo e analítico. Para responder à questão central do estudo, foi selecionada uma amostra com 954 participantes, probabilística, aleatória estratificada, das seis unidades da rede participantes do estudo, com dados coletados diretamente dos prontuários eletrônicos. A prevalência de bexiga neurogênica foi de 94,65% (n=903), 67% tinham diagnóstico de lesão medular traumática e 33% de lesão medular não traumática, 69,32% eram homens e 30,68%, mulheres, com média de idade de 46,12 anos (DP=13,26). O cateterismo vesical intermitente foi a principal forma de esvaziamento (66,11%), e a maioria realizava o autocateterismo intermitente (74,04%). A micção voluntária foi associada ao tipo de lesão, sendo mais prevalente entre os participantes com LMNT (p≤0,001, Teste Qui-quadrado). Para investigação urológica, 93,36% realizaram exames de ultrassonografia renal e vias urinárias e 87,82%, estudo urodinâmico. A irregularidade da parede vesical (p≤0,029, teste Qui-quadrado de Pearson), o espessamento vesical (p ≤ 0,001, teste Qui-quadrado de Pearson) e a hiperatividade detrusora (p≤0,009, teste Qui-quadrado de Pearson) também apresentaram diferença estatística de acordo com o tipo de lesão, mais prevalentes nos participantes com LMT. Assim como a dilatação pielocalicinal, mais prevalente nos participantes com LMNT (p≤0,025, teste Qui-quadrado de Pearson). Os participantes com LMT apresentaram maior pressão detrusora média, 38,73cmH2O vs. 30,17cmH2O do que os com LMNT (p ≤ 0,001, teste de Mann- Whitney). Sabe-se que a bexiga neurogênica de pessoas com lesão medular traumática tende a apresentar maior número de complicações e maior risco para o trato urinário superior, principalmente quando há relação com a presença de pressão elevada, baixa complacência e capacidade vesical reduzida. Este estudo evidenciou diferenças importantes entre o perfil de pessoas com lesão medular traumática e não traumática, mostrando a necessidade do manejo personalizado de acordo com a causa da lesão medular.

Neurogenic bladder is a dysfunction that results from changes in the nervous system, and is frequently associated with traumatic and non-traumatic spinal cord injuries. This study investigated and analyzed the neurogenic bladder, its prevalence and management in people diagnosed with traumatic spinal cord injury (TSCI) and non-traumatic spinal cord injury (NTSCI) in a network of rehabilitation hospitals. This is a quantitative, transversal, exploratory, descriptive and analytical study. A probabilistic, stratified random sample, composed of 954 participants, was used to answer the research question. Participants were selected from six of the hospital-network units and data were directly retrieved from electronic medical records. The prevalence of neurogenic bladder was 94.65% (n = 903), where 67% had a diagnosis of traumatic spinal cord injury and 33% non-traumatic spinal cord injury, 69.32% were male and 30.68% female, with a mean age of 46.12 years (SD = 13.26). The main draining method was intermittent bladder catheterization (66.11%), in most cases performed as intermittent self-catheterization (74.04%). Voluntary urination was associated with the type of injury, being more prevalent among participants with non-traumatic spinal cord injury (NTSCI) (p≤0.001, Chi- Square Test). For urological investigation, 93.36% of the participants were submitted to a renal and urinary-tract ultrasound scan and 87.82% to urodynamics. Bladder wall irregularity (p≤0.029, Pearson's chi-square test) and thickening (p ≤ 0.001, Pearson's chi-square test), and detrusor hyperactivity (p≤0.009, Pearson's chi-square test) also presented a statistical difference according to the type of injury, with a higher prevalence in participants with traumatic spinal cord injury (TSCI). That was also the case of pyelocaliceal dilation, which was more prevalent in participants with NTSCI (p≤0.025, Pearson's Chi-square test). Participants with TSCI showed a mean detrusor pressure of 38.73 cmH2O, higher than the value of 30.17 cmH2O recorded for those with NTSCI (p ≤ 0.001, Mann-Whitney test). It is known that a neurogenic bladder in people with traumatic spinal cord injury tends to have a greater number of complications and greater risk for the upper urinary tract, especially when there is a relationship with the presence of high pressure, low compliance and reduced bladder capacity. This study unveiled important differences in the profiles of people with traumatic and non-traumatic spinal cord injury, highlighting the need for treatment to be tailored according to the cause of the spinal cord injury.

Identification of potential traumatic spinal cord injury related circular RNA-microRNA networks by sequence analysis / 中国修复重建外科杂志

Objective: To systematically profile and characterize the circular RNA (circRNA) and microRNA (miRNA) expression pattern in the lesion epicenter of spinal tissues after traumatic spinal cord injury (TSCI) and predict the structure and potential functions of the regulatory network. Methods: Forty-eight adult male C57BL/6 mice (weighing, 18-22 g) were randomly divided into the TSCI ( n=24) and sham ( n=24) groups. Mice in the TSCI group underwent T 8-10 vertebral laminectomy and Allen's weight-drop spinal cord injury. Mice in the sham group underwent the same laminectomy without TSCI. The spinal tissues were harvested after 3 days. Some tissues were stained with HE staining to observe the structure. The others were used for sequencing. The RNA-Seq, gene ontology (GO) analysis, and circRNA-miRNA network analyses (TargetScan and miRanda) were used to profile the expression and regulation patterns of network of mice models after TSCI. Results: HE staining showed the severe damage to the spinal cord in TSCI group compared with sham group. A total of 17 440 circRNAs and 1 228 miRNAs were identified. The host gene of significant differentially expressed circRNA enriched in the cytoplasm, associated with positive regulation of transcription and protein phosphorylation. mmu-miR-21-5p was the most significant differentially expressed miRNA after TSCI, and circRNA6730 was predicted to be its targeted circRNA. Then a potential regulatory circRNA-miRNA network was constructed. Conclusion: The significant differentially expressed circRNAs and miRNAs may play important roles after TSCI. A targeted interaction network with mmu-miR-21-5p at the core of circRNA6730 could provide basis of pathophysiological mechanism, as well as help guide therapeutic strategies for TSCI.

Effects of Electroacupuncture on Skeletal Muscle Atrophy-associated Protein in Hind Limbs of Traumatic Spinal Cord Injury Rats / 中国康复理论与实践

Objective:To explore the effects and mechanism of electroacupuncture (EA) on expression of myostatin (MSTN), muscle-specific ring finger protein 1 (MuRF1/Trim63), F-box only protein 32 (Atrogin-1/ Fbxo32), myogenic differentiation antigen (Myod) and myogenin (Myog) in traumatic spinal cord injury (TSCI) rats. Methods:A total of 45 adult female Sprague-Dawley rats were randomly divided into sham operation group (n = 12) and operation group (n = 33). The TSCI model was established with the modified Allen's method. After modeling, there were 24 survival rats and they were randomly divided into model group (n = 12) and EA group (n = 12). EA group was electroacupunctured at Dazhui (DU 14), Mingmen (DU 4) and bilateral Zusanli (ST 36) for 10 minutes, once a day, six times a week for 28 days. Basso-Beattie-Bresnahan (BBB) score was tested before modeling, and three days, seven days, 14 days, 21 days and 28 days after modeling. The rats were measured their body mass before and 28 days after modeling. The ratio of gastrocnemius wet mass was calculated; the cross-sectional area (CSA) and fiber diameter were measured by HE staining; the expression of MSTN, Trim63, Fbxo32, Myod and Myog mRNA were tested with real-time quantitative polymerase chain reaction (qPCR). Results:Three days, seven days, 14 days, 21 days, and 28 days after modeling, the score of BBB was lower in the model group than in the sham operation group (P < 0.01); seven days, 14 days, 21 days, and 28 days after modeling, the score of BBB was higher in EA group than in the model group (P < 0.01). Compared with the sham operation group, the mass of rats, the gastrocnemius wet mass, the CSA and the diameter of the muscle fiber were smaller in the model group (P < 0.05), while the expression of MSTN, Trim63, Fbxo32, Myod and Myog mRNA were higher (P < 0.05). Compared with the model group, the mass of rats, the gastrocnemius wet mass, the CSA, the expression of Myod and Myog mRNA were higher (P < 0.05) in EA group, while the expression of MSTN, Trim63 and Fbxo32 mRNA were lower (P < 0.05). Conclusion:EA might delay the gastrocnemius atrophy in TSCI rats by down-regulating the expression of MSTN, Trim63, Fbxo32 mRNA and up-regulating the expression of Myod and Myog mRNA via controlling the differentiation of the muscle satellite cells and the degradation of protein in skeletal muscle cells.

Expert Consensus on Evaluation, Treatment and Rehabilitation of Traumatic Spinal Cord Injury / 中国康复理论与实践

Spinal cord injury is a catastrophic injury causing lifelong severe disabilities, and poses a great burden to the individuals, families and society. In order to promote the standardization in treatment of traumatic spinal cord injury, the consensus on the evaluation, treatment and rehabilitation of traumatic spinal cord injury was suggested by experts, who came from authoritative multicenter in China. The expert consensus, which formed a standardization process from the first aid clinical treatment to rehabilitation of spinal cord injury, shall give a better practical guide for clinic and rehabilitation physicians.

Actualización en la fisiopatología y manejo de traumatismo raquimedular: revisión bibliográfica / Actualization in pathophysiology and management of traumatic spinal cord injury: literature review

El Traumatismo Raquimedular (TRM) implica todas las lesiones traumáticas que dañan los huesos, ligamentos, músculos, cartílagos, estructuras vasculares, radiculares o meníngeas a cualquier nivel de la médula espinal. Las consecuencias personales, familiares, sociales y económicas de esta enfermedad, hacen que sea un tema relevante en la actualidad. El propósito de esta revisión es entregar al lector las herramientas elementales sobre el TRM, y está principalmente enfocada en el tratamiento, el cual se aborda estrechamente relacionado con la fisiopatología para comprender los mecanismos moleculares y biomecánicos de trauma, incluyendo sus complicaciones y el manejo de éstas. Respecto al tratamiento del TRM, se aborda la evidencia que ofrecen las terapias actualmente validadas y las aún controversiales, incluyendo los glucocorticoides, la reducción cerrada y la cirugía precoz. Además las terapias emergentes como la hipotermia terapéutica, los nuevos agentes neuroprotectores que se encuentran en fases preclínicas y clínicas de estudio como el riluzol, la minociclina, el litio, los antagonistas opioides, entre otros, y los agentes neurorregenerativos como el Cethrin y el Anti-Nogo que han mostrado buenos resultados en la recuperación neurológica. Las recomendaciones actuales respecto a la terapia con células madre y subtipos de células madre en la actualidad, es que deben llevarse a cabo sólo en el contexto de ensayos clínicos. Aunque aún no existen terapias que permitan la recuperación neurológica completa en todos o la mayoría de los pacientes, las terapias emergentes prevén un futuro promisorio en los resultados clínicos de los pacientes con TRM.

The traumatic spinal cord injury (TSCI) involves all traumatic injuries that harm the bones, ligaments, muscles, cartilage, vascular, radicular or meningeal structures, at any level of the spinal cord. The personal, family, social and economic consequences of this disease, make it an important issue today. The purpose of this review is to provide the reader, the basic tools of the TRM, and it is mainly aimed at the treatment, which it approaches closely related to the pathophysiology, to understand the molecular and biomechanical mechanisms of trauma, including its complications and his management. Regarding treatment of TSCI, the evidence offered by currently validated and controversial therapies is discussed, including glucocorticoids, closed reduction and early surgery. Also emerging therapies such as therapeutic hypothermia, new neuroprotective agents currently in preclinical and clinical phases as riluzole, minocycline, lithium, opioid antagonists, among others, and neuroregenerative agents like Cethrin and Anti- Nogo that have shown good results in neurological recovery. Current recommendations for therapy with stem cells and subtype stem cell, is that only should be carried out in the context of clinical trials. Although there are not still therapies that allow full neurological recovery in all or most patients, emerging therapies provide a promising future in the clinical outcomes of patients with TRM.

Efecto de Implantes de Polipirrol Sintetizados por Diferentes Métodos sobre Lesiones de Médula Espinal en Ratas / Effect of Pyrrole Implants Synthesized by Different Methods on Spinal Cord Injuries of Rats

Polypyrrole (PPy) and polypyrrole/polyethylene glycol (PPy/PEG) implants synthesized by chemical, electro-chemical, and plasma polymerization methods were implanted into the injured spinal cord of rats to determine their effect on motor function recovery. Before implantation, the materials were characterized by infrared (IR) spectroscopy. An experimental model of traumatic spinal cord injury (TSCI) by complete transection at thoracic level 9, in rats was used. The polymer implants were inserted immediately after transection. Motor function recovery was evaluated once a week during 5 weeks using the Basso, Beattie and Bresnahan (BBB) motor scale. Histological evaluation was done at the end of the recovery evaluation period using hematoxylin/eosin stain. Results showed that animals implanted with polymers synthesized by plasma had a better integration into the nerve tissue, less inflammatory response and a better functional recovery than animals implanted with polymers synthesized by chemical or electrochemical methods.

En el presente trabajo se comparó el efecto de implantes poliméricos derivados del pirrol (polipirrol o PPy) y del copolímero polipirrol/polietilenglicol (PPy/PEG), obtenidos por diferentes métodos de síntesis: químico, electroquímico y polimerización por plasma con el propósito de determinar si el método de síntesis puede influir sobre el efecto que producen al ser implantados después de una lesión traumática de la médula espinal de ratas. Antes de realizar el implante, las características químicas y estructurales de los polímeros fueron analizadas por espectroscopia de infrarrojo (IR). Se utilizó un modelo experimental de lesión traumática de médula espinal (LTME) por sección completa en ratas. La LTME se realizó a nivel torácico 9 y el polímero fue implantado de inmediato en la zona de lesión. La recuperación de la función motora se evaluó mediante la escala Basso, Beattie y Bresnahan (BBB) una vez por semana durante 5 semanas. La evaluación histológica se realizó al término del seguimiento con la tinción de hematoxilina/eosina. Los resultados muestran que los animales implantados con polímeros sintetizados por plasma se integraron mejor al tejido nervioso, redujeron la respuesta inflamatoria y favorecieron una mayor recuperación funcional en comparación con los animales implantados con materiales sintetizados por métodos químicos o electroquímicos.

Sintomas depressivos em pessoas com lesão medular traumática crônica / Depressive symptoms in people with chronic spinal cord injury / Síntomas depresivos en personas con lesión medular traumática crónica

Alterações do humor indicativas de estado depressivo são comuns em pessoas com lesão medular, principalmente nos casos em que a incapacidade é permanente. Este estudo transversal foi realizado em 2012, em Fortaleza-Ceará, com 35 pacientes portadores de lesão medular traumática e aplicada a Escala de Rastreamento Populacional para Depressão com o objetivo de avaliar a ocorrência de sintomas depressivos. Entre os participantes 91,43% eram paraplégicos e em 37,14% a etiologia da lesão medular foi perfuração por arma de fogo. Quanto aos sintomas depressivos, 48,57% dos participantes demonstraram ausência de sintomas; 22,86% apresentaram depressão leve a moderada e 28,57% apresentaram depressão grave. Conclui-se que a depressão é frequente em portadores de lesão medular traumática crônica; a Escala de Rastreamento é de uso simples e com boa sensibilidade para detecção do transtorno depressivo nestes pacientes.

Changes in mood indicative of a depressive state are common in persons with spinal cord injuries, principally in those cases where the disability is permanent. This cross-sectional study was undertaken in 2012, in Fortaleza-Ceará, with 35 patients with traumatic spinal cord injuries, and through applying the Scale for Populational Screening for Depression with the aim of evaluating the occurrence of depressive symptoms. Among the participants, 91.43% were paraplegics and in 37.14% the etiology of the spinal cord injury was a gunshot wound. In relation to the depressive symptoms, 48.57% of the participants showed an absence of symptoms; 22.86% had mild to moderate depression and 28.57% had serious depression. It is concluded that depression is frequent in those with chronic traumatic spinal cord injuries; the Screening Scale is simple to use and has good sensitivity for the detection of depressive disorder in these patients.

Alteraciones del humor indicativas de estado depresivo son comunes en personas con lesión medular, principalmente en los casos en que la incapacidad es permanente. Este estudio transversal fue realizado en 2012, en Fortaleza, Ceará, con 35 pacientes portadores de lesión medular traumática y aplicación de la Escala de Investigación Poblacional para Depresión con el objetivo de evaluar la ocurrencia de síntomas depresivos. Entre los participantes, 91,43% eran parapléjicos y en el 37,14% la etiología de la lesión medular fue perforación por arma de fuego. Cuanto a los síntomas depresivos, el 48,57% de los participantes demostraron ausencia de síntomas; el 22,86% presentaron depresión leve a moderada y el 28,57% presentaron depresión grave. Se concluye que la depresión es frecuente en portadores de lesión medular traumática crónica; la Escala de Investigación es de uso simple y con buena sensibilidad para detección del trastorno depresivo en estos pacientes.

Related Factors of Levels of Disability among 260 Patients with Traumatic Spinal Cord Injury / 中国康复理论与实践

@#Objective To understand the causes of injury and levels of disability of patients with traumatic spinal cord injury and explore the related factors with the levels of disability. Methods Literature review and experts panel advice were used to collect the related factors. The questionnaire "Survey on Related Factors of Disability Levels of Patients with Ttraumatic Spinal Cord Injury" was designed for the data collection, including the causes of injury, being conscious or not, protection of the injured areas, tools for transportation, the time getting first aid, levels of emergency hospitals and the time of first spinal surgery. From October 2010 to March 2011, 260 inpatients with traumatic spinal cord injury were surveyed by the well-trained researchers. Results 107 patients(41.2%) were caused by traffic accidents, 69 (26.5%) were caused by falls, 60 (23.1%) by crash, 6 (2.3%)by sports injury, and 18 (6.9%) by other reasons. The results of the extent and the levels were that complete paraplegia take up 41.15%, complete tetraplegia take up 25.38%, incomplete tetraplegia take up 18.08%, incomplete paraplegia take up 15.39%. There were significant differences in the causes of injury between the different extent and levels of injury (P<0.05). There were significant differences in levels of injury between the different extent of injury (P<0.05). Significant differences were existed in the levels of injury among being conscious or not, protection of injured areas during transportation and the secondary transportation (P<0.05). Whereas, no significant difference was observed among protection in the injury site, tools for transportation, the time getting first aid, the levels of emergency hospitals and the first time of spinal surgery between the different extent of injury(P>0.05). Conclusion Not only the causes of injury, but also the protection of injured areas, high frequency of secondary transportation are responsible for the extent of injury and levels of injury in individuals with traumatic spinal cord injury in China.

Characteristics of Urban Inpatients with Traumatic Spinal Cord Injuries in Tianjin, 2007 / 中国康复理论与实践

@#ObjectiveTo investigate the characteristics of traumatic spinal cord injury (TSCI) urban inpatients of Tianjin in 2007. MethodsInpatients with TSCI of 8 hospitals in Tianjin in 2007 were reviewed. ResultsThere were 73 patients in total. Mean age was (51.34±14.597) years. Male∶Female was 3.56∶1. Falling, motor vehicle accidents （MVC） were the main causes of TSCI. The cervical spinal cord injuries were predominant. 26% were complete injury and 74% were incomplete. 6 cases were dead. Patients with ASIA grade D recover well. ConclusionFor the TSCI, the ages of patients increases and falling is the main cause.

Holistic management of traumatic spinal cord injury resulting from a fracture of T-09 vertebra.

Traumatic spinal cord injury (SCI) is an disastrous condition resulting in not only disability and handicap to the victims but also profound psychological damage. We report a case of complete spinal cord injury resulting from a fracture of T-9 vertebra in a car accident. Emergency management is needed to prevent further damage to the neural tissue, as well as to treat a life threatening condition. Surgical treatment to maintain spinal alignment and stability provides early mobilization to prevent the complications caused by the immobilization syndrome. A holistic approach to management is fundamental to the rehabilitation program. Although physical impairment and disability are permanent, psychosocial management focused on cognitive and behavioral modification together with home modification plays an important role in reducing disability and handicap and allowing a patient to return to his home and previous social function with the best quality of life as possible.

Comparison of Outcome between Patients the Traumatic and Non-traumatic Spinal Cord Injured

OBJECTIVE: To investigate the difference of outcome variables and demographic features between traumatic and non-traumatic spinal cord injury (SCI) patients. METHOD: Medical records of 87 spinal cord injured patients were retrospectively reviewed. The patients were divided into traumatic and non-traumatic groups. The etiology, level and completeness of SCI were investigated. The functional evaluation was performed by Frankel's classification, American spinal cord injury association (ASIA) motor and sensory scores, and modified Barthel scores at the time of admission and discharge. Bladder function and emptying method were also investigated. RESULTS: Spinal cord injury of non-traumatic etiology was more likely to result in a incomplete injury and more prevalent in females. At admission, the ASIA motor and sensory scores and modified Barthel index of non-traumatic spinal cord injury patient were higher than those of traumatic patients. At discharge, same results were observed for ASIA motor and sensory scores, but the modified Barthel scores showed no difference between the two groups. The changes of the scores between time of admission and discharge showed no significant difference in the two groups. There was no significant difference of bladder type and bladder emptying method. CONCLUSION: This study suggest that favorable outcome in non-traumatic spinal cord injury patients might be due to better functional status at the time of admission and not due to the degree of recovery.

Vocational and avocational activities after traumatic spinal cord injury.

Vocational and avocational activities of the thoracic and lumbar level of the spinal cord injury patients admitted at the Orthopaedic Department, Siriraj Hospital, were studied. Fifty-five patients from the total of 78 answered the questionnaire. The vocational ability was found in 29.1 percent (16/55 patients) : 8 persons worked for the whole day, 5 persons did half-day work and 3 persons did less than a half-day work. The reasons for not working were disability, the condition of the working place and lack of transportation ; 32, 18 and 15 percent respectively. There were significant differences in the income and severity of diseases between the two groups (people who can work and can’t work) with p value of 0.0006 and 0.007. Sixty-nine percent of patients had avocational activities and the most favorite activity was reading. Modification of the working place or the job and improvement of public transportation system should be performed in order to increase the number of working peoples.