Epidemiological Study of Patients with Spinal Cord Injury Treated in POLEM, a Specialized Clinic in São Paulo State ­ Brazil

Objective To analyze the epidemiological profile of patients with spinal cord injury treated at POLEM ­ Associação de Apoio às Pessoas comLesão Medular (Association for Supporting People with Spinal Cord Injury). Method The population studied comprised 113 patients with spinal cord injury, of traumatic or nontraumatic etiology, and the data obtained were compared with those of other institutions. Results Of the 113 patients, 70.8% were male and 29.2% female. Traumatic lesions were responsible for 54% of the patients, and nontraumatic for 46%. Of the patients with traumatic injury, 90.2% were male, the main cause being traffic accidents. In nontraumatic lesions, women were the most affected, 51.9%; and dysraphism and myelitis were the main causes (31% and 21%, respectively). Conclusion The results showed an important incidence of spinal cord injury due to trauma,mainly affecting young individuals of productive age and low educational level, representing high economic and social costs. The data found in the present study are similar to those of other studies performed in our country.

Mechanisms of mid-thoracic spine fracture/dislocation due to falls during horse racing: A report of two cases / 中华创伤杂志(英文版)

We reported two cases of jockeys who sustained fracture/dislocation of the mid-thoracic spine due to traumatic falls during horse racing. We examined the injury mechanism based upon the patients' diagnostic images and video footage of races, in which the accidents occurred. Admission imaging of patient 1 (a 42 years old male) revealed T5 burst fracture with bony retropulsion of 7 mm causing complete paralysis below T5/6. There existed 22° focal kyphosis at T5/6, anterolisthesis of T5 relative to T6, T5/6 disc herniation, cord edema and epidural hemorrhage from T4 through T6, and cord injury from C3 through C6. Admission imaging of patient 2 (a 23 years old male) revealed T4/5 fracture/dislocation causing incomplete paralysis below spinal level. There existed compression fractures at T5, T6, and T7; 4 mm anterior subluxation of T4 on T5; diffuse cord swelling from T3 through T5; comminuted fracture of the C1 right lateral mass; right frontal traumatic subarachnoid hemorrhage; and extensive diffuse axonal injury. The injuries were caused by high energy flexion-compression of the mid-thoracic spine with a flexed posture upon impact. Our results suggest that substantially greater cord compression occurred transiently during trauma as compared to that documented from admission imaging. Video footage of the accidents indicated that the spine buckled and failed due to abrupt pocketing and deceleration of the head, neck and shoulders upon impact with the ground combined with continued forward and downward momentum of the torso and lower extremities. While a similar mechanism is well known to cause fracture/dislocation of the cervical spine, it is less common and less understood for mid-thoracic spine injuries. Our study provides insight into the etiology of fracture/dislocation patterns of the mid-thoracic spine due to falls during horse racing.

Perfil epidemiológico, clínico y funcionalidad alcanzada de la población con lesión medular traumática asistida en el Servicio de Rehabilitación y Medicina Física en el Hospital Universitario / Clinical and epidemiological profile and functionality achieved in patients with traumatic spinal cord injury assisted at the Rehabilitation and Physical Medicine Service at the University Hospital / Perfil epidemiológico, clínico e funcional alcançado da população com lesão medular traumática atendida no Serviço de Reabilitação e Medicina Física do Hospital Universitário

Resumen: La lesión medular traumática puede afectar todas las funciones de la médula espinal determinando limitaciones de la actividad y restricciones en la participación. Conocer el perfil epidemiológico propio es imperativo para planificar la asistencia, los recursos y actuar en prevención. En la Cátedra de Rehabilitación hay una larga trayectoria de asistencia en equipo interdisciplinario a personas con lesión medular traumática; a partir de 1987 se documentaron datos que fueron analizados y presentados en 2004 en el Congreso Nacional de Neurología. Objetivo: describir las características sociodemográficas, clínicas, funcionales y terapéuticas de nuestra población. Método: se realizó un estudio longitudinal, retrospectivo, descriptivo y analítico de toda la población asistida durante el período 2004-2017. Resultados: n=70, 86% masculino, de 40±18 años. Las causas fueron: precipitación 36,4%, tránsito 31,8% y violencia 28,8%; el nivel cervical 57%, dorsal 40% y lumbar 3%. La escala de la American Spinal Injury Association (ASIA) de inicio fue 36,2% A, 13,8% B, 22,4% C y 5,2% D. ASIA final, 29,0% A, 3,2% B, 27,4% C, 25,8% D. El 45% logró independencia en actividades básicas de la vida diaria, el 60% independencia en transferencias y el 45% en marcha. Conclusiones: disminuyó el número de nuevos casos en los últimos cuatro años y cambió el perfil etiológico. Predominaron los hombres jóvenes, lesiones por precipitación, tránsito y violencia, las cuadriparesias incompletas, seguido de paraplejias completas e incompletas. Las complicaciones más frecuentes fueron nefrourológicas y escaras. De la funcionalidad alcanzada, la mayoría de los pacientes fueron dependientes en actividades de vida diaria, transfirieron en forma independiente y no lograron marcha.

Summary: Traumatic spinal cord injury may affect all functionalities of the spinal cord, what determines limitation in activity and restrictions in participation. Learning about its epidemiological profile is of the essence to plan healthcare, resources and preventive actions. The Rehabilitation Chair has a long history in providing healthcare to people with traumatic spinal cord injury in multidisciplinary teams. Data has been recorded since 1987, which information was analysed and presented at the National Neurology Conference in 2004. Objective: to describe the socio-demographic, clinical, functional and therapeutic characteristics of our population. Method: we conducted a longitudinal, retrospective, descriptive and analytical study of the entire population assisted between 2004 and 2017. Results: n=70, 86% male, 40±18 years old. The following causes were found: falls 36.4%, road accidents 31.8% and violence 28.8%; cervical level 57%, dorsal spine 40% and lumbar spine 3%. Initial ASIA impairment scale was 36.2% A, 13.8% B, 22.4% C and 5.2% D. Final ASIA impairment scale was 29.0% A, 3.2% B, 27.4% C, 25.8% D. 45% achieved independence in everyday basic activities, 60% transfer independence and 45% independent gait. Conclusions: the number of new cases decreased in the last 4 years and the etiological profile changed. Young men prevailed, lesions caused by falls, road accidents and violence were the most frequent, incomplete quadriparesis, followed by complete and incomplete paraplegia. The most frequent complications were nephro-urological and pressure sores. As to the functionality achieved, most patients were dependent in every day life activities, they could transfer independently and could not achieve independent gait.

Resumo A lesão medular traumática pode afetar todas as funções da medula espinhal, determinando limitações de atividade e restrições de participação. Conhecer o perfil epidemiológico da população atendida é imprescindível para planejar cuidados, recursos e atuar na prevenção. A Cátedra de Reabilitação (CRMF) tem uma longa trajetória de assistência com equipe interdisciplinar às pessoas com Lesão Medular Traumática; a partir de 1987, foram registrados dados que foram analisados e apresentados em 2004 no Congresso Nacional de Neurologia. Objetivo: descrever as características sociodemográficas, clínicas, funcionais e terapêuticas da população atendida pela equipe de reabilitação da CRMF no período 2004-2007. Métodos: foi realizado um estudo longitudinal, retrospectivo, descritivo e analítico de toda a população assistida no período de 2004-2017. Resultados: 70 pacientes foram atendidos sendo 86% de sexo masculino, com idade 40 ± 18 anos. As causas foram: precipitação 36,4%, trânsito 31,8% e violência 28,8%; o nível cervical 57%, dorsal 40% e lombar 3%. A Escala da American Spinal Injury Association (ASIA) inicial era 36,2% A, 13,8% B, 22,4% C e 5,2% D. ASIA final, 29,0% A, 3,2% B, 27,4% C, 25,8% D. 45% alcançaram independência nas atividades básicas de vida diárias, 60% independência nas transferências e 45% na marcha. Conclusões: o número de casos novos diminuiu nos últimos 4 anos e o perfil etiológico mudou. Predominou o sexo masculino, as lesões por precipitação, trânsito e violência, as quadriparesias incompletas, seguidas de paraplegias completas e incompletas. As complicações mais frequentes foram nefrourológicas e escaras. Em relação à funcionalidade alcançada, a maioria dos pacientes era dependente nas atividades da vida diária, movia-se de forma independente e não conseguiram autonomia na marcha.

Standardization of a spinal cord lesion model and neurologic evaluation using mice

OBJECTIVE: To standardize a spinal cord lesion mouse model. METHODS: Thirty BALB/c mice were divided into five groups: four experimental groups and one control group (sham). The experimental groups were subjected to spinal cord lesion by a weight drop from different heights after laminectomy whereas the sham group only underwent laminectomy. Mice were observed for six weeks, and functional behavior scales were applied. The mice were then euthanized, and histological investigations were performed to confirm and score spinal cord lesion. The findings were evaluated to prove whether the method of administering spinal cord lesion was effective and different among the groups. Additionally, we correlated the results of the functional scales with the results from the histology evaluations to identify which scale is more reliable. RESULTS: One mouse presented autophagia, and six mice died during the experiment. Because four of the mice that died were in Group 5, Group 5 was excluded from the study. All the functional scales assessed proved to be significantly different from each other, and mice presented functional evolution during the experiment. Spinal cord lesion was confirmed by histology, and the results showed a high correlation between the Basso, Beattie, Bresnahan Locomotor Rating Scale and the Basso Mouse Scale. The mouse function scale showed a moderate to high correlation with the histological findings, and the horizontal ladder test had a high correlation with neurologic degeneration but no correlation with the other histological parameters evaluated. CONCLUSION: This spinal cord lesion mouse model proved to be effective and reliable with exception of lesions caused by a 10-g drop from 50 mm, which resulted in unacceptable mortality. The Basso, Beattie, Bresnahan Locomotor Rating Scale and Basso Mouse Scale are the most reliable functional assessments, and but the horizontal ladder test is not recommended.

Representações sociais de pescadores com lesão medular: repercussões e trajetória de vida / Representaciones sociales de pescadores con lesión medular: repercusiones e historia de vida / Social representations of fishermen with spinal cord injury: impacts and life trajectory

RESUMO Objetivo: analisar as representações sociais da trajetória de vida dos pescadores artesanais com lesão medular vítimas de acidente por mergulho nas praias do litoral Norte do Rio Grande do Norte. Método: estudo descritivo, de natureza qualitativa, desenvolvido com 31 pescadores entre outubro de 2013 e agosto de 2014, mediante entrevista semiestruturada. Empregou-se a análise lexicográfica e classificação hierárquica descendente dos textos (software ALCESTE), sob a ótica das Representações Sociais. Resultados: as representações sociais dos pescadores com lesão medular apresentaram as experiências com as limitações físicas e expectativas de aposentadoria, estas últimas configurando-se como uma realidade distante das exigências impostas por nossas leis trabalhistas. Conclusão: exigem-se medidas de promoção, prevenção e reabilitação da saúde do pescador vítima de lesão medular, além de condições seguras e dignas de trabalho como compromisso das políticas de saúde.

RESUMEN Objetivos: analizar las representaciones sociales de la historia de vida de pescadores artesanales con lesión medular víctimas de accidente de buceo en las playas del litoral Norte de Rio Grande do Norte. Método: estudio descriptivo, de naturaleza cuantitativa, desarrollado con 31 pescadores entre octubre de 2013 y agosto de 2014, mediante entrevista semiestructurada. Se empleó análisis lexicográfico y clasificación jerárquica descendiente en los textos (software ALCESTE), en la visión de las Representaciones Sociales. Resultados: las representaciones sociales de los pescadores con lesión medular expresaron las experiencias de las limitaciones físicas y expectativas de jubilación, configurándose éstas como realidad distante de las exigencias impuestas por la legislación laboral vigente. Conclusión: se requieren medidas de promoción, prevención y rehabilitación de la salud del pescador víctima de lesión medular, además de condiciones laborales seguras y dignas, con compromiso de las políticas de salud.

ABSTRACT Objective: analyze social representations in the life trajectory of artisanal fishermen with spinal cord injury caused by diving on the north coast of Rio Grande do Norte. Method: a descriptive, qualitative study was conducted with 31 fishermen between October 2013 and August 2014, using a semi-structured interview. A lexicographic analysis and descending hierarchical classification of texts were performed (with software ALCESTE), in the perspective of the social representations. Results: social representations of fishermen with spinal cord injury presented experiences with physical limitations and expectations regarding retirement, which appeared as a distant reality from the requirements in Brazilian labor laws. Conclusion: measures are required for the promotion, prevention and rehabilitation of the health of fishermen with spinal cord injury, as well as safe and decent fishing conditions, with the commitment of health authorities.

Secção medular subtotal por ferimento de arma branca / Section Subtotal for Spinal Cord Injury White Gun

Lesão demedula espinhal por arma branca é incomum, sendo responsável por 12% dos traumas raquimedulares. Os autores descrevem um caso de secção demedula espinhal cervical subtotal por arma branca em um paciente de 18 anos.

A spinal cord injury by stab is uncommon, accounting for 12% of spinal cord trauma. The authors describe a case of cervical spinal cord section subtotal stab wound in a patient of 18 years.

Epidemiologia do traumatismo raquimedular por projéteis de armas de fogo em um hospital de referência no estado do Pará / Epidemiology of Spinal Cord Injury by Firearm in a Reference Hospital in the State of Pará

Objetivo O presente trabalho objetivou descrever os aspectos clínicos e epidemiológicos do traumatismo raquimedular causado por ferimentos de armas de fogo em pacientes internados no Hospital Metropolitano de Urgências e Emergências, em Belém/PA, no período de janeiro de 2008 a dezembro de 2013. Método Estudo transversal, retrospectivo e descritivo, com base na análise de prontuários de 89 pacientes vítimas de trauma raquimedular por ferimento por arma de fogo, de acordo com os dados obtidos no setor de registro hospitalar. Resultados Os traumas decorrentes de projéteis de armas de fogo foram responsá- veis por 9,2% dos traumas raquimedulares, apresentando uma média de 14,8 novos casos por ano; 86,5% destes eram pacientes do sexo masculino, 73,1% apresentavam menos de 30 anos. O segmento cervical foi o mais acometido (46%) e 51,8% dos pacientes foram classificados como ASIA A. A maior parte foi tratada conservadoramente (75,3%) e 56,2% dos pacientes evoluíram com alguma complicação durante a internação, sendo mais prevalentes as complicações infecciosas (45%). A taxa de óbito foi de 18%. Conclusão O trauma raquimedular decorrente de ferimentos de armas de fogo nos pacientes atendidos no Hospital Metropolitano de Urgências e Emergências acomete principalmente homens jovens. O nível cervical foi o mais acometido e a classificação ASIA A foi a mais prevalente. O tratamento conservador foi adotado na maioria dos casos, sendo que mais da metade dos pacientes evoluiu com complicações, especialmente infecciosas, enquanto uma significativa parcela evoluiu para óbito.

Objective This study aimed to describe the clinical and epidemiological aspects of Spinal Cord Injury caused by firearms in patients admitted to the Metropolitan Urgency and Emergency Hospital, Belém, Pará, from January 2008 to December 2013.Methods It was developed a cross-sectional, retrospective and descriptive study, based on analysis of medical records of 89 patients diagnosed with Spinal Cord Injury by firearm's injury. Results It was observed that firearm's injury accounted for 9,2% of Spinal Cord Injury, with a average of 14,8 news cases per year; 86,5% of these were male; 73,1% had less than thirty years. The cervical segment was the most affected (46%) and 51,8% of the pacients were classified as ASIA A. The most were treated conservatively (75,3%) and 56,2% had some complication during the hospitalization, the infectious complications were the more frequent (45%). The dead rate was 18%. Conclusion Thus, this study concluded that the SCI by firearm's injury in patients treated at Metropolitan Urgency and Emergency Hospital affects mainly young men, the traumas occurred mainly in the cervical segment and the classification ASIA A was the most prevalent. Conservative treatment was adopted in most cases and more than half of the patients developed complications, especially infectious, while a significant portion evolve to death.

Incidence and functional evolution of traumatic injuries of the spine / Incidência e evolução funcional de lesões traumáticas da coluna / Incidencia y evolución funcional de lesiones traumáticas de la columna vertebral

OBJECTIVE: To determine the incidence and functional outcome of traumatic injuries of the spine in the period from January 1, 2013 to December 31, 2013, at the General Hospital "Dr. Rafael Pascacio Gamboa", state of Chiapas, México. METHODS: A retrospective, cross-sectional, descriptive, observational study, where all patients seeking medical and surgical care in the emergency department and inpatient unit for a traumatic spinal injury were included, regardless of age or sex. RESULTS: A sample of 60 patients, of whom 43 were male (71.7%) and 17 females (28.3%), with an average age of 35 was obtained. As for the cause of the injury, falls were the leading cause (61.7%) followed by motor vehicle accidents (35%) and finally, assaults (3.3%). In this sample, 21% had associated injuries being the most common (7.3%) the thoracic trauma. The most common site of injury was the thoracic spine, followed by the lower cervical and finally the thoracolumbar ones. We found that 70% of patients had partial or complete neurological injury, with complete spinal cord transection (Frankel A) being the most frequent lesion in 53%. CONCLUSION: The incidence in our series is similar that the reported in developing countries which have sociocultural problems similar to ours. The same applies to the etiology of these lesions, which is closely linked to social and economic activity in each country or region. .

OBJETIVO: Determinar a incidência e evolução funcional de lesões medulares traumáticas no período de 01 de janeiro de 2013 a 31 de dezembro de 2013, no Hospital Geral "Dr. Rafael Gamboa Pascacio" estado de Chiapas, México. MÉTODOS: Estudo retrospectivo, transversal, descritivo e observacional, onde foram incluídos todos os pacientes que procuraram atendimento médico-cirúrgico na unidade de pronto-socorro e hospitalar, independentemente de idade ou sexo, que tinham lesão traumática na medula espinhal. RESULTADOS: Obteve-se uma amostra de 60 pacientes, dos quais 43 eram homens (71,7%) e 17 mulheres (28,3%), com média de idade de 35 anos. Quanto à causa da lesão, as quedas foram a principal causa (61,7%), seguidas de acidentes com automóveis (35%) e por agressões (3,3%). Do total, 21% dos pacientes tiveram lesões associadas, sendo a mais comum o trauma torácico (7,3%). O local mais comum de lesão foi a coluna torácica, seguido pela cervical baixa e, finalmente, a coluna toracolombar. Verificamos que 70% dos pacientes tiveram lesão neurológica total ou parcial, sendo a transecção completa da medula espinhal (Frankel A) a lesão mais frequente (53%). CONCLUSÃO: A incidência em nossa série é semelhante à relatada em países em desenvolvimento que têm problemas socioculturais semelhantes aos nossos. O mesmo se aplica à etiologia das lesões, que está estreitamente ligada à atividade econômica e social de cada país ou região. .

OBJETIVO: Determinar la incidencia y evolución funcional de las lesiones traumáticas de la columna vertebral en el periodo comprendido del 01 de enero del 2013 al 31 de diciembre del 2013, en el hospital General "Dr. Rafael Pascacio Gamboa" del estado de Chiapas, México. MÉTODOS: Se trata de un estudio retrospectivo, transversal, descriptivo y observacional, donde se incluyeron a todos los pacientes que solicitaron atención médico-quirúrgica en el servicio de urgencias y hospitalización de la unidad, sin importar edad o sexo que presentaron una lesión vertebral traumática. RESULTADOS: Se obtuvo una muestra de 60 pacientes, de los cuales 43 eran del sexo masculino (71,7%) y 17 del sexo femenino (28,3%), con un promedio de edad de 35 años. En cuanto a la causa de la lesión, las caídas ocuparon el primer lugar (61,7%) seguidas de accidentes automovilísticos (35%) y en tercer lugar las agresiones (3,3%). El 21% presentaron lesiones asociadas siendo el trauma torácico el más frecuente (7,3%). El sitio de lesión más habitual fue la columna torácica, seguida de la cervical baja y finalmente las toraco-lumbares. Encontramos que el 70% de los pacientes presentaron lesión neurológica parcial o completa, siendo la sección medular completa (Frankel A) la lesión más frecuente en un 53%. CONCLUSIÓN: La incidencia encontrada en nuestra serie, es similar a la reportada en países en vías de desarrollo quienes cuentan con una problemática sociocultural similar a la nuestra. Lo mismo sucede con la etiología de estas lesiones, la cual se encuentra estrechamente ligada a la actividad social y económica de cada país o región. .

Análisis de la marcha en lesionado medular: a propósito de un caso / Gait analysis in spinal cord injured population: a case report

La lesión medular en edad pediátrica constituye una patología poco frecuente, con una incidencia menor que en la edad adulta. Supone una especial relevancia por las graves secuelas a nivel físico, emocional, social, familiar y económico. El análisis de la marcha en población lesionada medular es una herramienta diagnóstica actual y muy eficaz para poder prescribir un acertado y adecuado tratamiento rehabilitador. Se describe el caso clínico de un varón con lesión medular a nivel cervical, que requirió el uso de la toxina botulínica para su tratamiento de marcha. Se hizo un estudio pre y postratamiento para comprobar la efectividad de la terapia en la consecución de los objetivos propuestos.

Gait analysis in spinal cord injured population is a very effective current diagnostic tool to prescribe an appropriate rehabilitation treatment. Spinal cord injury in childhood is a rare condition, with lower incidence than in adulthood. It carries particular importance due to physical, emotional, social, family and economic consequences. A case of a man with cervical level spinal cord injury has been described; for his treatment it is necessary the use of botulinum toxin. It was made a pre and post-treatment study to test the effectiveness of this therapy. This clinical case, along with a literature review, will help clinicians in the best treatment of this pathology.

Lesión de la médula espinal: actualización bibliográfica: fisiopatología y tratamiento inicial / Lesão de medula espinal: atualização da literatura: fisiopatologia e tratamento inicial / Spinal cord injury: literature update: physiopathology and initial treatment

La fisiopatología del trauma raquimedular (TRM) es compleja y aún no se conoce completamente. La lesión al cordón espinal está determinada por procesos primarios y secundarios. La lesión primaria se debe a la transmisión de energía mecánica a la médula y las estructuras neurales durante el evento traumático. La lesión secundaria, que compromete estructuras que habían permanecido indemnes después del trauma inicial, desencadena alteraciones en: la perfusión microvascular, la liberación de radicales libres y de neurotransmisores, la peroxidación lipídica, la concentración iónica y la consecuente muerte celular tanto por necrosis como por apoptosis. La investigación en el tratamiento del TRM, basada en el conocimiento actual de estos mecanismos de lesión, ha buscado el desarrollo de intervenciones terapéuticas tempranas que atenúen el efecto de estos mecanismos fisiopatológicos secundarios, tanto en el sitio del accidente, como después del ingreso a un centro de trauma. Dentro de la intervención farmacológica se ha descrito, por su teórico efecto protector en el pronóstico neurológico de los pacientes con TRM, el uso de metil-prednisolona, gangliósidos y medicamentos antagonistas de los opiáceos, del receptor de glutamato y de los canales iónicos. Sin embargo, aún no se ha identificado ninguna intervención que modifique este pronóstico en forma significativa.

A fisiopatologia da lesão de medula espinal (LME) é complexa e não está completamente esclarecida. A LME é determinada por processos primários e secundários. A lesão inicial é produzida pela transmissão de energia mecânica para a medula espinal e as estruturas neurais. A lesão secundária atua sobre as estruturas que são poupadas pelo trauma inicial, afetando a perfusão microvascular e as concentrações iônicas, desencadeando a liberação de radicais livres e neurotransmissores e ativando a peroxidação lipídica, o que produz a morte celular. A pesquisa recente sobre o tratamento da LME concentra-se no desenvolvimento de intervenções oportunas que possam atenuar os efeitos dos mecanismos fisiopatológicos secundários. Entre as intervenções farmacológicas, têm sido usados: metilprednisolona, gangliosídeos e antagonistas de opiáceos, de receptores de glutamato e de canais iônicos, considerando seu efeito protetor teórico sobre o prognóstico neurológico dos pacientes com LME. Contudo, nenhuma dessas intervenções modificou significativamente esse prognóstico até agora.

The pathophysiology of spinal cord injury (SCI) is complex and still not fully elucidated. Primary and secondary processes determine SCI. The initial injury is produced by the transmission of the mechanical energy of the trauma to the spinal cord and neural structures. The secondary injury acts on those structures that were spared by the initial trauma, affecting microvascular perfusion and ionic concentrations, inducing the liberation of free radicals and neurotransmitters and activating lipid peroxidation, thus producing cellular death. Recent research in the treatment of SCI is focused on the development of timely therapeutic interventions that could attenuate the effects of these secondary pathophysiological mechanisms. Among the pharmacological interventions, methyl-prednisolone, gangliosides and antagonists of opiod, glutamate receptor and ionic channels have been used, advocating their theoretical protective effect in the neurological prognosis of patients with SCI. Nevertheless, none of these interventions has yet significantly modified this prognosis.

Spinal cord injury after conducting transcatheter arterial chemoembolization for costal metastasis of hepatocellular carcinoma

Transcatheter arterial chemoembolization (TACE) has been used widely to treat patients with unresectable hepatocellular carcinoma. However, this method can induce various adverse events caused by necrosis of the tumor itself or damage to nontumor tissues. In particular, neurologic side effects such as cerebral infarction and paraplegia, although rare, may cause severe sequelae and permanent disability. Detailed information regarding the treatment process and prognosis associated with this procedure is not yet available. We experienced a case of paraplegia that occurred after conducting TACE through the intercostal artery to treat hepatocellular carcinoma that had metastasized to the rib. In this case, TACE was attempted to relieve severe bone pain, which had persisted even after palliative radiotherapy. A sudden impairment of sensory and motor functions after TACE developed in the trunk below the level of the sternum and in both lower extremities. The patient subsequently received steroid pulse therapy along with supportive care and continuous rehabilitation. At the time of discharge the patient had recovered sufficiently to enable him to walk by himself, although some paresthesia and spasticity remained.

Traumatic Cervical Cord Transection without Facet Dislocations-A Proposal of Combined Hyperflexion-Hyperextension Mechanism: A Case Report

A patient is presented with a cervical spinal cord transection which occurred after a motor vehicle accident in which the air bag deployed and the seat belt was not in use. The patient had complete quadriplegia below the C5 level and his imaging study showed cervical cord transection at the level of the C5/6 disc space with C5, C6 vertebral bodies and laminar fractures. He underwent a C5 laminectomy and a C4-7 posterior fusion with lateral mass screw fixation. Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine. A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet dislocations is reported. Also, we propose a combined hyperflexion-hyperextension mechanism to explain this type of injury.

Evaluation of the results of cervical spine and spinal Cord trauma in children

Major differences exist in the anatomy and biomechanics of the growing spine that causes failure patterns different from those in adults. Spinal injury in the pediatric patient is a main concern because timely diagnosis and appropriate treatment can prevent further neurologic damage and deformity and potentiate recovery. We conducted a retrospective clinical study of 137 cases [93 boys, 44 girls] of pediatric cervical spine injuries, managed over fifteen years, to present data from a large series of pediatric patients with cervical spine injuries from a single regional trauma center. The aim was to assess and analyze complications, etiology, pathogenesis, site of injuries and age difference of cervical spine and spinal cord injury in a pediatric age group and compare the findings with current literature. One hundred and thirty seven children with cervical spine injuries, seen over twelve years, were divided into two age groups: 54 patients were in group one [0-9 years] and 83 patients were in group two [10-17 years]. We managed them according to status at presentation and type of injury. Forty seven patients were managed surgically and ninety nonsurgically [52 wore a halo brace and 38 wore different hard collars and braces]. T-test and Chi squares were used to analyze differences between groups. The most common cause of injury was motor vehicle accidents [MVA]. Our younger patients [Group 1] had sustained more neurological injuries than the older ones [Group 2], 77% vs. 48%; upper cervical spine was the most common site involved in 76%, while 43% suffered head injuries. In group two, 88% of children two sustained fractures or fracture/ subluxations; also in this group, subluxation, and fracture/ subluxation was present in 10 and 25% of children respectively. The most common radiological findings were vertebral fracutes [38%]. Solid fusions were demonstrated in all patients at late follow-up review [mean 6 years]. None of the children developed neurological deterioration; however 18% mortality was documented. Various fusion techniques were used and neurological and fusion outcomes improved as compared with the previous reports. Outcomes of cervical spine injuries in children are more positive than in adults, particularly in patients with incomplete injuries. The prognosis for children with complete spinal cord injuries, however, is still discouraging. Upper cervical spine injuries are more common between birth and 9 years of age; however fractures and fracture/subluxation are rare in this group. Surgical intervention with appropriate instrumentation and fusion are very effective in children with cervical spine instability

Infección urinaria nosocomial en el paciente con vejiga neurogénica / Nosocomial urinary infection in patients with neurogenic bladder

En la clínica de atención a pacientes lesionados medulares espinales (LME), las infecciones del tractus urinario (ITU) alcanzan una alta incidencia y prevalencia como consecuencia de múltiples factores de riesgo asociados a la vejiga neurogénica. Objetivos: Este estudio tiene como objetivo describir las formas clínicas de presentación de las ITU en pacientes con LME así como el comportamiento microbiológico y epidemiológico de las mismas. Pacientes y Método: Realizamos un estudio descriptivo, de tipo retrospectivo a 28 pacientes con LME, que se encontraban hospitalizados para evaluación y tratamiento neuro-restaurativo. A los mismos se les realizaron estudios clínicos (imagenológicos, cultivo de orina, vaginal y uretral) para definir posibles factores de riesgo para la infección. Resultados: La bacteriuria sintomática recurrente fue la forma más frecuente de presentación. Los gérmenes aislados fueron: Escherichia coli en el 60% de los aislamientos, seguido por Proteus mirabilis en el 14%, Klebsiella pneumoniae, Staphylococcus coagulasa negativa y Enterococcus faecalis, 11%. La sensibilidad a los aminoglucósidos se mantiene alta, aunque se observa una creciente resistencia a las Sulfas (>70%) y a las quinolonas (>45%) además, de reportarse un incremento de uropatógenos multirresistentes. Conclusiones: Existen particularidades clínicas de las ITU en pacientes con vejiga neurogénica, que necesitan adecuadas estrategias para el manejo clínico, microbiológico y epidemiológico de las mismas.

Management of penetrating spinal cord injuries in a non spinal centre: experience at Enugu, Nigeria

BACKGROUND:Penetrating injuries of the spinal cord are among the most dangerous of injuries. They are often associated with injuries to other vital organs of the body, which may demand priority attention. The objectives of this study were to determine the pattern of the penetrating spinal cord injuries and to evaluate outcome of treatment in our setting.METHODS:This is a retrospective study of all penetrating spinal cord injuries seen at the National Orthopaedic Hospital, Enugu over a fifteen-year period (April 1990 March 2005). Information about the demographics aetiology, level of injury, associated injuries, time of presentation, duration of hospitalization and outcome of treatment were retrieved from patients case notes. Data were analyzed using SPSS for windows version 11.RESULT: There were 22 patients, 13 males and 9 females, giving a M:F ratio of 1.7:1. Gunshot injury was the most common aetiological factor. The thoracic spine {9 (41%)} was most often involved. Chest and abdominal injuries were common associated injuries in 5 cases. The circumstances of the injury were mostly armed robbery attack {13 (59%)}. On admission the neurological status was Frankel grade A in 20(91%) cases. Period of hospitalization ranged from 1 week to 36 weeks with a mean of 11 weeks. Pressure sore was the most common complication that delayed rehabilitation. Five (23%) patients with injury at cervical level died from respiratory failure.CONCLUSION:Penetrating spinal cord injuries are relatively rare and demand extra care. Early recognition of associated injuries, minimal wound excision and antibiotic therapy give good result

Trauma Raquimedular: Caracterização em um Hospital Público / Spinal Cord Injury: Characterization at a Public Hospital

Trauma raquimedular é uma lesão traumática que acarreta comprometimento da função da medula espinal emgraus variados de extensão. No Brasil 130 mil indivíduos são portadores de lesão medular, com aumento anual da incidência decorrente de acidentes automobilísticos e da violência urbana, sendo imprescindível para a reabilitação a intervenção fisioterapêutica precoce. Nesse contexto, o presente estudo teve por objetivo identificar e caracterizar a demanda de pacientes com diagnóstico de trauma raquimedular atendidos em um Hospital Público de São José do Rio Preto, no ano de 2005. A pesquisa foi realizada por meio da análise dos prontuários desses pacientes, sendo encontrados 14 indivíduos com traumatismo raquimedular. A grande prevalência foi do sexo masculino, faixa etária entre 20 e 35 anos, sendo queda a maior causa e, a medula espinal, o segmento mais acometido com seqüela motora de tetraplegia na maior parte. Realizaram fisioterapia durante a internação hospitalar 11 indivíduos dentre os casos analisados. Em conclusão observaram-se índices consideráveis no Brasil e no mundo do trauma raquimedular, com aumento no número de casos a cada ano, principalmente entre os jovens. Assim a fisioterapia tem grande importância na reabilitação e recuperação dos indivíduos com lesão medular.

Spinal cord injury is a traumatic lesion that causes dysfunction, to a greater or lesser extent, of the spinal cord. In Brazil, a 130,000 people suffer spine cord injury. The incidence of spinal cord injury has gradually increased due to both car accidents and urban violence. It’s essential to start an early rehabilitation with a physical therapist. The objective of this study is to identify and to characterize the demand of patients with spinal cord injury treated at a Public Hospital of São José do Rio Preto in 2005. The study was carried out analyzing the patients’ medical records. It was found 14 patients with spinal cord injury. The majority was men, aged between 20 and 35-years-old, and the principal cause of lesion was accidental falls; the most impaired segment of the body was the cervical vertebrae, and in most patients, tetraplegia was the most common motor impairment. Of the 14 patients analyzed, 11 were submitted to physical therapy while at the hospital. In conclusion, in Brazil and in the world, spinal cord injury increases each year, and it prevail in young people. Therefore, the physical therapy plays an important role in the rehabilitation and recovery of people who have suffered spinal cord injury.