[Neurologic bladder in patients with spinal cord injury. Protocol of surveillance and managment]

Bladder dysfunction is constant in patients with spinal cord injury and this whatever is the injury level. They are characterized by a variable profile and changing in the course of the years. They constitute not only, an important cause of morbidity in this population but also mortality. The aim of this work is to emphasize the importance of the diagnosis and to study the bladder behaviour while clarifying the evolution of this type of bladder and to present a protocol of management of a neurogenic bladder. Retrospective study. 2 assessments in 6 months of interval were realized. The bladder evaluation consisted in a biological assessment, a urinary ultasound, a cystography and urodynamic investigations. The managment is initially realized there to hospital. Our study contains 62 persons with spinal cord injury of average age of 32, 4 years with post traumatic period average is of 41, 47 months. The various evaluations allowed us to conclude that there is a significant change of the neurological status as well as the urinary biological values with significant deterioration of the various ultrasound, cystography and urodynamic data. The diagnosis and the management of the neurological bladders of persons with spinal cord injury have to be besides the other deficiencies that these patients as well as neurological, orthopaedic, and cutaneous devices, because this is going to allow to improve their quality as well as their life expectation. Our results underline the importance and the necessity to establish a protocol of neurogenic bladder control rigorous and codified which remains to adapt according to every patient. This protocol is sometimes difficult to apply given the fact of the misunderstanding of this type of deficiency

[Necessity of physical activities restriction after lumbar discectomy]

Necessity of physical activities restriction after lumbar discectomy have been described in the literature. The aim of this study was to determine if early rehabilitation could favorably influence the prognosis of military patients who had undergone lumbar disk surgery. We performed a retrospective study involving patients who have had lumbar disk surgery, and had undergone physical rehabilitation program. A clinical evaluation, an assessment of pain and a functional assessment by the Arabic version amended self-questionnaire Oswestry have been made for these patients before and after a rehabilitation program started since the 40[th] postoperative day. We have collected 50 cases: 40 men and 10 women of average age 30 years. All these patients have been improved after surgery with no radiculalgies, but with persistence lumbar pain syndrome. After rehabilitation program, we noted a reduction of 42.85% of pain and functional improvement with a reduction in the average score of Oswestry index of 61.18%. The average work incapacity was 4 months. A workstation adaptation was indicated for all patients. Intensive rehabilitation program started early after lumbar disk surgery can improve the functionality of patients operated, and allows early return to professional activities with reduction of the healthcare cost

[Evaluation of pain in patients with spinal cord injury]

The aim of this study is to evaluate the pain in patients with spinal cord injury and it recurrences on daily activities. We report a prospective study about 30 cases of patients hospitalized for a spinal cord injury between march and may 2002. Pain was evaluated regarding to the time of appearance, the duration, the frequency, the type based on the TASP, the intensity based on the visual analogic scale, the sleep and social repercussion and daily actvities consequences. We report a series of 14 women and 16 men with a mean age of 30,4 years. The mean time of spinal cord injury occurence was about 2, 9 years. Twenty four patients were suffering from pain [80%]. In 61%of cases, the pain was chronic evolving for at least three months. It was noxious in 45%of cases and neuropathic in 80%of them. There were sleeping disturbances in 66%of cases and social repercussions in 62, 5%of patients. A professional reintegration was acquired in onIy 33%of patients. Pain is a frequent symptom in spinal cord injury. The evaluation of the pain can improve the management of patients suffering from this pathology. The improvement of therapeutic results needs evaluating scales standardization