Lesión medular asociada a hematoma epidural espinal espontáneo / Spinal cord injury associated with spontaneous spinal epidural hematoma

Introducción: El hematoma epidural espinal espontáneo (HEEE) es una entidad de baja incidencia, de elevada morbimortalidad y que causa una importante limitación funcional en la vida de los pacientes. Material y métodos: Con el objetivo de determinar la incidencia del HEEE y el tipo de lesión medular provocada y su repercusión funcional en este centro hospitalario, se realizó un estudio descriptivo retrospectivo analizando variables demográficas, de la lesión (ISCNSCI) y de la funcionalidad (SCIMIII). Resultados: Se revisaron los casos de HEEE atendidos en este centro. El 75% eran varones, con una mediana de edad de 55años. Todas las lesiones fueron incompletas. La localización más frecuente de las lesiones fue a nivel cervical bajo y dorsal alto. La mitad de los sangrados se produjeron en la región medular anterior. Se objetivó mejoría funcional tras el programa específico de rehabilitación. Conclusión: El HEEE podría considerarse de buen pronóstico funcional, relacionado con lesiones medulares habitualmente posteriores e incompletas sensitivo-motoras que se beneficiarían de un tratamiento rehabilitador específico precoz.(AU)

Introduction: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. Material and methods: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). Results: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. Conclusion: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.(AU)

[Spinal cord injury associated with spontaneous spinal epidural hematoma]. / Lesión medular asociada a hematoma epidural espinal espontáneo.

INTRODUCTION: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. MATERIAL AND METHODS: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). RESULTS: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. CONCLUSION: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.

The Impact of Robotic Therapy on the Self-Perception of Upper Limb Function in Cervical Spinal Cord Injury: A Pilot Randomized Controlled Trial.

BACKGROUND: The aim of the present study was to evaluate the impact of robotic therapy in patients with cervical spinal cord injury (SCI), measured on the basis of the patients' self-perception of limited upper limb function and level of independence in activities of daily living. METHODS: Twenty-six patients with cervical SCI completed the treatment after being randomly assigned to the intervention or control group. The training consisted of 40 experimental sessions 1 h in duration, ideally occurring 5 days/week for 8 weeks. In addition to the conventional daily therapy (30 min), the control group received another 30 min of conventional therapy, whereas the intervention group received 30 min of robotic therapy. Patients were evaluated by means of the Capabilities of Upper Extremity Questionnaire (CUE) and Spinal Cord Independence Measure (SCIM) clinical scales. RESULTS: The improvement in the feeding item of SCIM was significantly higher in the intervention group than in the control group after the treatment (2.00 (0.91) vs. 1.18 (0.89), p = 0.03). The correlation between the CUE and SCIM scales was higher at the ending than at baseline for both groups. CONCLUSIONS: Although both groups improved, the clinical relevance related to the changes observed for both assessments was slightly higher in the intervention group than in the control group.

Guía de práctica clínica para el tratamiento de la espasticidad espinal con toxina botulínica / Clinical practice guideline for the treatment of spinal spasticity with botulinum toxin

Introducción. Hasta en un 70% de los pacientes con lesión medular aparece espasticidad; la necesidad de tratarla va aumentando progresivamente con el tiempo de evolución. La espasticidad espinal suele ser generalizada y la toxina botulínica puede ser útil como tratamiento adyuvante al farmacológico para resolver problemas concretos. Las guías de práctica clínica son instrumentos que facilitan la toma de decisiones y mejoran los resultados clínicos. Material y método. Presentamos el protocolo de valoración y tratamiento con toxina botulínica definido tomando como base las peculiaridades clínicas propias de la espasticidad asociada a la lesión medular. Resultados y conclusiones. El uso de esta guía en nuestro centro nos ha permitido estandarizar la selección del paciente con espasticidad espinal y establecer unos objetivos claros de tratamiento y un plan apropiado de seguimiento, facilitando la valoración objetiva de los resultados (AU)

Introduction. Spasticity occurs in approximately 70% of patients with a spinal cord injury. The need for treatment progressively increases from the time of injury. In spinal spasticity, which is usually generalized, botulinum toxin is useful as an adjuvant therapy in specific situations. Clinical practice guidelines are tools that enhance decision-making and improve clinical outcomes. Material and methods. We present a protocol for spinal spasticity assessment and treatment with botulinum toxin designed according to the specific features of spasticity associated with spinal cord injury. Results and conclusions. The use of this protocol at our center has allowed us to standardize the selection of patients with spinal spasticity, to define clear treatment aims and to develop an accurate follow up schedule, thus aiding objective assessment of results (AU)

[A robotic system for gait re-education in patients with an incomplete spinal cord injury]. / Sistema robotizado para la reeducación de la marcha en pacientes con lesión medular incompleta.

INTRODUCTION: A spinal cord injury involves the loss or alteration of motor patterns in walking, the recovery of which depends partly on the rearrangement of the preserved neural circuits. AIM. To evaluate the changes that take place in the gait of patients with incomplete spinal cord injuries who were treated with a robotic walking system in association with conventional therapy. PATIENTS AND METHODS: The study conducted was an open-label, prospective, descriptive trial with statistical inference in patients with C2-L3 spinal cord injuries that were classified as degrees C and D according to the American Spinal Injury Association (ASIA) scale. The variables that were analysed on the first and the last day of the study were: number of walkers, 10-m gait test, the Walking Index for Spinal Cord Injury scale revision, technical aids, muscle balance in the lower limbs, locomotor subscale of the measure of functional independence, modified Ashworth scale for spasticity and the visual analogue scale for pain. At the end, data were recorded from the impression of change scale. The analysis was conducted by means of Student's t, chi squared and Pearson's correlation; p < or = 0.05. RESULTS: Forty-five patients, with a mean age of 44 +/- 14.3 years, finished the study; 76% were males, injury was caused by trauma in 58% of cases, and the time of progression was 139 +/- 70 days. Statistically significant increases were observed in the number of subjects capable of walking, walking speed, less need for technical aids, strength in the lower limbs and independence in activities of daily living. CONCLUSIONS: Treatment using the robotic system in association with conventional therapy improves walking capacity in patients with incomplete spinal cord injuries.

Sistema robotizado para la reeducación de la marcha en pacientes con lesión medular incompleta / A Robotic system for gait re-education in patients with an incomplete spinal cord injury

Resumen. Introducción. La lesión medular supone una pérdida o alteración de los patrones motores de marcha, cuya recuperación depende, en parte, de la reorganización de los circuitos neurales preservados. Objetivo. Evaluar los cambios en la marcha de los lesionados medulares incompletos que realizaron tratamiento con un sistema robotizado de marcha asociado a la terapia convencional. Pacientes y métodos. Estudio abierto, prospectivo, descriptivo, con inferencia estadística en lesionados medulares C2-L3 clasificados según la escala de la American Spinal Injury Association (ASIA) en grados C y D. Las variables analizadas el primer y el último día del estudio fueron: número de ambulantes, test de marcha de los 10 m, índice de marcha para la lesión medular Walking Index for Spinal Cord Injury, scale revision, ayudas técnicas, balance muscular de las extremidades inferiores, subescala locomotora de la medida de independencia funcional, escala de Ashworth modificada para la espasticidad y escala visual analógica para el dolor. Al final se registraron los datos de la escala de impresión de cambio. El análisis se realizó mediante la t de Student, chi al cuadrado y la correlación de Pearson; p ≤ 0,05. Resultados. 45 pacientes finalizaron el estudio con una edad media de 44 ± 14,3 años; el 76% fueron hombres, la etiología de la lesión fue traumática en el 58%, y el tiempo de evolución fue de 139 ± 70 días. Aumentaron de forma estadísticamente significativa el número de sujetos con capacidad de marcha, la velocidad en la marcha, la menor necesidad de ayudas técnicas, la fuerza de extremidades inferiores y la independencia en las actividades de la vida diaria. Conclusión. La terapia con el sistema robotizado asociado a la terapia convencional mejora la capacidad de marcha de los lesionados medulares incompletos. (AU)

Summary. Introduction. A spinal cord injury involves the loss or alteration of motor patterns in walking, the recovery of which depends partly on the rearrangement of the preserved neural circuits. Aim. To evaluate the changes that take place in the gait of patients with incomplete spinal cord injuries who were treated with a robotic walking system in association with conventional therapy. Patients and methods. The study conducted was an open-label, prospective, descriptive trial with statistical inference in patients with C2-L3 spinal cord injuries that were classified as degrees C and D according to the American Spinal Injury Association (ASIA) scale. The variables that were analysed on the first and the last day of the study were: number of walkers, 10-m gait test, the Walking Index for Spinal Cord Injury scale revision, technical aids, muscle balance in the lower limbs, locomotor subscale of the measure of functional independence, modified Ashworth scale for spasticity and the visual analogue scale for pain. At the end, data were recorded from the impression of change scale. The analysis was conducted by means of Student’s t, chi squared and Pearson’s correlation; p ≤ 0.05. Results. Forty-five patients, with a mean age of 44 ± 14.3 years, finished the study; 76% were males, injury was caused by trauma in 58% of cases, and the time of progression was 139 ± 70 days. Statistically significant increases were observed in the number of subjects capable of walking, walking speed, less need for technical aids, strength in the lower limbs and independence in activities of daily living. Conclusions. Treatment using the robotic system in association with conventional therapy improves walking capacity in patients with incomplete spinal cord injuries (AU)

Mielitis transversa asociada a lupus eritematoso sistémico / Transverse myelitis associated with systemic lupus erythematosus

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Manejo de la lesión medular debida a una malformación arteriovenosa / Management of spinal cord lesions due to arteriovenous malformations

Las malformaciones arteriovenosas (MAV) medulares son una patología poco frecuente, comúnmente denominadas como enfermedades raras. Causan diferentes daños a nivel de la médula espinal, dependiendo del tipo de MAV. En este caso clínico, un varón de 34 años con parestesias y paraparesia progresiva es diagnosticado mediante una resonancia magnética nuclear de mielopatía aguda dorsal, precisando realizar una angiografía medular donde se descubrió la fístula arteriovenosa. El tratamiento de las MAV va dirigido a restablecer el flujo normal en la vascularización arteriovenosa medular mediante la embolización de la fístula por vía endovascular. El tratamiento rehabilitador va encaminado a conseguir la mínima discapacidad posible. En este caso, consistió en la potenciación de los diferentes grupos musculares mediante cinesiterapia y electroestimulación con el fin de conseguir su total independencia a la hora de realizar las actividades de la vida diaria

Arteriovenous malformations (AVM) in the spinal cord are uncommon. Depending on the type of AVM, different types of damage to the spinal cord are caused. In this clinical case, a 34-year-old man with paresthesia and progressive paraparesis was diagnosed with acute thoracic myelopathy using magnetic resonance imaging; angiography of the spinal cord revealed an arteriovenous fistula. Treatment of AVM aims to reestablish normal flow in the arteriovenous vascularization of the spinal cord by endovascular embolization of the fistula. Rehabilitation treatment is directed toward achieving the minimum disability possible. In this case, it consisted of strengthening the different muscle groups through kinesitherapy and electrostimulation in order to achieve their total independence when carrying out routine daily activities

El manejo quirúrgico actual de las lesiones medulares traumáticas / Actual surgical treatment of traumatic spinal cord injuries

La indicación de tratamiento quirúrgico en las lesiones medulares traumáticas continúa siendo una cuestión controvertida. Debido a los avances técnicos en diversas áreas, el tratamiento quirúrgico se está convirtiendo en el estándar de este tipo de lesiones. En el presente artículo de actualización se repasan los aspectos más importantes del tratamiento quirúrgico de las lesiones medulares traumáticas: aspectos fisiopatológicos, las indicaciones con respecto a la región afectada, el momento más adecuado para la intervención, los resultados que se esperan obtener y las complicaciones

Surgical treatment of traumatic spinal cord injuries is still a very controversial topic in the literature. Because of technical advances in different areas, surgical treatment is the choice in many of these lesions. In the present update paper, the most important aspects about surgical treatment of traumatic spinal cord injuries will be reviewed: like pathophysiolgy, surgical indications depending on the injured zone, the most accurate moment for surgery, results are to be obtained an complications

Lesionado medular con dolor neuropático por condromatosis sinovial / Synovial chondromatosis and neuropathic pain

Presentamos un caso clínico de un varón de 20 años, diagnosticado de síndrome de lesión medular transversa (SLMT) Th4 ASIA A, de etiología traumática de tres años de evolución, que consulta por dolor de características neuropáticas en la cadera izquierda. En la exploración destaca una báscula pélvica y limitación de los últimos grados de las rotaciones. Con los estudios radiográficos se apreció: asimetría de las palas ilíacas, osteocondroma pediculado ilíaco izquierdo, osteocondroma pediculado del cuello femoral izquierdo, cambios degenerativos avanzados coxofemorales y subluxación coxofemoral izquierda. No se objetivó afectación de otras articulaciones. Se realizó una resonancia magnética para descartar cambios compatibles con una degeneración sarcomatosa. En dicho estudio se diagnosticó una condromatosis sinovial y se descartó la captación patológica de gadolinio. Se decidió mantener una actitud conservadora con tratamiento farmacológico para el dolor neuropático y mejorar el apoyo en sedestación con suplementos de fluido en el cojín antiescaras

A 20 year old male diagnosed of complete traumatic spinal cord injury at Th4 clinical case is reported. After 3 years of evolution he complained of neuropathic pain in his left hip. In the clinical exploration a pelvic disbalance, and limitation of rotations were observed. Findings in the radiological studies performed were: asimetry of iliac bones, pedicled osteochondromas in the left femoral neck and in the left iliac, severe degenerative changes and subluxation in the left hip. No other joints were affected. A magnetic resonance study was performed in order to diagnose a possible malign degeneration. In this study, a synovial chondromatosis was diagnosed and pathologic deposit of gadolinum was ruled out. A conservative treatment with specific drugs for neuropathic pain was initialised. Physical measures included improvement of sedestation support with suplements of fluid foam

[Gait training in incomplete spinal cord injuries with body weight support]. / Entrenamiento de la marcha en lesiones medulares incompletas con soporte del peso corporal.

INTRODUCTION: A spinal cord injury implies the loss of or alteration to the gait pattern. Stimulating the pattern generating centres in the sublesional spinal cord determines the appearance of flexion and extension automatisms that are useful for gait training in patients with spinal cord injuries. These centres can be stimulated using a treadmill and supporting the body weight by means of a harness. AIMS: To be able to trigger spinal cord automatisms and to stimulate pattern generating centres. To determine the value of an electromechanical system for mobilising the lower limbs as a complement to the treadmill and body weight support. To study changes in muscle tone. PATIENTS AND METHODS: A short gait training programming was carried out with ten individuals with incomplete spinal cord injuries who satisfied eligibility-exclusion criteria using a treadmill in association with a body weight support system and an electromechanical system for mobilising the lower limbs. RESULTS AND CONCLUSIONS: Spinal cord flexion and extension automatisms were stimulated and an important improvement in spasticity was achieved. Longer programmes are needed in order to evidence changes in the gait pattern and in muscular balance.

Entrenamiento de la marcha en lesiones medulares incompletas con soporte del peso corporal / Gait training in incomplete spinal cord injuries with body weight support

Introducción. La lesión medular supone una pérdida o alteración del patrón de la marcha. La estimulación de los centros generadores de patrones de la médula sublesional determina la aparición de automatismos de flexión y extensión útiles para el entrenamiento de la marcha en lesionados medulares. Estos centros pueden estimularse empleando un tapiz rodante asociado a la descarga del peso corporal con un arnés. Objetivos. Conseguir desencadenar los automatismos medulares y estimular los centros generadores de patrones. Valorar la utilidad de un sistema electromecánico de mo vilización de los miembros inferiores como complemento al tapiz rodante y a la descarga del peso corporal. Estudiar cambios en el tono muscular. Pacientes y métodos. Se ha realizado un programa de entrenamiento de la marcha de corta duración a diez individuos con lesión medular incompleta que cumplían los criterios de inclusión-exclusión, utilizando un tapiz rodante asociado a un sistema de soporte del peso corporal y a un dispositivo electromecánico de movilización de los miembros inferiores. Resultados y conclusión. Se ha conseguido la estimulación de automatismos de flexión y extensión medulares y una importante mejoría de la espasticidad. Para objetivar cambios en el patrón de marcha y en el balance muscular es necesario llevar a cabo programas de mayor duración (AU)

Introduction. A spinal cord injury implies the loss of or alteration to the gait pattern. Stimulating the pattern generating centres in the sublesional spinal cord determines the appearance of flexion and extension automatisms that are useful for gait training in patients with spinal cord injuries. These centres can be stimulated using a treadmill and supporting the body weight by means of a harness. Aims. To be able to trigger spinal cord automatisms and to stimulate pattern generating centres. To determine the value of an electromechanical system for mobilising the lower limbs as a complement to the treadmill and body weight support. To study changes in muscle tone. Patients and methods. A short gait training programming was carried out with ten individuals with incomplete spinal cord injuries who satisfied eligibility-exclusion criteria using a treadmill in association with a body weight support system and an electromechanical system for mobilising the lower limbs. Results and conclusions. Spinal cord flexion and extension automatisms were stimulated and an important improvement in spasticity was achieved. Longer programmes are needed in order to evidence changes in the gait pattern and in muscular balance (AU)

Resultados clínicos y funcionales tras el tratamiento rehabilitador: osteotomía tibial frente a artroplastia unicondílea / Clinical and functional results after rehabilitation treatment: tibial osteotomy compared to unicondylar arthroplasty

Se presenta un estudio comparativo retrospectivo de los resultados obtenidos tras desarrollar un programa de rehabilitación en pacientes tratados quirúrgicamente por gonartrosis de compartimento interno, mediante una osteotomía valguizante de tibia o una artroplastia unicondílea, con el objetivo de evaluar qué técnica ofrece mejores resultados clínicos y funcionales Se han estudiado 60 pacientes, a 30 se les realizó una osteotomía valguizante y a 30 una artroplastia unicondílea. En el periodo preoperatorio, a los seis meses y al año de la cirugía, fueron valorados según los criterios clínicos y funcionales de la escala 'American Knee Society'. Los resultados obtenidos muestran diferencias significativas a favor de las prótesis unicondíleas en cuanto a la valoración clínica y funcional, siendo significativamente menor el tiempo empleado en la realización de tratamiento rehabilitador tras este tipo de intervención quirúrgica (AU)