Predictive factors of destination at discharge after spinal cord injury.

INTRODUCTION: One of the main goals of the rehabilitation of patients with spinal cord injury (SCI) is the reintegration of the individual to their family, social, and work setting. The objective of this study was to identify the factors that determine the discharge destination after a traumatic spinal cord injury. MATERIAL AND METHODS: We conducted a retrospective descriptive study of 305 patients with SCI who completed the rehabilitation treatment at the spinal injury unit of Hospital Insular de Gran Canaria between 2001 and 2018. RESULTS: During the study period, we observed an increase in the number of patients referred to long-term care centres, from 9.14% between 2001 and 2010 to 18.4% between 2011 and 2018 (P < .01). Of 20 variables that presented a significant association with destination at discharge in the univariate study, 7 presented a significant association in the multivariate study: age (OR: 1.05; 95% CI, 1.02-1.08), living with a partner (OR: 0.26; 95% CI, 0.09-0.76), residing on another island (OR: 3.57; 95% CI, 1.32-9.63), smoking (OR: 3.44; 95% CI, 1.26-9.44), diabetes (OR: 6.51; 95% CI, 1.46-29.02), history of psychiatric disorders (OR: 3.79; 95% CI, 1.31-10.93), and scores on the Spinal Cord Independence Measure-III (SCIM-III) (OR: 0.48; 95% CI, 0.33-0.69). CONCLUSIONS: Our findings identified advanced age, living on the island of Tenerife, not being married, smoking, type 2 diabetes mellitus, history of psychiatric disorders, and low SCIM-III scores as predictive factors of referral to a long-term care centre in patients with traumatic SCI in the Canary Islands.

Factores asociados a la mejoría funcional en pacientes con lesión medular traumática cervical / Factors associated with functional improvement in patients with cervical spinal cord injuries

Objetivo Determinar los factores que influyen en la mejoría funcional de un lesionado medular cervical traumático durante la hospitalización. Material y métodos Se ha realizado un estudio retrospectivo donde se han incluido los pacientes que han sufrido una lesión medular cervical traumática aguda y que han concluido un programa de rehabilitación en la Unidad de Lesionados Medulares de Canarias entre 2001 y 2018. Para medir la mejoría funcional se ha realizado una valoración del SCIM III al ingreso y al alta. Resultados El 88% de los 141 pacientes de nuestra muestra han sido hombres: pacientes de edad avanzada, con antecedentes de consumo de alcohol, las lesiones completas y de mayor gravedad en la Escala de ASIA han tenido menores resultados funcionales. El tiempo desde la lesión hasta el ingreso en la unidad, el tiempo de estancia hospitalaria y el tiempo desde la lesión al alta hospitalaria han tenido una relación significativa con la mejoría funcional. Conclusiones En pacientes con edad avanzada y con antecedentes de consumo de alcohol las lesiones completas y de mayor gravedad en la Escala de ASIA han tenido menores resultados funcionales. Por otro lado, el ingreso precoz ha sido fundamental para obtener mejores resultados funcionales y se ha relacionado con estancias hospitalarias más cortas (AU)

Objective To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. Material and methods We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. Results Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. Conclusions Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays (AU)

[Factors associated with functional improvement in patients with cervical spinal cord injuries]. / Factores asociados a la mejoría funcional en pacientes con lesión medular traumática cervical.

OBJECTIVE: To determine the factors influencing functional improvement of cervical spinal cord injuries during hospital admission. MATERIAL AND METHODS: We performed a retrospective study of patients with an acute cervical spinal cord injury who had completed a rehabilitation programme in the Spinal Cord Injuries Unit of the Canary Islands between 2001 and 2018. To measure functional improvement, we administered the Spinal Cord Independence Measure III (SCIM III) on admission and at discharge. RESULTS: Of the 141 patients in our sample, 88% were men. Worse functional results were observed in older patients, those with a history of alcohol consumption, complete lesions and those with more severe lesions on the ASIA scale. Factors significantly associated with functional improvement were the interval between injury and admission to the unit, length of hospital stay, and the interval between injury and hospital discharge. CONCLUSIONS: Older patients, as well as those with a history of alcohol intake, complete lesions and greater severity on the ASIA scale, had worse functional outcomes. In contrast, early admission was crucial to obtain better functional outcomes and was associated with shorter hospital stays.

Granuloma eosinófilo vertebral. Un caso clínico / Vertebral eosinophilic granuloma. A case report

La lesión medular es un proceso patológico que afecta a la médula espinal, produciendo pérdida de fuerza, déficit de sensibilidad por debajo del nivel de la lesión, alteración del control de los esfínteres, disfunción sexual y alteraciones en el sistema nervioso vegetativo. Su etiología es debida a causas traumáticas, congénitas o médicas. El granuloma eosinófilo es una de las formas clínicas de presentación de la histiocitosis X consiste en una lesión osteolítica solitaria, limitada al esqueleto, que afecta de forma preferente a niños y adultos jóvenes. En este artículo presentamos el caso de un niño de 12 años que ingresa en la Unidad de Lesionados Medulares del Hospital Universitario Insular de Gran Canaria por un cuadro de paraplejia secundaria a una fractura vertebral tras sufrir un traumatismo leve. Mediante pruebas de imagen y biopsia percutánea fue diagnosticado de granuloma eosinófilo en la vértebra D8

Bone marrow lesion is a pathological condition that affects the spinal cord, producing loss of force, sensitivity deficit below the lesion level, alteration of sphincter control, sexual dysfunction, and alterations in the vegetative nervous system. Its etiology is due to traumatic, congenital or medical causes. Eosinophilic granuloma is one of the clinical presentation forms of histiocytosis X and consists in a solitary osteolytic lesion, limited to the skeleton that basically affects children and young adults. In this article, we present the case of a 12 year old boy who was admitted to the Spinal Cord Injury Unit of the University Hospital Insular of Canary Islands, due to a paraplegic picture secondary to a vertebral fracture after suffering a mild traumatism. Eosinophilic granuloma of the D8 vertebra was diagnosed through imaging tests and percutaneous biopsy

Lesión medular por enfermedad descompresiva. A propósito de un caso / Bone marrow injury due to decompression disease. A case report

Introducción. La afectación neurológica por enfermedad descompresiva representa el 60 % de los accidentes por inmersión. La lesión medular constituye del 10 al 30 % de este tipo de accidentes. El objetivo del presente caso clínico es describir el proceso diagnóstico y terapéutico de un paciente que sufre una lesión medular tras un accidente por descompresión. Caso clínico. Mostramos el caso de un sujeto que practicando submarinismo realizó un ascenso rápido sin las paradas descompresivas adecuadas. Tras haber sido sometido a tratamiento en una cámara hiperbárica, presentó una lesión medular completa con nivel motor C8 y sensitivo D2, American Spinal Cord Injury Association (ASIA A). En la resonancia magnética nuclear se observó una lesión isquémica en cordones posteriores de los segmentos cervicodorsales de la médula espinal. Discusión. Ante un paciente con sintomatología de una enfermedad descompresiva, es primordial el traslado a una cámara hiperbárica en las primeras horas para reducir la sobresaturación de nitrógeno a la que se encuentra sometido el organismo

Introduction. Neurological involvement in due to decompression disease accounts for 60 % of immersion accidents. Bone marrow injury accounts for 10 % to 30 % of them. The purpose of the present clinical case is to describe the diagnostic and therapeutic procedure for a patient to suffers a bone marrow injury after a decompression accident. Clinical case. We provide the case of a subject who practiced scuba diving, and made a rapid ascent without adequate decompression stops. After being treated in a hyperbaric chamber, he had a complete bone marrow injury motor level C8 and sensitive level D2, ASIA A (American Spinal Cord Injury Association). The magnetic nuclear resonance imaging showed an ischemic lesion in the posterior cord of the cervical dorsal segments of the spinal cord. Discussion. When a patient has symptoms of decompression disease, it is essential to transfer the patient to a hyperbaric chamber in the early hours to reduce the nitrogen oversaturation that the body is subjected to

Lesión medular secundaria a paraganglioma torácico y sus complicaciones. A propósito de un caso / Spinal cord injury secondary to a thoracic paraganglioma and complications. A case report

Los paragangliomas son tumores de células que forman parte del sistema neuroendocrino difuso. Estos tumores pueden presentarse como casos familiares y se clasifican en función de su localización o de acuerdo a su carácter funcionante (secretores de catecolaminas y serotonina) o no funcionantes. Su localización en la columna no es habitual y aún menos en la columna dorsal y con localización extradural. No suelen dar metástasis, pero los funcionantes pueden ocasionar un gran número de complicaciones. El tratamiento de elección cuando no hay metástasis es la resección quirúrgica. Presentamos el caso clínico de un paciente varón de 54 años afecto de una lesión medular incompleta, American Spinal Injury Association (ASIA) C, secundaria a un paraganglioma dorsal extradural y productor de dopamina. La evolución durante los seis meses de ingreso en la unidad de lesionados medulares fue tórpida y con numerosas complicaciones relacionadas con su carácter funcionante. El paciente fue tratado con cirugía y radioterapia

Paragangliomas are tumors that arise from the autonomic nervous system-associated paraganglia. These tumors can be hereditary cases and they are classified based on location and functioning character (catecholamine and serotonin secretors) and non-functioning character. Paraganglioma rarely occurs in the spinal canal and the extradural thoracic location is even less common. Metastases are rare but functioning tumors can develop complications. The treatment of choice is surgery when there is no metastasis. We report a case of a 54 year old man with an incomplete spinal cord injury, American Spinal Injury Asssociation (ASIA) C, secondary to an extradural thoracic dopamine-secreting paraganglioma. The patient stayed in the spinal cord unit for six months and developed complications related to the dopaminergic secretion. The patient underwent resection of the tumor and radiotherapy