Incidence of and factors associated with hyponatremia in traumatic cervical spinal cord injury patients.

STUDY DESIGN: Retrospective study. OBJECTIVE: To investigate the incidence of and factors associated with hyponatremia among traumatic cervical spinal cord injury (SCI) patients. SETTING: Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. METHODS: This retrospective study included traumatic cervical SCI patients that were admitted to the Siriraj Spinal Unit during January 2002 to May 2013. Patient demographic and clinical data were collected. RESULTS: One hundred and twenty-three patients (98 males, 25 females) were enrolled. The mean age of patients was 47.2 ± 16.9 years (range: 11-84). There were 38 complete and 85 incomplete cord injuries. Seventy-six patients were treated surgically, and all others received conservative treatment. Hyponatremia developed in 54 patients (43.9%), and 74.1% of all cases of hyponatremia presented within 9 days after SCI. Hyponatremia occurred on the first day in 10 patients (18.5%), on the fifth day in 6 patients (11.1%), and on the eighth day in 5 patients (9.26%). Hyponatremia occurred in 6/10 patients (60.0%) with upper cervical spine injury (C1-2), and in 48/113 patients (42.5%) with lower cervical spine injury (C3-7) (odds ratio [OR]: 2.031, 95% confidence interval [CI]: 0.543-7.596; p = 0.292). The incidence of hyponatremia was 65.8% in complete SCI patients, and 34.1% in incomplete SCI patients. Logistic regression analysis revealed complete SCI to be the only factor significantly associated with hyponatremia (OR: 3.714, 95% CI: 1.658-8.317; p < 0.001). CONCLUSION: Hyponatremia was found to be common in post-traumatic cervical SCI patients. Complete SCI was identified as the only factor significantly associated with hyponatremia in traumatic cervical SCI patients.

Cross-cultural adaptation and psychometric testing of the Thai version of the Spinal Cord Independence Measure III-Self Report.

STUDY DESIGN: Cross-sectional reliability and validation study. OBJECTIVE: To translate and assess the psychometric properties of the Thai version of the Spinal Cord Independence Measure III-Self Report (TH-SCIM-SR) in Thai spinal cord injury (SCI) patients. SETTING: Faculty of Medicine Siriraj Hospital, Mahidol University. METHODS: A cross-cultural forward and backward translation of the original Spinal Cord Independence Measure III-Self Report (SCIM-SR) was performed at the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand, to create the TH-SCIM-SR. The inclusion criteria were Thai patients with SCI duration of ≥3 months. Patients were evaluated by a team of healthcare professionals using the Thai version of the Spinal Cord Independence Measure Version III (TH-SCIM III). Study patients subsequently completed the TH-SCIM-SR two times with a 3-day interval between evaluations. Cronbach's Alpha, Pearson's correlation coefficient, and intraclass correlation coefficient (ICC) were used to examine internal consistency, concurrent validity, and reliability, respectively. Bland-Altman plot was used to compare scoring results between the TH-SCIM III and the TH-SCIM-SR. RESULTS: Thirty-two patients were included. Cronbach's alpha of total score, self-care subscale, respiration/sphincter management, and mobility subscale were 0.91, 0.94, 0.75, and 0.90, respectively. The reliability analysis showed good reliability. The test-retest ICC of total score, self-care subscale, respiration/sphincter management, and mobility subscale were 0.95, 0.95, 0.78, and 0.96, respectively. Regarding construct validity, the subscales of TH-SCIM-SR demonstrated a strong correlation with those of the TH-SCIM III (0.85-0.96). CONCLUSIONS: TH-SCIM-SR showed good reliability and validity for assessing functional independence in Thai patients with SCI.

The Role of Calcium Pyrophosphate Dihydrate Deposition in the Postoperative Outcome of Lumbar Spinal Stenosis Patients.

STUDY DESIGN: Retrospective study. PURPOSE: This study aimed to investigate the association of surgical intervention with clinical and quality of life (QoL) outcomes in patients who underwent posterior spinal surgery for lumbar spinal stenosis (LSS) with spinal calcium pyrophosphate dihydrate deposition (SCPPD) versus that in those who underwent the surgery for LSS without SCPPD. OVERVIEW OF LITERATURE: Calcium pyrophosphate (CPP)-associated arthritis is one of the most common types of arthritis. The clinical outcomes are well studied in CPP-associated arthritis of the appendicular joints. However, few studies have investigated SCPPD. METHODS: A single-institution database was reviewed. LSS patients were categorized as those who did and did not have SCPPD, based on histologic identification. Clinical presentations and postoperative results were analyzed. Disability and QoL were assessed using the Oswestry Disability Index (ODI) and the 36-item Short-Form Health Survey. RESULTS: Thirty-four patients were enrolled, with 18 patients being allocated to the SCPPD group and 16 being allocated to the non- SCPPD group. Preoperative and postoperative pain scores were not significantly different between the groups (p=0.33 and p=0.48, respectively). The average preoperative ODI score in the SCPPD group was slightly higher than that in the non-SCPPD group (57 vs. 51, p=0.33); however, the postoperative ODI score was significantly lower (15 vs. 43, p=0.01). The postoperative physical function, vitality, and mental health of the SCPPD patients were also significantly improved (p=0.03, p=0.022, and p=0.022, respectively). CONCLUSIONS: Surgical intervention resulted in good clinical outcomes in SCPPD patients. As per our findings, total removal of CPPinvolved tissue is unnecessary. As such, surgery should be performed as indicated according to clinical presentation without considering the presence of CPPD.

Risk factors relating to the need for mechanical ventilation in isolated cervical spinal cord injury patients.

BACKGROUND: Cervical spinal cord injuries (SCI) are a major public health problem. Respiratory complications are among the most important causes of morbidity and mortality in patients with cervical SCI, especially respiratory failure. Based on our evaluation of the existing English language literature, few previous studies appear to have reported on risk factors associated with the need for mechanical ventilation in isolated cervical SCI patients who had no concomitant injuries or diseases at the time ofadmission. OBJECTIVE: The purpose of this study was to determine incidence and riskfactors relating to the needfor mechanical ventilation in isolated cervical spinal cord injury (SCI) patients who had no concomitant injuries. MATERIAL AND METHOD: This retrospective study was conducted by reviewing and analyzing the patient data of 66 isolated cervical-SCI patients who were admitted in our hospital between January 1995 andDecember 2009. Patient medical records were reviewed for demographic data, neurological injuries, needfor mechanical ventilation, definitive treatment, complications, and outcomes. Univariate and multivariate analysis were used to identify predisposing risk factors relating to patient dependency on mechanical ventilation. RESULTS: Of the 66patients, 30.3% (20/66) required mechanical ventilation and 22.7% (15/66) were identified as complete cord injury, ofwhich seven sustained injury above CS. Of the patients with complete SCI, 66.7% (10/15) were dependent on mechanical ventilation, as were 85% (6/7) with SCI above C5. All five of the patients with complete-SCI above C5 who received operative treatment were dependent upon mechanical ventilation, postoperatively. Only 19.6% (10/51) of the incomplete injury group required mechanical ventilation. Univariate analysis indicated the following factors as significantly increasing the risk ofventilator dependence: complete SCI (p = 0.001), SCI above C5 level (p = 0.011) and operative treatment (p = 0.008). Multivariate analysis identified the following factors as being predisposing risk factors relating to the need of mechanical ventilation: complete SCI (OR: 12.8; 95% CI 2.4-66.9; p = 0.003), SCI above C5 level (OR: 12.0; 95% CI 2.4-60.2; p = 0.002), and operative treatment (OR: 14.8; 95% CI2.1-106.9;p = 0.008). CONCLUSION: Complete SCI, SCI above C5, and operative treatment were predisposing risk factors relating to the need for mechanical ventilation in isolated cervical SCI patients. The data and findings put forth in this study suggest that these factors may assist in predicting the needfor mechanical ventilation as a long-term treatment for isolated cervical SCI patients.

Reliability and validity study of a Thai version of the Neck Disability Index in patients with neck pain.

OBJECTIVE: To evaluate the reliability and validity of the Thai version of the neck disability index (NDI) in neck pain patients. MATERIAL AND METHOD: The NDI was translated into Thai. The translation strategy used international standards. Forty-six Thai patients with neck pain were included in the present study. Thai version NDI, short form-36 (SF-36) and visual analogue scale (VAS) were completed by all subjects, twice, one week apart. The reliability and validity were subsequently analyzed. RESULTS: Intraclass correlation coefficient score for test retest reliability was 0.986. Cronbach's alpha for internal consistency was calculated as 0.925. For concurrent validity, the relation between NDI and VAS was investigated, the r value was 0.886 (p < 0.001). For construct validity, the relation between NDI and the Thai version of SF-36 was -0.427. The mental health component was highest correlated with NDI. CONCLUSION: The Thai version of NDI is a valid and reliable measurement method for evaluating neck pain disability.

Fatally idiopathic spontaneous hemoperitoneum in a patient with cervical spine injury: a case report and review of the literature.

OBJECTIVES: Idiopathic spontaneous hemoperitoneum has never been reported in patients with associated orthopedic injury. The present report aimed to demonstrate a case of this life-threatening condition concomitant with cervical spine injury. CASE REPORT: A 50-year-old male was an illegal immigrant and transferred to the emergency department with the conditions of the bilateral facet subluxation of C5-6 spine, including incomplete cord lesion (American-Spinal-lnjury-Association: grade-C) and without associated injury, caused by falling from a 3-meters-scaffold He underwent anterior cervical discectomy, fusion with iliac bone graft, and plating of C5-6 level at 20-hours after injury His overall conditions recovered gradually with the same neurological deficit as pre-operative status. On postoperative day 15, he developed acute hemodynamic instability and cardiac arrest in an hour without preceding signs. Autopsy showed free intra-peritoneal blood 1000 ml and fresh blood in gastric lumen-small bowels 500 ml without definitive source of bleeding. DISCUSSION: The patient in this present report had no complaint of preceding abdominal symptoms in both pre-and-postoperative periods. His visceral sensibility might be lost due to incomplete cord lesion. At this point, he might have an incompetency of detection of intra-abdominal abnormality when it occurred Hence, this patient had no classic symptoms of spontaneous hemoperitoneum. This made the diagnosis of this condition quite difficult in the presented patient. This situation was very uncommon and essentially unique. CONCLUSION: The authors recommend "high index of suspicion" of this diagnosis as a cause of hemodynamic instability in patients with neurological deficit, due to spine injury or any cause, which might prevent them to recognize antecedent abdominal symptoms.

The thickness of skull at the halo pin insertion site.

STUDY DESIGN: The thickness of 415 skulls of Thai population was measured at the areas where halo pins are placed. OBJECTIVE: Analysis of skull thickness at the area of halo pin insertion site. SUMMARY OF BACKGROUND DATA: Halo orthosis is a device used for providing stable fixation of instability of cervical spine injury. Although this device can be applied quickly and safely, complications do occur. While clinical experiences have informed us that cranial bone thickness varies with age. METHODS: Coronal computerized tomography scans of 415 heads of patients who had no head injury, skull fracture, or craniofacial abnormalities were reviewed. All scans were performed with a Philips CX/Q. The patients' ages were between 15 days and 89 years. Measurements were taken directly from the computer console, using the measure mode function. These measurements were obtained in millimeters at the locations where halo pins would normally be placed. Statistical analyses within and between all age groups were performed using analysis of variance tests. RESULTS: The skull thickness increased with age at all sites measured. The average thickness of skull at the anterior midline varied from 5.62 mm (0-9 years) to 7.42 mm (80-89 years). The average thickness of the anterolateral was from 5.52 to 8.54 mm, and the average thickness of the posterolateral was from 5.59 to 8.86 mm. CONCLUSION: The thickness of skull at the halo pin insertion site gradually increases with age. Our study reveals that the thickness of skull reaches a steady peak in third to sixth decades. The thickness of skull at the anterior midline can be predicted by a simple linear regression equation: A = 7.302 + 0.014*age.