Traumatic cervical spinal cord injury: a prospective clinical study of laryngeal penetration and aspiration.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: Dysphagia is a relatively common secondary complication in patients with traumatic cervical spinal cord injuries (TCSCI). The purpose of this study was to determine the incidence of aspiration and penetration in patients with acute TCSCI. SETTING: Tampere University Hospital, Tampere, Finland. METHODS: A total of 46 patients with TCSCI were evaluated with a videofluoroscopic swallowing study (VFSS). Rosenbek's penetration-aspiration scale (PAS) was used to classify the degree of penetration or aspiration. The medical records of each patient were systematically reviewed. RESULTS: Of the 46 patients, 85% were male. The mean age at the time of the injury was 62.1 years. Most patients had an incomplete injury (78%), and most of them due to a fall (78%). In the VFSS 19 (41%) patients penetrated and 15 (33%) aspirated. Only 12 (26%) of the patients had a PAS score of 1 indicating that swallowed material did not enter the airway. Of the patients who aspirated, 73% had silent aspiration. CONCLUSION: The incidence of penetration or aspiration according to VFSS is high in this cohort of patients with TCSCI. Therefore, the swallowing function of patients with acute TCSCI should be routinely evaluated before initiating oral feeding. VFSS is highly recommended, particularly to rule out the possibility of silent aspiration and to achieve information on safe nutrition consistency.

Centralized spinal cord injury care in Finland: unveiling the hidden incidence of traumatic injuries.

STUDY DESIGN: Population-based prospective study. OBJECTIVES: To determine the incidence and evaluate the characteristics of newly injured patients with traumatic spinal cord injury (TSCI) admitted to two of the three national spinal cord injury (SCI) centers during the first year after the centralization of SCI care in Finland. SETTING: Oulu and Tampere University Hospital SCI centers, Finland. METHODS: The designated rehabilitation teams evaluated all of the patients with a new SCI and persisting neurological symptoms. The data were recorded according to the International Spinal Cord Injury Core Data Set. RESULTS: In a 1-year period, 77 new patients with TSCI were admitted to the study centers serving a population of 3 065 946. In the whole catchment area, the mean annual incidence of TSCI was 25.1 per million, and in the hospital districts of the SCI centers, the incidence was even higher, at 38.1 per million. The mean age of the patients was 58.7 years. Falls were the leading cause of injury (64.9%), and the injury resulted in tetraplegia in 70.1% of the cases. Alcohol use was a contributing factor in 39% of the cases in the entire sample and in 58.6% of cases among patients aged younger than 60 years. CONCLUSION: The incidence rates of TSCI were markedly higher than expected, demonstrating the previously hidden morbidity. The epidemiological features of TSCI appeared to follow the trends in developed countries, highlighting the increasing incidence of cervical lesions due to falling among the elderly. The results need to be confirmed in an extended follow-up.

Clinical correlates of cerebral diffusion tensor imaging findings in chronic traumatic spinal cord injury.

STUDY DESIGN: Prospective clinical case-control study. OBJECTIVES: The aim of this study was to use diffusion tensor imaging (DTI) to assess the state of cerebral white matter tracts after spinal cord injury (SCI). The DTI metrics were evaluated in relation to neurological deficits and to the size and level of the spinal cord lesions. SETTING: Tampere University Hospital, Tampere, Finland. METHODS: Thirty-four patients (n=34) with clinically complete and incomplete SCI were evaluated using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). DTI metrics (fractional anisotropy (FA) and apparent diffusion coefficient (ADC)) were calculated for multiple levels along the course of the corticospinal tract. The state of the spinal cord after injury was assessed using conventional magnetic resonance imaging (MRI). DTI parameters were compared with 40 orthopedically injured control subjects. RESULTS: Statistically significant differences in the DTI values between patients and controls were detected in the posterior area of the centrum semiovale. In this area, the FA values were lower in the patients compared with controls (P=0.008). For patients with clinically complete injury, the difference was even more significant (P=0.0005). Motor and sensory scores of the ISNCSCI correlated positively with FA and negatively with ADC values of the centrum semiovale. A moderate association was observed between the macroscopic changes in the spinal cord and the DTI abnormalities in the centrum semiovale. CONCLUSION: In patients with chronic SCI, DTI changes can be observed in the cerebral white matter. These alterations are associated with the clinical state of the patients.