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.

Surgical management of spinal metastases: the postoperative quality of life.

OBJECTIVE: The surgical treatment of spinal metastases remains controversial. Increasing life expectancy has resulted in greater interest in overall quality of life, pain and neurologic improvements. There are few prospective studies on functional and quality of life outcomes in patients with vertebral metastases. Therefore, the authors conducted the prospective study evaluating the clinical, neurologic function and quality of life after surgery in these patients. MATERIAL AND METHOD: Fifty-two patients undergoing surgical treatment for spinal metastases during October 2007 to October 2009 were prospectively evaluated. Surgical intervention included neurological decompression,fusion and spinal instrumentation. Pre- and post-operative assessments at 1st month, 3rd month and 6th month were performed using a visual analog scale, the modified Frankel grade classification and a Shortform-36 (SF-36). RESULTS: Pain scores were improved significantly at all post-operative time points (p < 0.001). The neurological functions were improved at 1st month (p < 0.001), 3rd month (p < 0.001) and 6th month (p = 0.260) postoperatively. At 1st month after surgery, 40 patients (76.9%) had improvement in quality of life. However, at 3rd month postoperatively, there were 31 patients (59.6%) improved. At 6th month postoperatively, only 15 patients (28.8%) were improved. Internal organ metastases was the only factor that related to the reduction of quality of life at 1 month, 3rd month (p < 0.001) and 6th month (p < 0.05). CONCLUSION: Patients with spinal metastases will have benefit from palliative surgery in significant pain reduction and neurological recovery. As the global assessment in the quality of life, the patients may have the improvement at 1st month postoperatively but after 3 months and 6 months postoperatively, selected patients may have benefit from the surgery and the factors such as internal organ metastases and primary site of cancer have great effects on the improvement in the quality of life. This data may be useful for counseling the patients and relatives about the prognosis and expected surgical outcome before surgical intervention is decided.