Correction: Exploration of surgical blood pressure management and expected motor recovery in individuals with traumatic spinal cord injury.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Correction: Exploration of surgical blood pressure management and expected motor recovery in individuals with traumatic spinal cord injury.

A correction to this paper has been published and can be accessed via a link at the top of the paper.

Exploration of surgical blood pressure management and expected motor recovery in individuals with traumatic spinal cord injury.

STUDY DESIGN: Retrospective analysis. OBJECTIVE: To assess the impact of mean arterial blood pressure (MAP) during surgical intervention for spinal cord injury (SCI) on motor recovery. SETTING: Level-one Trauma Hospital and Acute Rehabilitation Hospital in San Jose, CA, USA. METHODS: Twenty-five individuals with traumatic SCI who received surgical and acute rehabilitation care at a level-one trauma center were included in this study. The Surgical Information System captured intraoperative MAPs on a minute-by-minute basis and exposure was quantified at sequential thresholds from 50 to 104 mmHg. Change in International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor score was calculated based on physiatry evaluations at the earliest postoperative time and at discharge from acute rehabilitation. Linear regression models were used to estimate the rate of recovery across the entire MAP range. RESULTS: An exploratory analysis revealed that increased time within an intraoperative MAP range (70-94 mmHg) was associated with ISNCSCI motor score improvement. A significant regression equation was found for the MAP range 70-94 mmHg (F[1, 23] = 5.07, r2 = 0.181, p = 0.034). ISNCSCI motor scores increased 0.039 for each minute of exposure to the MAP range 70-94 mmHg during the operative procedure; this represents a significant correlation between intraoperative time with MAP 70-94 and subsequent motor recovery. Blood pressure exposures above or below this range did not display a positive association with motor recovery. CONCLUSIONS: Hypertension as well as hypotension during surgery may impact the trajectory of recovery in individuals with SCI, and there may be a direct relationship between intraoperative MAP and motor recovery.

Use of nonsteroidal anti-inflammatory drugs to prevent heterotopic ossification after spinal cord injury: a retrospective chart review.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: The objective of this study is to evaluate the efficacy of nonsteroidal anti-inflammatory drug (NSAID) prophylaxis for heterotopic ossification (HO) in the acute phase after spinal cord injury (SCI). SETTING: Acute rehabilitation hospital in California, USA. METHODS: This retrospective chart review (October 2013-March 2017) included individuals with motor complete SCI followed by the SCI service within 60 days of injury. Group demographics and HO diagnosis were compared in those who received and those who did not receive NSAID prophylaxis. A backward stepwise multiple regression was employed to assess the predictive association between injury characteristics and HO prophylaxis on HO diagnosis. RESULTS: A total of 108 AIS A and B cases were included, and 27 received ≥ 15 days of therapy (overall range 6-44 days). Logistic regression analysis revealed those who received ≥ 15 days of NSAID prophylaxis had an odds ratio of 0.1 of being diagnosed with HO compared with those who did not (95% CI, 0.02 to 0.52). Significant predictors of HO diagnosis were tracheostomy (OR 2.8, 95% CI, 1.05 to 7.5), urinary tract infection (OR 4.3, 95% CI, 1.5 to 12.2), and pressure injury (OR 3.3, 95% CI, 1.1 to 9.5). Adverse effects of NSAID use were minimal. CONCLUSIONS: NSAID prophylaxis appears to help prevent HO development during the acute phase after SCI. Prospective study with prolonged follow up is necessary to confirm the long-term efficacy of HO prevention and to further evaluate safety following spinal fusion. SPONSORSHIP: None.

Mechanical insufflation-exsufflation device prescription for outpatients with tetraplegia.

BACKGROUND: Mechanical insufflation-exsufflation (MIE) is an option for secretion mobilization in outpatients with spinal cord injury (SCI) who lack an effective cough and are at high risk for developing pneumonia. OBJECTIVE: To describe characteristics of persons with SCI who received MIE devices for outpatient use and compare respiratory hospitalizations before and after MIE prescription. DESIGN: Retrospective cohort study of all persons who were prescribed MIE devices for outpatient use during 2000 to 2006 by a Veterans Affairs SCI service. RESULTS: We identified 40 patients with tetraplegia (4.5% of population followed by the SCI service) who were prescribed MIE devices. Of these, 30 (75%) had neurologic levels of C5 or rostral, and 33 (83%) had motor-complete injuries. For chronically injured patients who were prescribed MIE for home use, there was a nonsignificant reduction in respiratory hospitalization rates by 34% (0.314/y before MIE vs 0.208/y after MIE; P = 0.21). A posthoc subgroup analysis showed a significant decline in respiratory hospitalizations for patients with significant tobacco smoking histories. CONCLUSIONS: Mechanical insufflation-exsufflation was typically prescribed for people with motor-complete tetraplegia. Outpatient MIE usage may reduce respiratory hospitalizations in smokers with SCI. Further research of this alternative, noninvasive method is warranted in the outpatient SCI population.