Efficacy of early versus delayed spinal cord decompression in neurological recovery after traumatic spinal cord injury: Systematic review and meta-analysis. / Eficacia de la descompresión medular precoz versus tardía en la recuperación neurológica tras lesión medular traumática. Revisión sistemática y metaanálisis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare early (<24 h) versus late (>24 h) spinal cord decompression on neurological recovery in patients with acute spinal cord injury. METHODS: A systematic review was performed according to the PRISMA protocol to identify studies published up to December 2022. PROSPECTIVE: cohort studies and controlled trials comparing early versus delayed decompression on neurological recovery were included. Variables included number of patients, level of injury, treatment time, ASIA grade, neurological recovery, use of corticosteroids, and complications. For the meta-analysis, the «forest plot¼ graph was developed. The risk of bias of the included studies was assessed using the ROBINS-I22 and Rob223 tools. RESULTS: Six of the seven studies selected for our review were included in the meta-analysis, with a total of 1188 patients (592 patients in the early decompression group and 596 in the delayed decompression group), the mean follow-up was 8 months, in 5 studies used methylprednisolone, the most reported complications were thromboembolic cardiopulmonary events.Five studies showed significant differences in favour of early decompression (risk difference 0.10, 95% confidence interval 0.07-0.14, heterogeneity 46%). The benefit was greatest in cervical and incomplete injuries. CONCLUSION: There is scientific evidence to recommend early decompression in the first 24 h after traumatic spinal cord injury, as it improves final neurological recovery, and it should be recommended whenever the patient and hospital conditions allow it to be safely done.

SCIWORA. Una rara entidad clínica en la población pediátrica. Estudio ambispectivo / SCIWORA in children. A rare clinical entity: Ambispective study

Introducción: La lesión medular tipo SCIWORA es una entidad clínica con baja incidencia y alta repercusión funcional. El objetivo del estudio es la descripción epidemiológica de esta lesión y su evolución funcional con un seguimiento medio de 10 años. Material y métodos: Estudio analítico, longitudinal, de cohortes ambispectivo. Fueron evaluados 13 pacientes con el diagnóstico de SCIWORA en el periodo de estudio 2001-2022. Variables evaluadas: edad, sexo, días hasta la lesión medular, causa de lesión, imagen medular en la RM postraumatismo, nivel neurológico de lesión, ASIA ingreso/alta/5 años, SCIM III ingreso/alta/3 años, tipo de tratamiento empleado, empleo de terapia NASCIS III ingreso, tiempo de hospitalización, seguimiento medio. En octubre del 2022 fueron nuevamente evaluados en consultas externas mediante: cuestionario de discapacidad cervical (NDI)/Oswestry y cuestionario de calidad de vida validado en castellano para lesionados medulares (SV-QLI/SCI). Resultados: La mediana de edad fue de 4 años, 77% varones. El 54% de las lesiones corresponden a nivel cervical. El ASIA al ingreso fue del 31% A y del 31% C, nivel neurológico: C2 (22%) y T10 (15%), tráfico como causa de lesión (77%), SCIM III ingreso/alta: 28,5/42. La estancia media hospitalaria fue de 115 días. NDI: 11,6 y Oswestry: 15,3. Conclusión: El 77% de los SCIWORA se producen en menores de 8 años. Al año del alta hospitalaria un 31% de los pacientes fueron catalogados como ASIA D y a los 5 años el porcentaje se mantiene constante. No se encontraron diferencias significativas entre la causa de la lesión y tipo de alteración en RM (p = 0,872), ni entre la edad y el tipo de lesión medular objetivada en RM (p = 0,149).(AU)

Introduction: SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. Material and methods: Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. Results: Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. Conclusions: Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P = 0.872), age and MRI spinal cord findings (P = 0.149) were found in SCIWORA patients.(AU)

Evolución neurológica en la lesión medular traumática en función del tamaño de la hemorragia intraparenquimatosa / Neurological evolution in traumatic spinal cord injury according to the size of the intraparenchymal hemorrhage

Introducción y objetivos: La presencia de hemorragia medular es considerada como un factor de mal pronóstico evolutivo en el estudio de la lesión medular traumática (LMT). No obstante, se ha sugerido en trabajos publicados que el pronóstico de los sangrados de menor tamaño no es tan negativo. El objetivo del presente trabajo es valorar la evolución neurológica en individuos con hemorragia intraparenquimatosa en función del tamaño de la misma. Material y métodos: Estudio observacional retrospectivo. Recopilados los pacientes ingresados por LMT aguda con estudio de resonancia, que objetivase una hemorragia medular entre los años 2010 y 2018. Se establecieron 2 grupos en función del tamaño del sangrado: microhemorragias (menor de 4mm) y macrohemorragias (superior a 4mm). Se comparó la exploración neurológica al ingreso y al alta atendiendo al grado AIS y el índice motor (IM). Resultados: Recogidos 46 casos, 17 microhemorragias y 29 macrohemorragias. El 70,6% de las primeras eran AIS A mientras que entre las macrohemorragias el porcentaje era del 89,6%. Al momento del alta se apreció una mejoría del grado AIS en el 40,0% de las microhemorragias por un 4,0% de las macrohemorragias (p=0,008). El IM inicial fue muy similar, 45,2±22,2 en las microhemorragias y 40,9±20,4 en las mayores (p=0,459), pero al alta era superior en el primer grupo: 60,4±20,5 por 42,7±22,8 (p=0,033). Ocho pacientes (17,4%) fallecieron durante el ingreso. Conclusiones: Existe relación entre el tamaño de la hemorragia intraparenquimatosa y el pronóstico neurológico de la LMT, presentando una mejor evolución las hemorragias menores de 4mm.(AU)

Introduction and objectives: The presence of spinal cord hemorrhage is considered as a poor prognostic factor in traumatic spinal cord injury (SCI). However, it has been suggested in published works that the prognosis of small hemorrhages is not so negative. The aim of this paper is to assess the neurological evolution in individuals with intraparenchymal hemorrhage according to its size. Material and methods: Retrospective observational study. Selected all the patients admitted for acute traumatic SCI between 2010 and 2018 with early magnetic resonance study and spinal cord hemorrhage. Two groups were established depending on the size of the bleeding: microhemorrhages (less than 4mm) and macrohemorrhages (greater than 4mm). The neurological examination at admission and discharge was compared according to the AIS grade and the motor score (MS). Results: Forty-six cases collected, 17 microhemorrhages and 29 macrohemorrhages. 70.6% of the microhemorrhages were AIS A while among macrohemorrhages the percentage was 89.6%. At the time of discharge, an improvement in the AIS grade was observed in 40.0% of the microhemorrhages compared to 4.0% of the macrohemorrhages (P=.008). Initial MS was similar, 45.2±22.2 in the microhemorrhages and 40.9±20.4 in the macrohemorrhages (P=.459), but at discharge it was higher in the first group: 60.4±20.5 for 42.7±22.8 (P=.033). Eight patients (17.4%) died during admission. Conclusions: There is a relationship between the size of the intraparenchymal hemorrhage and the neurological prognosis of SCI, with hemorrhages smaller than 4mm presenting a better evolution.(AU)

[Translated article] Effects of duroplasty with bovine pericardium on fibrosis and extent of spinal cord injury: An experimental study in pigs.

INTRODUCTION: Traumatic spinal cord injury (SCI) leads to increased intraspinal pressure that can be prevented by durotomy and duroplasty. The aim of the study was to evaluate fibrosis and neural damage in a porcine model of SCI after duroplasty and application of hyaluronic acid (HA) in the tissue cavity. MATERIALS AND METHODS: Experimental study. We created a porcine SCI model by durotomy and spinal cord hemisection of a cervical segment (1cm). Six pigs (Sus scrofa domestica) were used to evaluate three surgical scenarios: (1) control injury with dural reparative microsurgery, (2) duroplasty using bovine pericardium (BPD), and (3) previous method plus HA applied at the lesion. Animals were sacrificed one-month post-injury to assess fibrotic responses and neural tissue damage using conventional histological and immunohistochemical methods. RESULTS: In the control case, dural suture prevented invasion of the lesion by extradural connective tissue, and the dura mater showed a 1-mm thickening in the perilesional area. The bovine pericardium patch blocked the entrance of extradural connective tissue, decreased dura-mater tension, and satisfactorily integrated within the receptor tissue. However, it also enhanced subdural and perilesional fibrosis, which was not inhibited by filling the lesion cavity with low- or high-molecular-weight HA. CONCLUSIONS: Duroplasty prevents collapse of the dura-mater over the spinal cord tissue, as well as invasion of the lesion by extramedullary fibrotic tissue, without creating additional neural damage. Nevertheless, it enhances the fibrotic response in the spinal cord lesion and the perilesional area. Additional antifibrotic strategies are needed to facilitate spinal cord repair.

SCIWORA in children. A rare clinical entity: Ambispective study. / SCIWORA. Una rara entidad clínica en la población pediátrica. Estudio ambispectivo.

INTRODUCTION: SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS: Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS: Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS: Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P = 0.872), age and MRI spinal cord findings (P = 0.149) were found in SCIWORA patients.

[Translated article] SCIWORA in children. A rare clinical entity: Ambispective study.

INTRODUCTION: SCIWORA has a low incidence but a high functional repercussion. The aim of the present study was to characterize the epidemiology of this clinical-radiological condition and evaluate functional outcome with a mean of 10-years follow-up. MATERIAL AND METHODS: Observational, longitudinal ambispective cohort study. Thirteen SCIWORA patients were admitted in the study period. Demographics, mechanism of injury, spinal cord MRI findings, neurological level of injury, time to SCI, neurological status (AIS) at admission/discharge/5 years, spinal cord independence measure (SCIM III) scale at admission and discharge, hospital length of stay and mean follow-up were recorded. On October 2022 patients were re-evaluated using NDI, Oswestry, and SV-QLI/SCI. RESULTS: Median age was 4 years. The study population for this investigation was mostly men (77%). 54% of level of injury correspond to cervical spine. AIS at admission was A (31%) and C (31%). Neurological level of injury was C2 (22%) and T10 (15%). Motor vehicle-related injury was the most prevalent mechanism of injury (77%), SCIM III scale at admission and discharge: 28.5/42, hospital length of stay was 115 days. The NDI was 11.6, Oswestry: 15.3 and SV-QLI/SCI: 17. CONCLUSIONS: Seventy-seven percent of SCIWORA patients was detected under 8 years-old. At 1 year follow-up after discharge 31% patients were AIS grade D and with 5 years follow-up the percentage remain constant. No statistically significant differences in the mechanism of injury and MRI findings (P=0.872), age and MRI spinal cord findings (P=0.149) were found in SCIWORA patients.

[Neurological evolution in traumatic spinal cord injury according to the size of the intraparenchymal hemorrhage]. / Evolución neurológica en la lesión medular traumática en función del tamaño de la hemorragia intraparenquimatosa.

INTRODUCTION AND OBJECTIVES: The presence of spinal cord hemorrhage is considered as a poor prognostic factor in traumatic spinal cord injury (SCI). However, it has been suggested in published works that the prognosis of small hemorrhages is not so negative. The aim of this paper is to assess the neurological evolution in individuals with intraparenchymal hemorrhage according to its size. MATERIAL AND METHODS: Retrospective observational study. Selected all the patients admitted for acute traumatic SCI between 2010 and 2018 with early magnetic resonance study and spinal cord hemorrhage. Two groups were established depending on the size of the bleeding: microhemorrhages (less than 4mm) and macrohemorrhages (greater than 4mm). The neurological examination at admission and discharge was compared according to the AIS grade and the motor score (MS). RESULTS: Forty-six cases collected, 17 microhemorrhages and 29 macrohemorrhages. 70.6% of the microhemorrhages were AIS A while among macrohemorrhages the percentage was 89.6%. At the time of discharge, an improvement in the AIS grade was observed in 40.0% of the microhemorrhages compared to 4.0% of the macrohemorrhages (P=.008). Initial MS was similar, 45.2±22.2 in the microhemorrhages and 40.9±20.4 in the macrohemorrhages (P=.459), but at discharge it was higher in the first group: 60.4±20.5 for 42.7±22.8 (P=.033). Eight patients (17.4%) died during admission. CONCLUSIONS: There is a relationship between the size of the intraparenchymal hemorrhage and the neurological prognosis of SCI, with hemorrhages smaller than 4mm presenting a better evolution.

Lesión medular asociada a hematoma epidural espinal espontáneo / Spinal cord injury associated with spontaneous spinal epidural hematoma

Introducción: El hematoma epidural espinal espontáneo (HEEE) es una entidad de baja incidencia, de elevada morbimortalidad y que causa una importante limitación funcional en la vida de los pacientes. Material y métodos: Con el objetivo de determinar la incidencia del HEEE y el tipo de lesión medular provocada y su repercusión funcional en este centro hospitalario, se realizó un estudio descriptivo retrospectivo analizando variables demográficas, de la lesión (ISCNSCI) y de la funcionalidad (SCIMIII). Resultados: Se revisaron los casos de HEEE atendidos en este centro. El 75% eran varones, con una mediana de edad de 55años. Todas las lesiones fueron incompletas. La localización más frecuente de las lesiones fue a nivel cervical bajo y dorsal alto. La mitad de los sangrados se produjeron en la región medular anterior. Se objetivó mejoría funcional tras el programa específico de rehabilitación. Conclusión: El HEEE podría considerarse de buen pronóstico funcional, relacionado con lesiones medulares habitualmente posteriores e incompletas sensitivo-motoras que se beneficiarían de un tratamiento rehabilitador específico precoz.(AU)

Introduction: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. Material and methods: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). Results: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. Conclusion: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.(AU)

Effects of duroplasty with bovine pericardium on fibrosis and extent of spinal cord injury: An experimental study in pigs. / Efecto de la reparación de la duramadre con pericardio bovino sobre la fibrosis y la extensión de la lesión medular: estudio experimental en cerdos.

INTRODUCTION: Traumatic spinal cord injury (SCI) leads to increased intraspinal pressure that can be prevented by durotomy and duroplasty. The aim of the study was to evaluate fibrosis and neural damage in a porcine model of SCI after duroplasty and application of hyaluronic acid (HA) in the tissue cavity. MATERIALS AND METHODS: Experimental study. We created a porcine SCI model by durotomy and spinal cord hemisection of a cervical segment (1cm). Six pigs (Sus scrofa domestica) were used to evaluate three surgical scenarios: (1)control injury with dural reparative microsurgery, (2)duroplasty using bovine pericardium (BPD), and (3)previous method plus HA applied at the lesion. Animals were sacrificed one-month post-injury to assess fibrotic responses and neural tissue damage using conventional histological and immunohistochemical methods. RESULTS: In the control case, dural suture prevented invasion of the lesion by extradural connective tissue, and the dura mater showed a 1-mm thickening in the perilesional area. The bovine pericardium patch blocked the entrance of extradural connective tissue, decreased dura-mater tension, and satisfactorily integrated within the receptor tissue. However, it also enhanced subdural and perilesional fibrosis, which was not inhibited by filling the lesion cavity with low- or high-molecular-weight HA. CONCLUSIONS: Duroplasty prevents collapse of the dura-mater over the spinal cord tissue, as well as invasion of the lesion by extramedullary fibrotic tissue, without creating additional neural damage. Nevertheless, it enhances the fibrotic response in the spinal cord lesion and the perilesional area. Additional antifibrotic strategies are needed to facilitate spinal cord repair.

Efficacy of early versus delayed spinal cord decompression in neurological recovery after traumatic spinal cord injury: Systematic review and meta-analysis. / Eficacia de la descompresión medular precoz versus tardía en la recuperación neurológica tras lesión medular traumática. Revisión sistemática y metaanálisis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare early (<24h) versus late (>24h) spinal cord decompression on neurological recovery in patients with acute spinal cord injury. METHODS: A systematic review was performed according to the PRISMA protocol to identify studies published up to December 2022. Prospective cohort studies and controlled trials comparing early versus delayed decompression on neurological recovery were included. Variables included number of patients, level of injury, treatment time, ASIA grade, neurological recovery, use of corticosteroids, and complications. For the meta-analysis, the «forest plot¼ graph was developed. The risk of bias of the included studies was assessed using the ROBINS-I22 and Rob223 tools. RESULTS: Six of the seven studies selected for our review were included in the meta-analysis, with a total of 1188 patients (592 patients in the early decompression group and 596 in the delayed decompression group), the mean follow-up was 8 months, in 5 studies used methylprednisolone, the most reported complications were thromboembolic cardiopulmonary events. Five studies showed significant differences in favor of early decompression (risk difference 0.10, 95% confidence interval 0.07-0.14, heterogeneity 46%). The benefit was greatest in cervical and incomplete injuries. CONCLUSION: There is scientific evidence to recommend early decompression in the first 24h after traumatic spinal cord injury, as it improves final neurological recovery, and it should be recommended whenever the patient and hospital conditions allow it to be safely done.

Paciente con lesión medular cervical y vértigo posicional paroxístico benigno tratado con maniobras de reposición de partículas / Patient with cervical spinal cord injury and benign paroxysmal positional vertigo treated with particle repositioning maneuvers

El vértigo posicional paroxístico benigno (VPPB) se caracteriza por episodios cortos y bruscos de vértigo cuando la cabeza se mueve en posiciones específicas. El tratamiento son las terapias de reposición de partículas. En general el VPPB es subdiagnosticado, no reportado y por lo tanto no es tratado de forma adecuada. Presentamos el caso de un paciente con lesión medular y VPPB. Paciente de 72 años que sufre una fractura de C5 y como resultado una lesión medular C5 AIS C que necesitó la fijación quirúrgica. En la unidad de lesionados medulares se documentó VPPB del conducto semicircular lateral izquierdo y se trató mediante el uso de terapias de reposición específicas; el paciente mejoró progresivamente y pudo concluir el tratamiento rehabilitador. Las unidades de lesión medular con acceso a unidades de rehabilitación vestibular pueden realizar el diagnóstico y tratamiento específico del VPPB, minimizando los riesgos para el paciente.(AU)

Benign paroxysmal positional vertigo (BPPV) is characterized by short, sudden episodes of vertigo when the head moves in specific positions. The treatment is particle repositioning maneuvers. BPPV usually is underdiagnosed, unreported and therefore not adequately treated. We present the case of a patient with spinal cord injury and BPPV. A 72-year-old patient who suffered a C5 fracture with spinal cord injury C5 AIS C that required surgical fixation. In the spinal cord injury unit BPPV of the left lateral semicircular canal was documented and treated using specific repositioning maneuvers, the patient progressively improved and was able to complete the rehabilitation treatment. The spinal cord injury unit with access to vestibular rehabilitation units can carry out the diagnosis and specific treatment of BPPV, minimizing the risks for the patient.(AU)

[Patient with cervical spinal cord injury and benign paroxysmal positional vertigo treated with particle repositioning maneuvers]. / Paciente con lesión medular cervical y vértigo posicional paroxístico benigno tratado con maniobras de reposición de partículas.

Benign paroxysmal positional vertigo (BPPV) is characterized by short, sudden episodes of vertigo when the head moves in specific positions. The treatment is particle repositioning maneuvers. BPPV usually is underdiagnosed, unreported and therefore not adequately treated. We present the case of a patient with spinal cord injury and BPPV. A 72-year-old patient who suffered a C5 fracture with spinal cord injury C5 AIS C that required surgical fixation. In the spinal cord injury unit BPPV of the left lateral semicircular canal was documented and treated using specific repositioning maneuvers, the patient progressively improved and was able to complete the rehabilitation treatment. The spinal cord injury unit with access to vestibular rehabilitation units can carry out the diagnosis and specific treatment of BPPV, minimizing the risks for the patient.

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.

Impacto de los ejercicios físicos en la rehabilitación de pacientes con lesiones medulares cervical incompleta, en Guinea-Bissau

Las personas con lesiones de la médula espinal cervical tienen de dos a cinco veces más probabilidades de morir prematuramente, estas lesiones son una de las causas de muerte más frecuente en la población mundial independientemente de la religión, edad, raza, sexo, nacionalidad o clase social; las tasas de supervivencia más bajas, se encuentran en los países de ingresos bajos y medianos. En Guinea-Bissau, los pacientes desconocen su enfermedad y los beneficios de la actividad física para su tratamiento; por ello, se realizó un estudio con diez pacientes que asisten al área de Neuro-rehabilitación motora, Bissau, donde el objetivo fue: determinar el impacto de los ejercicios físicos en la rehabilitación de los pacientes con lesión medular cervical incompleta. Se utilizaron métodos de orden cualitativo (revisión documental) y cuantitativos (medición) y criterio de expertos que permitieron el estudio del objeto y la evaluación teórica y práctica de los ejercicios físicos, los que fueron validados por 17 expertos, entre los cuales el 95 % evaluaron los indicadores en adecuados y muy adecuados y se aplicó en la práctica a diez pacientes con resultados muy satisfactorios, lo que confirmó la pertinencia del estudio realizado. El 100 % de los participantes alcanzaron un nivel significativo en las actividades de la vida diaria, capacidades físicas y funcionales. Este estudio respondió a necesidades investigativas de la Universidad de Ciencias de la Cultura Física y el Deporte "Manuel Fajardo", de Cuba y al Centro de Neuro-Rehabilitación Físico Motor Sanca, de Guinea-Bissau.

SÍNTESE Pessoas com lesões da medula cervical têm duas a cinco vezes mais probabilidade de morrer prematuramente, essas lesões são uma das causas de morte mais freqüentes na população mundial, independentemente da religião, idade, raça, sexo, nacionalidade ou classe social; as mais baixas taxas de sobrevivência são encontradas em países de baixa e média renda. Na Guiné-Bissau, os pacientes desconhecem sua doença e os benefícios da atividade física para seu tratamento; portanto, foi realizado um estudo com dez pacientes que freqüentavam a área de neuro-reabilitação motora, Bissau, onde o objetivo era: determinar o impacto dos exercícios físicos na reabilitação de pacientes com lesão incompleta da medula cervical. Foram utilizados métodos qualitativos (revisão documental) e quantitativos (medição) e julgamento de especialistas para estudar o objeto e a avaliação teórica e prática dos exercícios físicos, que foram validados por 17 especialistas, 95% dos quais avaliaram os indicadores como adequados e muito adequados, e foram aplicados na prática a dez pacientes com resultados muito satisfatórios, confirmando a relevância do estudo realizado. 100% dos participantes atingiram um nível significativo nas atividades de vida diária, nas habilidades físicas e funcionais. Este estudo respondeu às necessidades de pesquisa da Universidade de Cultura Física e Ciências do Esporte "Manuel Fajardo", Cuba e do Centro de Reabilitação Neuro-Motora Sanca, Guiné-Bissau.

People with cervical spinal cord injuries are two to five times more likely to die prematurely, these injuries are one of the most frequent causes of death in the world population regardless of religion, age, race, sex, nationality or social class; the lowest survival rates are found in low- and middle-income countries. In Guinea-Bissau, patients are unaware of their illness and the benefits of physical activity for their treatment; for this reason, a study was carried out with ten patients who attend the area of Motor Neuro-rehabilitation, Bissau, where the objective was: to determine the impact of physical exercises on the rehabilitation of patients with incomplete cervical spinal cord injury. Qualitative (documentary review) and quantitative (measurement) and expert criteria methods were used, which allowed the study of the object and the theoretical and practical evaluation of the physical exercises, which were validated by 17 experts, among whom 95% they evaluated the indicators as adequate and very adequate and it was applied in practice to ten patients with very satisfactory results, which confirmed the relevance of the study carried out. 100% of the participants reached a significant level in activities of daily living, physical and functional capacities. This study responded to the research needs of the "Manuel Fajardo" University of Physical Culture and Sports Sciences, of Cuba and the Sanca Neuro - Physical Motor Rehabilitation Center, of Guinea-Bissau.

[Spinal cord injury associated with spontaneous spinal epidural hematoma]. / Lesión medular asociada a hematoma epidural espinal espontáneo.

INTRODUCTION: Spontaneous spinal epidural hematoma (SSEH) is a disease with low incidence and high morbidity/mortality. It can cause severe loss of function. MATERIAL AND METHODS: In order to determine the incidence, type of spinal injury and functional impact, a descriptive and retrospective study was developed, analysing demographic data, functional scores (SCIMIII) and neurological scores (ISCNSCI). RESULTS: Cases of SSEH were reviewed. Seventy-five percent were male, median age was 55years old. All of the spinal injuries were incomplete and were frequently in the lower cervical and thoracic regions. Fifty percent of bleedings occurred in the anterior spinal cord. Most showed with a progress after an intensive rehabilitation program. CONCLUSION: SSEH could be considered to have a good functional prognosis, related to usually posterior and incomplete sensory-motor spinal cord injuries that would benefit from early specific rehabilitative treatment.

Efectividad de la respiración glosofaríngea en pacientes con enfermedades neuromusculares y lesión medular: Revisión sistemática exploratoria / Effectiveness of glossopharyngeal breathing in patients with neuromuscular diseases and spinal cord injury: Scoping review

Antecedentes Las enfermedades neuromusculares y las lesiones medulares comprometen los músculos respiratorios y función pulmonar ocasionando complicaciones respiratorias. La insuficiencia respiratoria aguda y el compromiso respiratorio crónico ocasionan alto riesgo de morbilidad y mortalidad. Se ha descrito el uso de la respiración glosofaríngea para mejorar variables de función pulmonar y muscular respiratoria que promueven la tos más efectiva y aumento del tiempo libre de ventilación mecánica. Objetivo Describir y presentar la evidencia actual de la efectividad de la respiración glosofaríngea en mejorar la función pulmonar y muscular respiratoria en pacientes adultos y pediátricos con enfermedades neuromusculares o lesión medular con o sin ventilación mecánica. Diseño Revisión exploratoria con la metodología PRISMA-ScR. Se realizó una búsqueda en las bases de datos PEDro, Web of Science, Scopus, PubMed, ScienceDirect, Springer, Medline, Cochrane, SciELO, Lilacs, Google Académico, se usaron palabras claves y términos MeSH en idiomas español, inglés y portugués, entre los años 2000-2020. Los resultados se presentan de forma descriptiva. Resultados Se identificaron 491 estudios y fueron incluidos 12. El 58,3% fueron realizados en países europeos. El 41,6% de los estudios fueron valorados y ninguno cumplió totalmente los criterios de calidad. La efectividad de la respiración glosofaríngea en la función pulmonar y muscular respiratoria estuvo relacionada con mejoría de capacidad vital en 66,6% y pico flujo de tos en 33,3% de los estudios. Se reportó mejoría en expansión torácica en 66,6% de los estudios y complicaciones como síncope, mareo en 33,3%. Conclusión La efectividad de respiración glosofaríngea en pacientes con enfermedades neuromusculares y lesión medular está relacionada con aumento de capacidad vital y pico flujo de tos. Se recomienda la realización de estudios con más rigurosidad científica para soportar la validez de estos resultados (AU)

Background Neuromuscular diseases and spinal cord injuries compromise respiratory muscles and lung function, causing respiratory complications. Acute respiratory failure and chronic respiratory compromise cause high risk of morbidity and mortality. The use of glossopharyngeal respiration has been described to improve pulmonary and respiratory muscle function variables that promote more effective coughing and increased time off mechanical ventilation. Objective Describe and present the current evidence of the effectiveness of glossopharyngeal respiration in improving lung and respiratory muscle function in adult and pediatric patients with neuromuscular diseases or spinal cord injury with or without mechanical ventilation. Design Exploratory review with the PRISMA-ScR methodology. A search was carried out in the PEDro, Web of Science, Scopus, PubMed, ScienceDirect, Springer, Medline, Cochrane, SciELO, Lilacs, Google Academic databases, keywords and MeSH terms were used in Spanish, English and Portuguese languages, among the years 2000–2020. The results are presented in a descriptive way. Results 491 studies were identified and 12 were included. 58.3% were conducted in European countries. 41.6% of the studies were critically appraised and none fully met the quality criteria. The effectiveness of glossopharyngeal breathing in lung and respiratory muscle function was related to an improvement in vital capacity in 66.6% and peak cough flow in 33.3% of the studies. Improvement in thoracic expansion was reported in 66.6% of the studies and complications such as syncope, dizziness in 33.3%. Conclusion The effectiveness of glossopharyngeal respiration in patients with neuromuscular diseases and spinal cord injury is related to increased vital capacity and peak flow of cough. Studies with more scientific rigor are recommended to support the validity of these results (AU)

Programa de ejercicios para las transferencias y la marcha en los pacientes lesionados medulares / Programa de exercícios para transferências e marcha em pacientes feridos da medula espinhal / Exercise program for transfers and gait in spinal cord injured patients

RESUMEN Introducción: La lesión medular es considerada como un trauma que influye en todos los aspectos de la vida, reduce las capacidades físicas y restringe a la persona en sus labores cotidianas. Una de las principales consecuencias derivadas de la lesión medular es la limitación a nivel de movilidad la cual incluye la marcha y las transferencias. Objetivo: Describir cómo influye el programa de ejercicios físicos del CIREN en la marcha y las transferencias en los pacientes lesionados medulares. Materiales y métodos: Según el diseño metodológico, el tipo de estudio es experimental, según el método de estudio es observacional de acuerdo al tiempo de ocurrencia de los hechos y registro de la información. Para el desarrollo de la investigación, se seleccionó una muestra de 15 pacientes con niveles de lesión entre T1 y T6 que cumplieron con los criterios de inclusión. Resultados: Se observaron cambios estadísticamente significativos en la marcha y transferencias en el grupo; por niveles de lesión, las lesiones entre T1 y T6 no presentaron cambios en el manejo de la escalera y en las transferencias del suelo a la silla; por sexo tantos los hombres como las mujeres no presentaron cambios estadísticamente significativos en el manejo de la escalera y en las transferencias del suelo a la silla. Conclusiones: El programa de ejercicios empleados en la rehabilitación de los pacientes es efectivo al poder producir cambios en las actividades relacionadas con la marcha y las transferencias. Se debe aumentar el tiempo de rehabilitación para lesiones por encima de T6.

RESUMO Introdução: A lesão medular é considerada um trauma que influencia todos os aspectos da vida, reduz as habilidades físicas e restringe a pessoa em suas tarefas diárias. Uma das principais conseqüências das lesões da medula espinhal é a mobilidade limitada, incluindo marcha e transferências. Objetivo: Descrever como o programa de exercícios físicos CIREN influencia a marcha e as transferências em pacientes com lesões da medula espinhal. Materiais e métodos: De acordo com o desenho metodológico, o tipo de estudo é experimental, e acordo com o método de estudo é observacional de acordo com o tempo de ocorrência dos fatos e registro de informações. Para o desenvolvimento da pesquisa, foi selecionada uma amostra de 15 pacientes com níveis de lesão entre T1 e T6 que preenchiam os critérios de inclusão. Resultados: Mudanças estatisticamente significativas na marcha e transferências foram observadas no grupo; por níveis de lesão, as lesões entre T1 e T6 não mostraram mudanças no gerenciamento de escadas e transferências do andar para a cadeira; por sexo, tanto homens quanto mulheres não mostraram mudanças estatisticamente significativas no gerenciamento de escadas e transferências do andar para a cadeira. Conclusões: O programa de exercícios utilizado na reabilitação de pacientes é eficaz na produção de mudanças nas atividades de marcha e transferência. O tempo de reabilitação deve ser aumentado para lesões acima de T6.

ABSTRACT Introduction: Spinal cord injury is considered a trauma that influences all aspects of life, reduces physical abilities and restricts the person in their daily work. One of the main consequences derived from spinal cord injury is the limitation at the level of mobility, which includes walking and transfers. Objective: To describe how the CIREN physical exercise program influences gait and transfers in spinal cord injured patients. Materials and methods: According to the methodological design, the type of study is experimental, according to the study method, it is observational taking into account the time of occurrence of the events and the recording of the information. For the development of the research, a sample of 15 patients with injury levels between T1 and T6 who met the inclusion criteria was selected. Results: Statistically significant changes in gait and transfers were observed in the group; by injury levels, injuries between T1 and T6 did not present changes in stair management and transfers from the floor to the chair; by sex, both men and women did not show statistically significant changes in stair handling and floor-to-chair transfers. Conclusions: The exercise program used in the rehabilitation of patients is effective in being able to produce changes in the activities related to walking and transfers. Rehabilitation time should be increased for injuries above T6.

Outcomes of spinal cord injury following cervical fracture in ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH): A prospective cohort study / Lesión medular cervical traumática en pacientes afectados de espondilitis anquilosante y DISH. Estudio comparativo prospectivo

Introduction The ankylosed spine is prone to increased fractures risk even after minor trauma. The lower cervical spine is most frequently injured, and fractures of the ankylosed spine tend to precipitate spinal cord injury (SCI). The objective of the current study is to assess the incidence, management, and outcomes of patients with ankylosis of the spine sustaining a cervical fracture with associated SCI over a 7-year period. Material and methods Prospective cohort study. Patients referred to the institution with a cervical fracture associated with SCI on a background of AS or DISH from 2009 to 2017 were reviewed. Demographics, mechanism of injury, fracture type, neurological level of injury, time to surgery, surgical management, neurological status (AIS), spinal cord independence measure (SCIMIII) scale at admission and discharge, and hospital length of stay. In September 2019 the summative data was analyzed using NDI, VAS, SV-QLI/SCI and length of survival were analyzed for statistical significance. Pathological fractures and dementia were excluded. Results 1613 patients with traumatic SCI were admitted in this period of whom 37 (12 AS and 25 DISH) met the inclusion criteria (mean age 65 years AS; 67 DISH). Fracture-dislocation was the most frequent fracture type (33% AS patients, 24% DISH patients). C4 was the most common neurological level of injury. SCIMIII score at admission was 1 point and 59 at discharge. AIS at admission was A (50%). At time of discharge no patient had neurologically deteriorated. Post-discharge mortality was 58% in AS patients and 32% in DISH patients (p=0.13).ConclusionsBoth AS and DISH patients have high levels of disability and mortality associated with trauma to the cervical spine... (AU)

Introducción Los pacientes afectados de espondiloartropatías son susceptibles de fracturas cervicales ante un traumatismo de baja energía, siendo la lesión medular una posible complicación devastadora. El objetivo del presente estudio es describir y evaluar la evolución de la lesión medular de estos pacientes con un seguimiento medio de 7 años. Material y métodos Estudio analítico longitudinal de cohortes prospectivo de pacientes afectados de espondiloartropatías ingresados en nuestro centro en el periodo del 2009 al 2017. Criterios de inclusión: diagnóstico de espondilitis anquilosante (EA) o hiperostosis idiopática difusa (DISH), fractura cervical, presencia de lesión medular. Ingreso en nuestro centro en el postoperatorio inmediato y edad superior al diagnóstico de 18 años. La presencia de demencia o fractura patológica se catalogaron como criterios de exclusión. Se han evaluado las variables de interés: edad, sexo, número de pacientes afectados de EA, DISH, mecanismo energético, tipo de fractura, tiempo hasta la cirugía, tipo de cirugía realizada, SCIM III ingreso/alta, nivel de lesión cervical, ASIA ingreso/alta, tiempo estancia, seguimiento en años. En septiembre del 2019 fueron nuevamente evaluados en consultas externas mediante: cuestionario de discapacidad cervical (NDI), escala visual analógica numérica, cuestionario de calidad de vida validado en castellano para lesionados medulares (QLI) y análisis de la supervivencia. Resultados Mil seiscientos trece pacientes afectados de lesión medular ingresaron en nuestro centro en el periodo de estudio, de los cuales 37 pacientes (12 EA y 25 DISH) cumplían los criterios de inclusión con una edad media de 65 años (EA) y de 67 años (DISH). La fractura luxación fue el tipo de fractura más prevalente (33% EA, 24% DISH). El nivel neurológico de lesión más prevalente tras la fractura cervical fue C4. El SCIM III al ingreso fue de 1 punto y de 59 puntos al alta. La escala ASIA al ingreso fue ASIA... (AU)

Outcomes of spinal cord injury following cervical fracture in ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH): A prospective cohort study.

INTRODUCTION: The ankylosed spine is prone to increased fractures risk even after minor trauma. The lower cervical spine is most frequently injured, and fractures of the ankylosed spine tend to precipitate spinal cord injury (SCI). The objective of the current study is to assess the incidence, management, and outcomes of patients with ankylosis of the spine sustaining a cervical fracture with associated SCI over a 7-year period. MATERIAL AND METHODS: Prospective cohort study. Patients referred to the institution with a cervical fracture associated with SCI on a background of AS or DISH from 2009 to 2017 were reviewed. Demographics, mechanism of injury, fracture type, neurological level of injury, time to surgery, surgical management, neurological status (AIS), spinal cord independence measure (SCIMIII) scale at admission and discharge, and hospital length of stay. In September 2019 the summative data was analyzed using NDI, VAS, SV-QLI/SCI and length of survival were analyzed for statistical significance. Pathological fractures and dementia were excluded. RESULTS: 1613 patients with traumatic SCI were admitted in this period of whom 37 (12 AS and 25 DISH) met the inclusion criteria (mean age 65 years AS; 67 DISH). Fracture-dislocation was the most frequent fracture type (33% AS patients, 24% DISH patients). C4 was the most common neurological level of injury. SCIMIII score at admission was 1 point and 59 at discharge. AIS at admission was A (50%). At time of discharge no patient had neurologically deteriorated. Post-discharge mortality was 58% in AS patients and 32% in DISH patients (p=0.13). CONCLUSIONS: Both AS and DISH patients have high levels of disability and mortality associated with trauma to the cervical spine. Despite their distinct clinical differences, in this cohort there were no statistically significant differences between AS and DISH patients regarding fracture type, SCIMIII, AIS, hospital stay, mortality, VAS, and SV-QLI/SCI after cervical fracture over 7 years follow-up.

Level of physical activity and its association with depression among chronic spinal cord injury patients at a paraplegic centre in Peshawar / Nivel de actividad física y su asociación con la depresión entre pacientes con lesión medular crónica en un centro para parapléjicos en Peshawar

Introduction: Spinal cord injury results in disability, limited participation in physical activities, and mental health problems which greatly affects the quality of life of the injured person. Engaging in physical activity is necessary for optimal recovery in individuals with spinal cord injury. Chronic spinal cord injury patients suffer from many secondary complications which become a challenge for the patient and the health care community to manage due to which recovery will be complex and difficult. The aim of this study is to find out the association of physical activity with depression among chronic spinal cord injury patients at Paraplegic Centre Peshawar.Material and methods: This study was a cross-sectional survey in which a consecutive sampling technique was used. Data was collected from n=109 spinal cord injury patients in which 85 (78.0%) were males and 24 (22.0%) were females. Physical activity was measured using the PARA-SCI scale and the CESD-R-10 questionnaire was used to assess depression.Results: The average minutes of participating in mild physical activity was 67.72 ± 17.98 minutes/week, moderate physical activity was 140.79 ± 33.47 minutes/week, heavy physical activity was 21.92 ± 9.18 minutes/week and total PA was 247.93 ± 55.76. P value= .004 for mild physical activity with depression, p value= .097 for moderate physical activity with depression, p value= .137 for heavy physical activity with depression and p value= .001 for total physical activity with depression.Conclusions: Mild and total physical activity was associated with depression. Moderate and heavy physical activity was not associated with depression. (AU)

Introducción: La lesión de la médula espinal produce discapacidad, participación limitada en actividades físicas y problemas de salud mental que afectan en gran medida la calidad de vida de la persona lesionada. La actividad física es necesaria para una recuperación óptima de las personas con lesión de la médula espinal. Los pacientes con lesiones crónicas de la médula espinal sufren muchas complicaciones secundarias que se convierten en un desafío para el paciente y la comunidad de atención médica debido a que la recuperación será compleja y difícil. El objetivo de este estudio es averiguar la asociación de la actividad física con la depresión entre los pacientes con lesiones crónicas de la médula espinal en el Centro Parapléjico de Peshawar.Material y métodos: Este estudio fue una encuesta transversal en la que se utilizó una técnica de muestreo consecutivo. Se recopilaron datos de n = 109 pacientes con lesión de la médula espinal, de los cuales 85 (78,0 %) eran hombres y 24 (22,0 %) eran mujeres. La actividad física se midió mediante la escala PARA-SCI y el cuestionario CESD-R-10 para evaluar la depresión.Resultados: El promedio de minutos de participación en actividad física leve fue 67,72 ± 17,98 minutos/semana, actividad física moderada 140,79 ± 33,47 minutos/semana, actividad física intensa 21,92 ± 9,18 minutos/semana y AF total 247,93 ± 55,76. Valor de p= .004 para actividad física leve con depresión, valor de p= .097 para actividad física moderada con depresión, valor de p= .137 para actividad física intensa con depresión y valor de p= .001 para actividad física total con depresión.Conclusiones: La actividad física leve y total se asoció con la depresión. La actividad física moderada e intensa no se asoció con la depresión. (AU)