Sessions I
O01
Abstract #: 146.00
Authors: Dr. Vivek Mittal, Dr. Harvinder Chhabra, Dr. Gururaj Sangondimath
Title: Acute outcomes of cervical spine injuries in the elderly
Study Design: Retrospective database review of all traumaticcervical spine injuries in patients of and above 65 years of age at single center.
Summary of Background Data: Elderly patients with cervicalspine injuries have historically suffered from high morbidity and mortality rates treated either conservatively or operatively.
Methods: Twenty four patients between 2002 and 2010, more than 65 years of age were identifiedand hospitalization records reviewed. Patients were divided by age into young (65- 74 years) and old (75 or more) elderly groups. Sex distribution, mechanism, injury type, ICU stay duration, radiographic findings, neurological deficit, comorbidities , type of management and mortality and complications rates were studied.
Results: 16 patients were young elderly and 8 old elderly. 22 were males. 8 had suffered road traffic accident, 16 had a fall. C5-6 and C6-7 were the most common injured levels.15 patientswere complete. Majority of the patients had comorbid medical conditions.17 patients underwent surgery. Pulmonary complications were the most frequent. 5 patients died while in hospital.
Conclusions: This study highlights the fact of high morbidity and mortality rates in geriatric patients with cervical spine injuries.
O02
Abstract #: 70.00
Authors: Dr. Amrithlal Mascarenhas, Dr Pradeep Singh, Dr Harvinder Chhabra
Title: A prospective randomised study on the outcome of three different surgical methods of management in thoracolumbar burst fracturs with neurological deficit.
Purpose: There is no prospective-randomised study in literature comparing the results of posterior fixation, anterior fixation and combined anterior-posterior fixation in thoracolumbar burst fractures having neurological deficit.
Materials and Methods:Single-level AO-A3 fractures of thoracolumbar junction with neurologic deficit participated in our prospective-randomized study.
Patients were divided into two broad treatment groups based on the load-sharing classification and subsequently randomised. Clinico-radiological follow-up was at 3,6,12and 24months. Bridwell-criteria and Tan-criteria were used to assess fusion.
Results: These are the early results of an ongoing study with follow-up of 6-24 months. Of the 29 cases anterior-surgery was done in 11, posterior-surgery in 4 and combined-surgery in 14 cases. Average preoperative, postoperative and follow-up Cobb-angle was 17.1±6.97,7.55±6.17and16.76±10.05degrees. The average preoperative and follow-up canal-compromise was 51.91±21.09 and 8.86±8.33. Spinal Cord Independence measure improved from 67.83±16.98to76.9±18.35. Improvement in neurology by 0- 3 ASIA-grades noted. The average VAS score was 7.3 at presentation and 0.69 at follow-up. Duration and blood loss was least in posterior surgery. Two cases developed incisional hernias following anterior approach.
Conclusion: Anterior-surgery promotes neurological recovery with least correction loss but more complications. No technique can maintain the postoperative correction of kyphosis. No correlation between kyphosis and pain-functional ability noted. Combined surgery has no additional benefit.
O03
Abstract #: 102.00
Authors: Dr. Ramaswamy Pankajam Hariharan, Mr. Jamil Firas, Mr. Wajid Raza
Title: Spinal epidural abscess: experience from a regional spinal injuries centre
Purpose of the study: Highlight the importance of early recognition/diagnosis of Spinal Epidural Abscess presenting as Back pain.
Methods: Retrospective analysis of clinical data from medical records of 19 patients admitted to a Regional spinal injuries centre in UK, between Oct 2006 and March 2010.
Information collected included age, sex, risk factors, Neurology at presentation & discharge, time between onset of symptoms and intervention, site of the abscess and management.
Results: Review of 19 patients revealed 84% of pts. between 30-70 yrs of age and 74% men. 74% had some kind of risk factors and the remaining did not have any documented. Majority [89%] had incomplete lesions [ASIA B, C, D] and except 1 patient, remaining [95%] had surgical intervention. In 68% SEA was located posterior and in the 2 patients with Tuberculosis it was anterior. Time between onset of symptoms and intervention varied from few hours to maximum of 2 weeks [21%].
Conclusions: This study highlights the importance of having high index of suspicion when somebody, especially middle aged, presents with back/interscapular pain.
Triad of Back pain, Fever & neurological deficits, suspect SEA
The problem with SEA lies not in the treatment but on early recognition and diagnosis.
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Session II
O04
Abstract #: 183.00
Authors: Dr. Pia Moeller Faaborg, Mr. Peter Christensen, Dr. Mona Rosenkilde,
Professor Saren Laurberg, Dr. Klaus Krogh
Title: Do gastrointestinal transit times and colonic dimensions change with time since SCI?
Purpose: To determine whether gastrointestinal transit times (GITT) and colonic dimensions change during the first or subsequent decades after spinal cord injury (SCI).
Methods: GITT and colonic dimensions were evaluated by means of radio-opaque markers and abdominal x-rays. Group A (n= 12) was investigated one year after SCI and again 13 (range 11-14) years later. Group B (n=10) was studied 19 (range 9-36) years post injury and again 12 (range 11-12) years later. All had been treated with conservative bowel management.
Results: In group A, the median GITT one year post-injury was 4.3 (range 1.1-6.5) days and 13 years later it was 2.9 (range 1.3-6.5) days, p=0.62. In group B, the median GITT 19 years post-injury was 2.4 (range 0.6-5.9) days and 12 years later it was 3.5 (range 1.9-5.5) days, p=0.28. None of the two groups experienced a significant change in the diameter of the caecum/ascending colon, transverse colon, descending colon or the sigmoid during long-term follow-up. Megacolon was present in 4 patients at base-line and in 5 at follow-up.
Conclusion: Gastrointestinal transit times and colonic dimensions did not change, neither during the first decade nor long after SCI.
O05
Abstract #: 57.00
Authors: Prof. Lisa Harvey, Dr Che Fornusek, Prof Glen Davis, Jocelyn L Bowden, Nick Pontifex, Joanne Glinsky, James Middleton, Simon C Gandevia
Title: Electrical stimulation combined with progressive resistance training increases strength in people with SCI
The purpose of this study was to determine the effectiveness of electrical stimulation (ES) superimposed on progressive resistance training for increasing voluntary strength in the quadriceps muscles of people with spinal cord injuries (SCI). A randomised controlled trial was undertaken in which 20 people with established SCI and neurologically-induced weakness of the quadriceps muscles were randomised between experimental and control groups.
Participants in the experimental group received ES superimposed on progressive resistance training to the quadriceps muscles of one leg three times a week for eight weeks.
Participants in the control group received no intervention. Assessments occurred at the beginning and at the end of the eight-week period. The four primary outcomes were voluntary strength (Nm) and endurance (fatigue ratio) as well as the performance and satisfaction items of the Canadian
Occupational Performance Measure (COPM; points). The between-group mean differences (95% confidence interval) for voluntary strength and endurance were 14 Nm (1 to 27; p = 0.034) and 0.1 (-0.1 to 0.3; p = 0.221), respectively. The between-group median differences (95% confidence interval) for the performance and satisfaction items of the COPM were 1.7 points (-0.2 to 3.2; p = 0.103) and 1.4 points (-0.1 to 4.6; p = 0.058), respectively. ES superimposed on progressive resistance training improves voluntary strength, although there is uncertainty about whether the size of the treatment effect is clinically important. The relative effectiveness of ES and progressive resistance training is yet to be determined.
Sponsorship: NSW Office for Science and Medical Research.
O06
Abstract #: 49.00
Authors: Prof. Amiram Catz, Mr. Tal Galili, Ms. Tami Polliack, Dr. Vadim Bluvshtein, Ms. Malka Itzkovich, Prof. Jacob Hart, Prof Yoav Benjamini
Title: Non linear formulas for the spinal cord injury ability realization measurements index (SCI-ARMI)
Background: SCI-ARMI assesses rehabilitation potential and efficacy based on linear relationship between SCIM III and AIS motor scores (AMS).
Objective: Develop new SCIA-RMI formulas, not necessarily linear and not sensitive to the number of SCI patients available for AMS.
Methods: SCIM III and AMS of 185 Israeli SCI patients were monitored. A method was developed to estimate the 95-percentile of SCIM III values for patients with given AMS. The method allows linear, quadratic, or nonparametric relationship between the two, and a check of their quality. SCIM95 equations specify the SCIM III score that 95% of patients with similar AMS can achieve (only 5% of them can achieve higher).
Results: For the study group, quadratic formulas for SCIM95 were found to be appropriate for calculation of the total SCIARMI score and of the scores for self-care, respiration and sphincter management, and mobility.
Conclusions: The new formulas improve the accuracy of calculated ability realization for any AMS. The new statistical procedure will be used for upcoming data analysis of a larger scale international SCIARMI study.
O07
Abstract #: 107.00
Authors:Mr. Joost J. van Middendorp, Dr. Allard J.F. Hosman, Mr. Martin H. Pouw, Dr. A. Rogier Donders, Dr. Alexander C.H. Geurts, Dr. Armin Curt, Dr. Hendrik Van de Meent
Title: To walk or not to walk? Introduction of a validated clinical prediction rule and grading system for independent ambulation outcomes in traumatic SCI: a European multicenter study
Objective: To develop and validate a clinical prediction rule based on neurological findings in the acute phase of traumatic SCI predicting chronic phase ambulation outcome.
Design, Setting, and Patients: In a prospective European multicenter study 640 adult acute traumatic SCI patients were included. A prediction rule was developed on the basis of regression coefficients of age and four neurological predictors derived from the International standards in a multivariate logistic regression model. Model performances were quantified with respect to discrimination (area under receiver operating characteristics curve, AUC). An additional temporal validation was performed.
Outcome Measure: The ability to walk independently 1-year post-injury.
Results: A combination of age, MRC scores of key muscles innervated by myotomes L3 and S1, and light touch sensory scores of dermatomes L3 and S1 showed an excellent discriminating ability in distinguishing independent from dependent and non-walkers (AUC:0.956, P<0.001, 95% CI:0.936 - 0.976)
Temporal validation confirmed the excellent discriminating ability (AUC:0.967, P<0.001, 95% CI:0.939 - 0.995).
Conclusions: Based on age and four simple neurological tests, a clinical prediction rule for acute traumatic SCI patients accurately predicts chronic phase ambulation outcome. Until clinically effective therapies become available, this rule could be used to counsel individual patients and formulate individual rehabilitation programs.
O08
Abstract #: 251.00
Authors:Mrs. Sacha van Langeveld, Marcel W. Post, Floris W. van Asbeck, Mel Gregory, Annette.Halvorsen, Hennie Rijken, Jacqueline Leenders, Karin Postma, Eline Lindeman
Title: Comparing contents and quantity of therapy for pateints with a SCI in postacute rehabilitation in Australia, Norway and the Netherlands
Purpose: To present differences and similarities in therapy to improve mobility and self-care for patients with SCI in postacute rehabilitation in different countries.
Method: Seventy-three physical, occupational and sports therapists in the Netherlands, Australia, and Norway documented all therapy for patients with a recent SCI in during 4 consecutive weeks. To describe specific contents and quantity of treatments therapists used the Spinal Cord Injury-Interventions Classification System (SCI-ICS). The SCI-ICS is a multidisciplinary tool comprising 3 levels (body functions, basic activities, and complex activities), 25 categories and a total of 139 interventions.
Results: Seventy-three therapists recorded 2526 treatments of 79 patients with SCI (Netherlands 48, Australia 20, and Norway 11). Most therapy time was spent on 'Muscle Power' (all countries), 'Muscle length' (Norway), 'Walking' (Netherlands), and 'Transfers' (Australia). The mean time in minutes per treatment (Netherlands, 28; Australia, 43; and Norway, 39), and the total time per patient per week in hours (Netherlands, 4.3; Australia, 5.8; and Norway, 6.2) differed significantly.
O09
Abstract #: 50.00
Authors: Dr. Lawrence Vogel, Dr. Peter Sturm, Jennifer Schottler
Title: SCI in children injured at five years of age and younger
Purpose: Describe the epidemiology and complications of spinal cord injuries (SCI) in children injured at 5 years of age and younger.
Methods: Medical record review of 159 patients injured at 5 years of age and younger from one pediatric SCI program was performed. Complications studied included scoliosis, hip dysplasia, deep venous thrombosis, stones, pressure ulcers, autonomic dysreflexia, latex allergies. Age at initiation of wheelchair use, wheelchair type and amount of assistance needed was reviewed. Finally, information about intermittent catheterization (IC) and bowel program (BP) was reviewed.
Results: Median age of injury was 2 years, 58% were male, 49% were injured in vehicular incidents with 77% not being in a child restraint, 60% had complete lesions, 66% had paraplegia, 72% had SCI without radiologic abnormalities (SCIWORA). 97% developed scoliosis, 57% had hip dysplasia, 7%
had latex allergy, 34% with T6 or higher lesions experienced autonomic dysreflexia, 41% developed pressure ulcers, and 61% experienced spasticity. 66% of patients were on IC program and 58% were on a BP; median age that patients became independent with IC program was 8.25 years and 11.75
years for BP. Median age when wheelchair use was initiated was 3.4 year and 94% were independent in propulsion. 23 (15%) subjects were community ambulators, and they exhibited a lower rate of complications.
Conclusion: The epidemiology, complications and manifestations of SCI in children injured at a young age are unique.
O10
Abstract #: 104.00
Authors: Mr. Ralph Marino, S Burns, B Leiby, D Graves, S Kirshblum, D Lammertse
Title: Neurological recovery after traumatic cervical SCI
Purpose: Report neurological recovery in persons with traumatic tetraplegia included in the United States Spinal Cord Injury Model Systems (SCIMS) from 1994-2009.
Methods: Records of 715 subjects with tetraplegia, over age 15, admitted ≤7 days were analyzed for change in ASIA Impairment Scale (AIS), upper and lower extremity motor scores (UEMS, LEMS), and motor level (ML) from time of injury to 1 year.
Results: The sample was 79% male. Main etiologies were vehicular accidents (48%), falls (26%), sports (12%) and violence (11%). For AIS-A subjects, 30% converted to incomplete (≥AIS-B) by one year; 15% to motor incomplete. Conversion to motor incomplete was not related to timing of initial exam or ML. For AIS-B subjects, 30% became AIS-C and 37% AIS-D. Most AIS-C subjects (83%) improved. For AIS-A with ML C4-7, mean UEMS gain was 9-11 points; for ML C1-3 and C8-T1 gain was 2-3 points. The ML did not improve in 35%, improved one level in 40%, ≥two levels in 25%. Longer motor ZPPs were associated with gaining ≥2 ML (p<.001).
Conclusion: This update on neurological outcomes from the US National SCI database adds to the understanding of prognosis for recovery and will be helpful for clinical trial planning.
O11
Abstract #: 126.00
Authors: Dr. Gururaj sangondimath, Dr Harvinder singh Chhabra, Dr Vikas Tandon, Dr Ankur Nanda, Dr Vivek mittal,
Title: Study of septic arthritis of hip joint in spinal injury patients as a complication of bed sore
Objective:
To report septic arthritis of hip as one of the rare but serious complications of bed sores around the hip joint and sacrum in spinal injury patients and to stress upon the importance of regular screening of hip joint for this morbid complication.
Methods:
Totally 120 patients with bed sores of various grades where followed up in two years period and found septic arthritis of hip in eight patients treated with girdle stone arthroplasty.
Results:
Of the 120 patients eight cases (6.6%) of septic arthritis of the hip were found. In 5 cases the diagnosis was only made as incidental finding .The treatment combined antibiotic therapy with resection of the head and neck with secondary rotation flap for bed sore gave good results in seven out of eight patients(87%).One patient required repeated debridement because of persistent infection(12%).One patient recovered fully with only antibiotics as the infection was not florid(12%).
Conclusions:
Regular screening of hip joint for the septic arthritis should be done in these patients to avoid significant morbidity and negative effect on rehabilitation.
MRI is the best non- invasive tool. Girdlestone arthroplasty with soft-tissue coverage is a successful treatment of septic arthritis hip joint with bed sore.
O12
Abstract #: 77.00
Authors: Dr. Amish Sanghvi, Dr. Harvinder Singh Chhabra
Title: Thoracic myelopathy due to ossification of ligamentum flavum: predictors of surgical outcome
Introduction: Despite good posterior decompression of thoracic myelopathy due to ossification of ligamentum flavum(OLF), recovery rate(RR) varies widely.
Methods: Retrospective analysis of various clinical and magnetic resonance imaging(MRI) parameters with postoperative recovery in 25 patients who underwent decompressive laminectomy for thoracic myelopathy due to OLF with mean postoperative followup of 30.3 months. Patients were assessed using JOA scale and RR was calculated.
Results: With Pearson correlation, RR significantly correlated with preoperative duration of symptoms, JOA score, sensory JOA score, canal grade, dural canal-body ratio(DCBR), intramedullary signal size(ISS), and intramedullary signal type(IST) on MRI. Two types of signals were identified; normal in T1/hyperintense in T2 representing cord edema and hypointense in T1/hyperintense in T2 representing cystic changes. Presence or absence of signal changes didn't correlate with RR; but whenever present, ISS>15mm significantly compromised recovery. Multiple regression analysis(MRA) identified preoperative duration of symptoms and preoperative ISS as significant predictors of postoperative outcome. Based on MRA, we formulated a multiple regression equation to predict RR as:Predicted RR=83.4+(0.1×Age in years)-(0.7×preoperative duration of symptoms in months)+(1.5×preoperative JOA score)+(0.2×preoperative canal grade in percentage)-(2.5×ISS in mm)-(1.5×IST in grade).
Conclusion: Predictors of postoperative recovery are preoperative duration of symptoms and ISS. Postoperative recovery can be predicted by formulated equation.
O13
Abstract #: 214.00
Authors: Dr. Yuying Chen, Dr. Obianuju Okonkwo, Dr. Yue Cao, Dr. Michael DeVivo
Title: Racial/ethnic disparities in mortality and causes of death in persons with SCI
Objective: Examine racial/ethnic differences in mortality and causes of death among persons with spinal cord injury (SCI).