Spinal Cord Injury Update

Summer 2006: Volume 15, Number 2

Literature Review: 10 abstracts on SCI topics

Topics:

Genitourinary:

Urolithiasis in patients with spinal cord injuries: risk factors, management, and outcomes. Despite major advances in the urological care of SCI patients, the incidence of urolithiasis (kidney stones) has not changed. Risk factors include recurrent urinary tract infections, indwelling catheters, vesicoureteral reflux, and immobilization hypercalcuria. Retrograde endourologic techniques are often not a viable treatment for stone disease due to lower extremity contractures, spinal curvature, and pelvic tilt. Extracorporeal shockwave lithotripsy success rates vary from 50 to 90%, but clearance rates are often delayed. Success rates for percutaneous nephrolithotomy match those quoted in the general population ( > 90%), but have a higher rate of complications (6-20%). Appropriate prophylactic antibiotics and body position can improve chances of successful outcomes. Routine genitourinary imaging of SCI patients is recommended in order to identify and treat those individuals at highest risk, with the goal of preserving renal function and minimizing associated complications.
Ost MC, Lee BR.
Curr Opin Urol. 2006 Mar;16(2):93-9.
Penile prosthetic surgery in neurologically impaired patients: long-term followup. Between 1980 and 1996, 245 neurologically impaired men between age 16 and 75 (mean age 40.8) were treated for erectile dysfunction and/or urinary incontinence with penile prosthesis implantation. The subjects had been paralyzed an average of 11.2 years (range 1 to 52 years). Over 17 years, surgical implantations in this population consisted of 147 semirigid (Jonas), 113 self-contained inflatable (Dynaflex) and 33 inflatable 3-piece ( AMS 700) prostheses. Reasons for implants were: urinary management only (134 patients); erectile dysfunction only (60 patients); and urinary management and erectile dysfunction (51 patients). At a mean followup of 7.2 years (maximum 17) 195 patients were reevaluated in clinic. In 122 patients (90.3%) urinary management problems were resolved. Erectile dysfunction treatment was successful in 76 patients (82.6%). There were 43 revisions for technical reasons and infections. The infection rate was 5% (12 patients). The perforation rate differed depending on the specific device implanted. The implantation of a penile prosthesis was found to be a safe procedure for erectile dysfunction and/or urinary incontinence in neurologically impaired patients. Based on technical advances the complication rates significantly decreased during the years of the study.
Zermann DH, Kutzenberger J, Sauerwein D, et al.
J Urol. 2006 Mar;175(3 Pt 1):1041-4; discussion 1044.

Females With SCI:

Disease prevalence and use of preventive services: comparison of female veterans in general and those with spinal cord injuries and disorders.
A cross-sectional survey was conducted among female veterans with (n = 115) and without (n = 478) SCI&D. Female veterans with SCI&D were similar in age and race but were better educated and less likely to be employed than female veterans in general. Coronary heart disease prevalence was higher (17% vs. 8%) and health status was lower (27% vs. 41%) in those with SCI&D than those without. Fewer women with SCI&D reported having received recommended dental care (56% vs. 69%), colon screening in prior 5 years (59% vs. 72%) or prior 10 years (67% vs. 92%), mammogram (84% vs. 91%), and Pap smear (88% vs. 98%). There were no differences in receipt of respiratory vaccinations or cholesterol screening. The researchers concluded that women with SCI&D were less likely to receive services requiring the use of equipment, body adjustments, and potential discomfort due to disability than the general group. Efforts to increase preventive care in women with SCI&D should address equipment and access barriers and patient and provider education.
Lavela SL, Weaver FM, Smith B, Chen K.
JWomens Health (Larchmt). 2006 Apr;15(3):301-311.

Pediatrics:

Stability of transition to adulthood among individuals with pediatric-onset spinal cord injuries.
One hundred sixty-six individuals who had sustained an SCI at age 18 years or younger were interviewed at age 24 years or older in 3 consecutive annual interviews using the Functional Independence Measure, Craig Handicap Assessment and Recording Technique (CHART), Short-Form 12 measure of perceived health, and the Satisfaction with Life Scale. Of this group, 64% were living independently at the first interview, and 90% of those continued to live independently; 64% were employed at first interview, of which 83% continued to be employed; and 48% reported life satisfaction at the first interview, and 84% of these continued to be satisfied. Factors most closely associated with stable independent living were physical independence, mobility, and occupation. Factors associated with stable employment were sex, race, independent living, mobility, and cognitive independence. Factors associated with stable life satisfaction were occupation and fewer pressure ulcers. Understanding the factors associated with successful adult outcomes can help us improve rehabilitation for future patients.
Anderson CJ, Vogel LC, Willis KM, Betz RR.
J Spinal Cord Med. 2006;29(1):46-56.

Respiratory

Effect of neuromuscular electrical stimulation on cough capacity and pulmonary function in patients with acute cervical cord injury.
Twenty-six patients with complete SCI between C4 and C7 and within three months of injury were randomly assigned to receive a conventional program of SCI rehabilitation, either with or without the addition of neuromuscular electrical stimulation (NMES) therapy (13 control subjects, 13 NMES subjects). NMES was applied to the clavicular portion of the pectoralis major and abdominal muscle over a 30-minute period daily, five days a week, for four weeks. Pulmonary function tests were performed before and after therapy, and at 3 months and 6 months follow-up, and pulmonary complications during this 6-month follow-up period were also recorded. After the 4-week therapy, and at 3 months and 6 months follow-up testing, patients in the NMES therapy group displayed significant improvement in their peak expiratory flow, forced expiratory volume in 1 second, forced vital capacity, maximal expiratory pressure and maximal inspiratory pressure, compared with those in the control group. In addition, patients in the NMES therapy group had fewer pulmonary complications in the follow-up period than controls.
Cheng PT, Chen CL, Wang CM, Chung CY.
J Rehabil Med. 2006 Jan;38(1):32-6.

Review Article on Cannabis

Cannabinoids in medicine: A review of their therapeutic potential.
A review and meta-analysis of research on the therapeutic potential of cannabinoids (marijuana chemicals), published to July 1, 2005, in three languages, identified 72 controlled studies evaluating cannabinoids as a treatment for pain, spasticity and nausea, in several disease and disability categories. Three controlled studies on SCI were identified, all on five or fewer patients. These found that cannabinoids administered in sublingual (under the tongue) spray may, in some patients, lead to an improvement in spasticity, pain, vesical dysfunction and sleep quality. New formulations for administering and delivering cannabinoids are currently under investigation to reduce undesirable side effects and maximize benefits.
Ben Amar M.
J Ethnopharmacol. 2006 Apr 21;105(1-2):1-25. Epub 2006 Mar 15.

Osteoporosis

Electrically induced muscle contractions influence bone density decline after spinal cord injury.
Six individuals with complete SCI between C5 and T12 and within 4.5 months of injury participated in a training program consisting of electrical stimulation applied to the plantar flexor (tibia) muscles of one leg only, four times per day for three years. The opposite leg served as a within-subject control. Compliance with the training program was very good (> 80%). Compressive force on the tibia from the protocol was > 140% of body weight. Dual Energy X-ray Absorptiometry scans before, during and at the end of training revealed that bone mineral density (BMD) declined significantly less in the trained tibia (approx. 10%) than in the untrained limb (approx. 25%) and both hips. Lumbar spine BMD showed minimal change. Important features of this program were the early start date (less than 4.5 months after injury), high compressive force (more than 150% of body weight), high dose (about 1,680 contractions per week), and long duration (average 2.5 years of training). Weight bearing slows but doesn't eliminate bone loss.
Shields RK, Dudley-Javoroski S, Law LA.
Spine. 2006 Mar 1;31(5):548-53.

Syringomyelia

Cordectomy for the treatment of posttraumatic syringomyelia. Report of four cases and review of the literature.
Cordectomy (cutting the spinal cord) is an effective treatment option in patients with complete SCI who develop posttraumatic syringomyelia. While newer developments have drawn the attention of surgeons and researchers away from cordectomy, the authors encourage a reconsideration of cordectomy for the treatment of posttraumatic syringomyelia in this population. They describe four patients who, after cordectomy, exhibited improvements in their preoperative neurological deficits and remained stable at follow-up examinations between two and ten years later. A literature review indicated that neurological improvement or stabilization occurred in 88% of patients in published reports of posttraumatic syringomyelia treated with cordectomy.
Laxton AW, Perrin RG.
J Neurosurg Spine. 2006 Feb;4(2):174-8.

Weight-Supported Treadmill Training

Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI.
A total of 146 subjects within 8 weeks of SCI from six regional centers were entered in a single-blinded, multicenter, randomized clinical trial to receive 12 weeks of either step training with body weight support on a treadmill (BWSTT) with over-ground practice or a defined over-ground mobility therapy (control). Subjects had incomplete ( ASIA B, C, or D) injuries between C5 and L3, and a Functional Independence Measure for locomotion (FIM-L) score less than 4 (i.e., unable to walk without assistance). Primary outcome measures were FIM-L (for ASIA B and C subjects) and walking speed (for ASIA C and D subjects) 6 months after SCI. No significant differences in these outcomes were observed between those who received BWSTT versus controls. This finding was partly due to the unexpectedly high percentage of ASIA C subjects who achieved functional walking speeds, irrespective of treatment. The results did not support the expectation that BWSTT would be more effective than the defined over-ground mobility therapy.
Dobkin B, Apple D, Barbeau H, et al.
Neurology. 2006 Feb 28;66(4):484-93.

Comparing Researcher and Consumer Perspectives

A Web-based systematic review on traumatic spinal cord injury comparing the "citation classics" with the consumers' perspectives.
The number of times an article is cited in the medical literature is an indication of its impact on the scientific community. The 100 top-cited articles on traumatic SCI published between 1986 and 2003 were identified using the Internet database of the Science Citation Index Expanded and the Web of Science were analyzed and compared to the areas of greatest interest among people with SCI based on surveys. At least 51% of the top 100 top-cited articles were focused on motor function, which was of concern in 62.7% of the survey responses. Other concerns reported by SCI consumers were bladder (44.9%), bowel (43.5%), sexual (42.1%) and pain (37.2%) problems, while only 8% of the 100 top scientific articles were focused on these areas of interest. The 100 top-cited SCI articles have been predominantly focused on basic science SCI research, indicating a need for greater bench-to-bedside translational studies. Although the majority (63%) of this literature matches with the consumers' perspective, most of this research has been focused on motor function assessment and recovery following SCI.
Furlan JC, Fehlings MG.
J Neurotrauma. 2006 Feb;23(2):156-69.