Literature Review

The articles previewed below were selected from a recent screening of the National Library of Medicine database for articles on spinal cord injury. In the judgement of the editors, they include potentially useful information on the diagnosis or management of spinal cord injury. You may obtain copies of the complete articles through your local medical library or from UW Health Sciences Library Document Delivery Service (call 206-543-3436 for fee schedule).

Contents:

Complications | Genitourinary | Rehab Care | Other

Complications:

1. Acupuncture as a promising treatment for below-level central neuropathic pain: a retrospective study.
   In a retrospective chart review of 36 inpatients with SCI and below-level central neuropathic pain (diffuse pain characterized by generalized burning) of between 2-week and 15-year duration who received an electroacupuncture protocol for pain, 26 patients showed improvement after treatment. Pain ratings were assessed using an 11-point visual analog scale before the first acupuncture treatment and compared to ratings at discharge. Type of injury, level of injury, and duration of below-level central neuropathic pain was not correlated with improvement. However, patients with burning pain that was bilateral, symmetric, and constant were the most likely to improve. Patients experienced noticeable benefits quickly (usually by the third treatment) and had no adverse effects.
   Rapson LM, Wells N, Pepper J, et al.
   J Spinal Cord Med. 2003 Spring;26(1):21-6
   
2. Healthy body mass index values often underestimate body fat in men with spinal cord injury.
   Body mass index (BMI) (kg/m(2)) and dual-energy x-ray absorptiometry measures of total and regional lean tissue mass and fat mass were measured in 19 men with traumatic SCI and 19 age-, height-, and weight-matched able-bodied controls. Although the groups had similar BMIs, total lean tissue mass was 8.9kg lower, total fat mass was 7.1kg greater, and body fat percentage was 9.4% greater in the SCI group. Regional measures showed a similar pattern. Many patients with SCI do not appear to be obese yet carry large amounts of fat tissue. A healthy BMI may mask excessive adiposity in people with SCI.
   Jones LM, Legge M, Goulding A.
   Arch Phys Med Rehabil. 2003 Jul;84(7):1068-71
   
3. Prevention of venous thromboembolism in the rehabilitation phase after spinal cord injury: prophylaxis with low-dose heparin or enoxaparin.
   In a prospective, nonrandomized, multicenter study, 119 subjects received either low-dose unfractionated heparin (UFH) or enoxaparin for prophylaxis against venous thromboembolism (VTE) during the rehabilitation phase after SCI. After 2 weeks of acute-phase prophylaxis, patients without objective evidence of VTE entered the rehabilitation phase and received up to 6 additional weeks of thromboprophylaxis with either UFH 5,000 U every 8 hours or enoxaparin 40 mg once daily. Repeat bilateral lower extremity duplex ultrasonography found new VTE in 13 of 60 UFH versus 5 of 59 enoxaparin patients (21.7% vs. 8.5%). While both interventions were safe, enoxaparin appeared more effective than heparin in the prevention of thromboembolic complications during rehabilitation after SCI.
   Merli G
   J Trauma. 2003 Jun;54(6):1111-5.
   
4. Prevalence of vitamin B12 deficiency in spinal cord injury
   Fasting blood samples were obtained at annual evaluation for serum B12, folic acid, methylmalonic acid (MMA), and homocysteine in 106 adult men with SCI or SCD seen at a regional Veterans Affairs SCI Service. Vitamin B12 deficiency was found in 5.7% of subjects by subnormal serum B12 level and in 19% by supranormal serum MMA level. Most (67%) had symptoms suggestive of B12 deficiency. Vitamin B12 deficiency was most commonly associated with middle age (40-59 years); complete or near-complete injury; long duration of SCI; and tetraplegia. Given the possible risk of irreversible neuropsychiatric deficits, low cost of screening, and high efficacy of high-dose B12 replacement, screening and early treatment of B12 deficiency is recommended.
   Petchkrua W, Burns SP, Stiens SA, et al.
   Arch Phys Med Rehabil. 2003 Nov;84(11):1675-79
   
5. Do spinal cord injuries adversely affect serum lipoprotein profiles?
   Sixty persons with SCI (46 men; 14 women; mean age, 28.1 years) were matched for age and sex with 28 non-injured controls. Serum low-density lipoprotein cholesterol level was significantly higher in subjects with SCI than in controls and serum high-density lipoprotein cholesterol level was lower. Apolipoprotein A-I level was significantly lower in the SCI group compared with controls and apolipoprotein B level was significantly higher. Results show that serum lipoprotein level should not be ignored for the follow-up of the patients with SCI.
   Ozgurtas T, Alaca R, Gulec M, et al.
   Mil Med. 2003 Jul;168(7):545-7.

Genitourinary:

1. A protocol of electroejaculation and systematic assisted reproductive technology achieved high efficiency and efficacy for pregnancy for anejaculatory men with spinal cord injury.
   Ten men with traumatic SCI (9 with paraplegia; 1 with tetraplegia; mean years since injury 11; mean age 33) underwent assisted reproductive technology for infertility. One couple achieved pregnancy after the second cycle of electroejaculation and intrauterine insemination. Seven couples underwent 8 cycles of intracytoplasmic sperm injection (ICSI): 4 with fresh electroejaculates; 2 with cryopreserved samples; and 2 with cryopreserved samples with added pentoxifylline. Seven (88%) clinical pregnancies occurred, one from ICSI with cryopreserved sperm from vasal aspiration. Fertilization and pregnancy rates from ICSI cycles using sperm from men with SCI were comparable to men without SCI. The cumulative successful pregnancy rate per couple was 80% (8/10).
   Shieh JY, Chen SU, Wang YH, et al.
   Arch Phys Med Rehabil. 2003 Apr;84(4):535-40
   
2. A 7-year follow-up of sacral anterior root stimulation for bladder control in patients with a spinal cord injury: quality of life and users' experiences.
   Thirty-seven patients with complete SCI who had sacral anterior root stimulation (SARS) implanted between 1987 and 2000 responded to a questionnaire about complications, technical failures and personal experiences. Respondents reported decreased infection rate (68%), improved social life (54%), and complete daytime (54%) and nighttime (70%) continence. SARS is effective and safe for neurogenic bladder management in patients with complete SCI and seems to reduce the effects of urinary-disorder-specific quality of life (QoL) aspects and to increase QoL in general.
   Vastenholt JM, Snoek GJ, Buschman HP, et al.
   Spinal Cord. 2003 Jul;41(7):397-402
   
3. Effect of controlled-release oxybutynin on neurogenic bladder function in spinal cord injury.
   A 12-week, prospective, open-label dose-titration study of extended-release oxybutynin enrolled 10 subjects with complete and incomplete SCI who had urodynamically defined detrusor hyperreflexia. Following a 7-day washout period, subjects were evaluated via video-urodynamic study and treatment was initiated at a dosage of 10 mg per day. Dosage was increased in weekly intervals to a maximum of 30 mg per day. Micturation frequency diaries and urodynamics were completed at baseline and repeated at week 12. Tolerability information was collected at each follow-up visit. Participants reported decreased urinary frequency and fewer incontinence episodes with oxybutynin therapy following titration to 30 mg per day. All subjects chose a final effective dosage of greater than 10 mg, with 4 taking the maximum of 30 mg per day. Mean cystometric bladder capacity increased from 274 mL to 380 mL. Onset of clinical efficacy occurs within 1 week, and daily dosages up to 30 mg are well tolerated.
   O'Leary M, Erickson JR, Smith CP, et al.
   J Spinal Cord Med. 2003 Summer;26(2):159-62.

Rehabilitation Care:

1. Satisfaction with upper-extremity surgery in individuals with tetraplegia.
   Sixty-seven individuals with SCI between C4 and C8 responded to a mailed survey measuring satisfaction with upper-extremity reconstructive surgery to improve function. Procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis. Participants were generally satisfied with the results of their upper-extremity surgery (70%) and reported a positive impact on their lives (77%), improvements in activities of daily living (68%), improved independence (66%), improvement in occupation (69%), and improved appearance or neutral (71%). They also reported that postoperative therapy was beneficial (86%).
   Wuolle KS, Bryden AM, Peckham PH, et al.
   Arch Phys Med Rehabil. 2003 Aug;84(8):1145-9.
   
2. Effects of a wheelchair ergometer training programme on spinal cord-injured persons.
   Seven males with T6-L5 SCI (ages 21-55, time since injury 1-30 years) performed 45 minutes of wheelchair ergometry three times per week, for 6 weeks. Training resulted in significant improvements in maximal tolerated power, peak oxygen consumption and oxygen pulse. Heart rate and ventilation were significantly lower while VO2 was unchanged. Between the first and the last training session, the total physical work was improved by 24.7%, whereas heart rate was unchanged. An individualized interval-training program using a wheelchair ergometer can significantly improve fitness level and endurance capacity.
   Bougenot MP, Tordi N, Betik AC, et al.
   Spinal Cord. 2003 Aug;41(8):451-6.
   
3. Wheelchair configuration and postural alignment in persons with spinal cord injury.
   Fourteen subjects with motor-complete C6-T10 SCI sat in 3 manual wheelchairs: standard setup E&J Premier (S1), standard setup Quickie Breezy (S2), and test configuration Quickie TNT (T) with posterior seat inclination and a low backrest set perpendicular to the floor. Shoulder and neck alignment and pelvic tilt were determined from sagittal plane digital photographs at rest and with maximal vertical reach. At rest, T produced less shoulder protraction, less head-forward position, and greater vertical reach above the seat plane than either conventional configuration. The wheelchair with a positive seat slope (14?), acute inside backrest angle, and relatively low backrest (meeting the lowest ribs) produces more vertical postural alignment and greater reach ability versus the standard factory setup wheelchairs, and may be associated with reduced neck and shoulder pain in this population.
   Hastings JD, Fanucchi ER, Burns SP.
   Arch Phys Med Rehabil. 2003 Apr;84(4):528-34
   
4. The short-term effect of hippotherapy on spasticity in patients with spinal cord injury.
   Thirty-two patients with SCI between C4 and T12; ASIA A-D; ages 16-72; time since injury 1-60 months; and various degrees of spasticity received repeated sessions (range: 5-24; mean 11) of 25-30 minutes of Hippotherapy-K treatment (therapeutic horseback riding). Spasticity testing of the lower extremities before and immediately after each session found that Hippotherapy significantly reduced spasticity of the lower extremities. Of the 351 sessions performed, 327 (93%) led to lower Ashworth scores immediately after treatment. Highest improvements were observed in subjects with very high spasticity. There was no significant difference in improvement between subjects with paraplegia versus tetraplegia.
   Lechner HE, Feldhaus S, Gudmundsen L, et al.
   Spinal Cord. 2003 Sep;41(9):502-5.

Other:

1. Catastrophic spine injuries in American football, 1977-2001.
   This study describes 25 years (1977-2001) of catastrophic neck injuries, including incidence, cause, and variables that have either increased or decreased these injuries. National data from all organized football programs (public school, college, professional, and youth) found 223 permanent cervical injuries during this time period. Rule changes regarding allowed techniques of the game; teaching and enforcing the correct techniques; equipment standards; and improved medical care both on and off the playing field have led to a 270% reduction in permanent SCI from a peak of 20 per year between 1971-75 to 7.2 per year during the past 10 years. Recommendations are given for reducing catastrophic cervical spine injury in football.
   Cantu RC, Mueller FO.
   Neurosurgery. 2003 Aug;53(2):358-62; discussion 362-3.

 

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