Socio-economic outcome of paraplegia compared to lower limb amputation.

STUDY DESIGN: The socio-economic outcome was retrospectively compared between patients with traumatic lower limb amputation and those with paraplegia due to a spinal cord injury (SCI). OBJECTIVE: To evaluate the effect of specific rehabilitative procedures on the socio-economic outcome. SETTING: Paraplegic Centre at the University Hospital in Zurich, Switzerland. METHODS: Accidents occurring in a collective of 1.9 million persons in Switzerland over 3 years were included in the study. Fifty-six persons with unilateral amputation of lower limbs were compared with 54 persons with paraplegia. The follow-up was assessed over 5 years. RESULTS: The following data was obtained in patients with amputations compared to those with SCI (median values): (1) hospital stay: 150 versus 164 days; (2) the work was taken up after 689 versus 616 days; (3) the global average case costs amounted to SFr. 491.000 versus SFr. 606.000 during the first 5 years after injury; (4) the permanent degree of disability was determined to 40% versus 42%. Except for the global costs, all differences were not significant. CONCLUSIONS: There are only a few differences between the socio-economic outcomes between patients with lower limb amputations and those with paraplegia. It remains unclear if the highly specialised rehabilitation services provided for patients with SCI accounts for the similarity since individuals with SCI have additional neurogenic dysfunction of the bladder and bowel. Alternatively, the data may suggest a need for greater rehabilitation services for amputees or may reflect a threshold effect in rehabilitation outcomes.

[Cardiovascular disorders in paraplegic patients]. / Kardiovaskuläre Störungen bei querschnittgelähmten Patienten.

While the consequences of damage to the sensorimotor nervous system in spinal cord injury are obvious, autonomic dysreflexia often goes unrecognised. Spinal cord injury affecting the cord above the fifth thoracic segment involves interruption of the connection between brain and sympathetic nervous system and, below the level of the lesion, the sacral parasympathetic nervous system. The isolated spinal cord continues to function, except for the directly damaged segment, but there is no central control. The autonomic nervous system below the level of the lesion can trigger severe reactions from the cardiovascular system which diminish quality of life and even promote severe morbidity. Autonomous malfunction can also have clinical effects in relation to thermoregulation and gastrointestinal, genital and urinary tract function.

[Post-inpatient after-care of paraplegic patients: selected internal medicine aspects]. / Poststationäre Nachsorge bei Querschnittgelähmten: ausgewählte internistische Aspekte.

In-hospital rehabilitation of para-/tetraplegic patients is followed by the family doctor's long-term surveillance supported by annual checkups in the rehabilitation clinic. The family doctor bears a heavy burden of responsibility. Loss of sensation may cover a wide range of complications. Most of these functional disorders are the consequence of reduced physical activity and a disturbed autonomic nervous system. There is a significantly high incidence of pulmonary infection, in particular pneumonia and atelectasis, coronary heart disease, autonomic dysreflexia, urinary tract infections, kidney stones, renal and hepatic insufficiency, gallstones, constipation and ileus, as well as decubitus, osteoporosis and so on. Chronic severe pain and spasm also require optimum therapy, in view of their potential to reduce quality of life and working capacity. This article provides an overview of several relevant problems in internal medicine involving diagnosis, therapy and long-tem surveillance of patients with spinal cord injuries.

[Differential diagnosis of acute spinal cord diseases]. / Differentialdiagnose der akuten Rückenmarkerkrankungen.

We discuss the most important differential diagnosis in acute non traumatic spinal cord lesions. To therapy these patients, a large diagnostic and therapeutic spectrum must be considered. Nontraumatic spinal cord lesions include inflammatoric, immunologic, toxic-metabolic and physical reasons, tumours, bleedings, myelomalazies, neurodegenerative myelopathies and spinal deformities. The aimes of rehabilitation of these patients are almost similar to patients with tramatic spinal cord injured.

[Toxic-metabolic and physically-induced myelopathies]. / Toxisch-metabolisch und physikalisch induzierte Myelopathien.

The differential diagnosis in patients with spinal cord disorders is sometimes very difficult. There is an overview about important toxic-metabolic myelopathies, like drugs, ergotamines, Kichererbsen, avitaminosis, diving accidents and radiation exposition. Beside the cause- and the senso-motoric therapy, disturbances bladder-, bowel-, sexual and cardiovascular disorders needs a specialised therapy.

[Pain therapy after spinal cord lesion]. / Schmerztherapie nach Rückenmarkläsion.

An important part of patients with spinal cord disorder suffers chronic pain. Especially the neuropathic pain syndrome is a problem. The pain lost his function of a protective warning sign, it can reduce the quality of life dramatically. We show the diagnosis and pharmacotherapy in neuropathic pain syndromes in patients with spinal cord disorder.

Prognosis and recovery in ischaemic and traumatic spinal cord injury: clinical and electrophysiological evaluation.

OBJECTIVES: To compare prognostic factors and functional recovery between paraplegic patients with either ischaemic (28 patients) or traumatic (39 patients) spinal cord injury (SCI). METHODS: On admission to the spinal injury centre and 6 months later the patients underwent clinical (following the guidelines set down by the American Spinal Injury Association) and electrophysiological (tibial and pudendal somatosensory evoked potentials) examinations in parallel. The degree of ambulatory capacity was assessed after discharge from the rehabilitation programme or at least 6 months after trauma. RESULTS: At the acute stage of either ischaemic or traumatic SCI similar motor and sensory deficits and pathological SSEP recordings were present. Both patient groups recovered to similar degrees with respect to motor, sensory, and ambulatory capacity. The clinical examination in both patient groups was the most sensitive prognostic factor of functional recovery irrespective of the aetiology of the SCI. In the ischaemic patients only the tibial SSEP whereas in the traumatic patients both the pudendal and tibial SSEP were of value in predicting recovery. CONCLUSIONS: Although the two patient groups are pathophysiologically different, the severity and extent of neurological deficits and rate of recovery are quite similar. In both ischaemic and traumatic SCI clinical and electrophysiological examinations are of prognostic value for the functional recovery.