RESUMO
Context: Osteoporosis is a known complication in spinal cord injury patients and can result in an increased risk of fractures and associated morbidity. Bone demineralization is most common in long bones below the level of injury. The pathogenesis is complex and not fully understood.Findings: We present the case of a 65-year-old male with chronic spinal cord injury who was found to have multiple vertebral compression fractures causing autonomic dysreflexia and new onset spasticity.Conclusion/Clinical Relevance: This case illustrates the need for improved awareness, diagnosis, and prevention for this disease process.
Assuntos
Disreflexia Autonômica , Fraturas por Compressão , Fraturas de Estresse , Traumatismos da Medula Espinal , Fraturas da Coluna Vertebral , Idoso , Disreflexia Autonômica/diagnóstico , Disreflexia Autonômica/etiologia , Fraturas de Estresse/complicações , Humanos , Masculino , Quadriplegia/complicações , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/patologia , Fraturas da Coluna Vertebral/complicaçõesRESUMO
Pain that develops in the coccyx or surrounding tissues is known as coccydynia, which occurs as a result of many etiologies both traumatic and nontraumatic. Although coccydynia most commonly affects middle-aged women, it may be found in both sexes and in all age groups. The aim of this article is to provide an overview of the presentation, diagnostic imaging, and pathophysiology of coccydynia, and to comprehensively review the current treatment options. A review of publications from 1990 to 2020 using search words related to the treatment of coccydynia in PubMed and Google Scholar was completed. Level II evidence was found supporting stretching, manipulation, and extracorporeal shock wave therapy. There are no data from high-quality studies to support injection-based therapy including corticosteroids, prolotherapy, nerve blocks, and radiofrequency ablation, although there are small retrospective and prospective observational studies suggesting benefit. Level III evidence was found supporting coccygectomy for chronic/refractory coccydynia. There are no data from randomized controlled trials to support the use of neuromodulation (sacral burst and dorsal root ganglion stimulation), although there are case reports suggesting benefit. High-level, comparative studies are lacking to guide the treatment of coccydynia and should be a focus for future research studies.
Assuntos
Dor Lombar , Dor Musculoesquelética , Dor nas Costas , Cóccix/cirurgia , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , Dor Pélvica , Estudos RetrospectivosRESUMO
The Merit-based Incentive Payment System (MIPS) is a requirement for all physicians for value-based reporting. Medicare has approved registries as a mechanism for MIPS reporting. Concurrently, residencies continue to abide by the Accreditation Council for Graduate Medical Education's (ACGME's) curriculum requirement of utilizing/practicing quality improvement (QI).The objectives of this study were as follows: (1) incorporate a meaningful functional outcome measure into an electronic health record (EHR) to track spine functional outcomes; (2) generate a report containing covariables extracted from the EHR system to provide trackable data for current and future resident QI projects/investigations; and (3) establish an infrastructure to align ACGME QI initiatives with the MIPS requirements. This pilot study and retrospective analysis successfully demonstrates how a meaningful functional outcome measure can be incorporated into the EHR system for QI. Moreover, it demonstrates successful establishment of infrastructure for alignment of QI projects for ACGME residency requirements with MIPS requirements.
