Neuropathic pain development and maintenance and its association with motor recovery after cervical spinal cord injury.

BACKGROUND: In our published randomized controlled trial, we revealed that patients with acute ASIA Grade C incomplete cervical spinal cord injury (SCI) who underwent early surgery (within 24 h post-injury) had accelerated motor recovery at six months than those with delayed surgery (>2 weeks post-injury); however, neuropathic pain (NeP) worsened regardless of surgery timing. Here, we conducted post-hoc analyses to intensively assess NeP development and maintenance. METHODS: Of 44 patients (median 64.5 years; three female; early intervention, n = 26), NeP was categorized into at-level and below-level pain and evaluated at  two weeks and one year after injury using the Neuropathic Pain Symptom Inventory (NPSI). We compared the two groups based on background characteristics. A mixed-design analysis of variance with sex as a covariate was conducted to analyze motor recovery and Health-related quality of life (HRQOL) in groups with severe (NPSI ≥ 10) or mild (NPSI < 10) pain. RESULTS: Upper and lower limb motor impairments were comparable between both groups regardless of pain severity. Severe at-level pain remained stable and worsened at one year than mild at-level pain; however, the upper- and lower-limb motor scores and HRQOL had comparable recovery. Background characteristics did not affect severity or time course of NeP. Patients with severe below-level pain demonstrated slower lower-limb motor recovery than those with mild below-level pain, whereas HRQOL improved regardless of pain severity. CONCLUSIONS: Both at-level and below-level NeP developed and persisted relatively early in the course of traumatic SCI with incomplete motor paralysis; their severities worsened over time or remained severe since onset.

[Patient with cervical spinal cord injury and benign paroxysmal positional vertigo treated with particle repositioning maneuvers]. / Paciente con lesión medular cervical y vértigo posicional paroxístico benigno tratado con maniobras de reposición de partículas.

Benign paroxysmal positional vertigo (BPPV) is characterized by short, sudden episodes of vertigo when the head moves in specific positions. The treatment is particle repositioning maneuvers. BPPV usually is underdiagnosed, unreported and therefore not adequately treated. We present the case of a patient with spinal cord injury and BPPV. A 72-year-old patient who suffered a C5 fracture with spinal cord injury C5 AIS C that required surgical fixation. In the spinal cord injury unit BPPV of the left lateral semicircular canal was documented and treated using specific repositioning maneuvers, the patient progressively improved and was able to complete the rehabilitation treatment. The spinal cord injury unit with access to vestibular rehabilitation units can carry out the diagnosis and specific treatment of BPPV, minimizing the risks for the patient.

Pattern of neurological recovery in persons with an acute cervical spinal cord injury over the first 14 days post injury.

Introduction: Following a traumatic spinal cord injury (SCI) it is critical to document the level and severity of injury. Neurological recovery occurs dynamically after injury and a baseline neurological exam offers a snapshot of the patient's impairment at that time. Understanding when this exam occurs in the recovery process is crucial for discussing prognosis and acute clinical trial enrollment. The objectives of this study were to: (1) describe the trajectory of motor recovery in persons with acute cervical SCI in the first 14 days post-injury; and (2) evaluate if the timing of the baseline neurological assessment in the first 14 days impacts the amount of motor recovery observed. Methods: Data were obtained from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) site in Vancouver and additional neurological data was extracted from medical charts. Participants with a cervical injury (C1-T1) who had a minimum of three exams (including a baseline and discharge exam) were included. Data on the upper-extremity motor score (UEMS), total motor score (TMS) and American Spinal Injury Association (ASIA) Impairment Scale (AIS) were included. A linear mixed-effect model with additional variables (AIS, level of injury, UEMS, time, time2, and TMS) was used to explore the pattern and amount of motor recovery over time. Results: Trajectories of motor recovery in the first 14 days post-injury showed significant improvements in both TMS and UEMS for participants with AIS B, C, and D injuries, but was not different for high (C1-4) vs. low (C5-T1) cervical injuries or AIS A injuries. The timing of the baseline neurological examination significantly impacted the amount of motor recovery in participants with AIS B, C, and D injuries. Discussion: Timing of baseline neurological exams was significantly associated with the amount of motor recovery in cervical AIS B, C, and D injuries. Studies examining changes in neurological recovery should consider stratifying by severity and timing of the baseline exam to reduce bias amongst study cohorts. Future studies should validate these estimates for cervical AIS B, C, and D injuries to see if they can serve as an "adjustment factor" to control for differences in the timing of the baseline neurological exam.

An analysis of the heart rates and the therapeutic effect of aminophylline injections in patients with acute cervical spinal cord injuries and bradycardia.

OBJECTIVE: To investigate the changes in the heart rates and the clinical effectiveness of aminophylline injections in acute cervical spinal cord injury (ACSCI) patients with bradycardia. METHODS: This retrospective study was conducted by studying the clinical data of 100 ACSCI patients also suffering from bradycardia admitted to our hospital from June 2019 to June 2020. The patients were randomly placed into a control group (n=50) that was administered atropine therapy and a test group (n=50) that was administered aminophylline injections. The changes in the patients' heart rates and the clinical effectiveness were analyzed. RESULTS: After the treatment, the test group had a significantly higher average heart rate, shorter heart rate recovery times, and a lower bradycardia recurrence rate than the control group (all P<0.05). The systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels in the test group were significantly higher than they were in the control group (all P<0.05). Remarkably higher clinical effectiveness and satisfaction rates and a significantly lower incidence of adverse reactions were observed in the test group compared to the control group (all P<0.05). In addition, the Japanese Orthopaedic Association (JOA) cervical spine scores were similar in the two groups (P>0.05). CONCLUSION: For ACSCI patients also suffering from bradycardia, aminophylline injections ameliorate the clinical heart rate and have a good clinical effectiveness with few adverse reactions, so the treatment merits clinical promotion and application.

Synchronized and integrated prehospital treatment for acute cervical spinal cord injury.

OBJECTIVE: To explore the effect of synchronized and integrated prehospital treatment strategies for on-site first aid, rescue transport and prehospital first aid in patients with acute cervical spinal cord injury. METHODS: A prospective non-randomized controlled study was designed to include patients with acute cervical spinal cord injury. A total of 50 patients were included in a Control group (before the implementation of synchronized and integrated prehospital treatment), and 50 patients were included in an Observation Group (after the implementation of synchronized and integrated prehospital treatment). We compared the timeliness of prehospital treatment, the proportion of patients received methylprednisolone treatment within 3 h after injury, the changes in Japanese Orthopaedic Association (JOA) score during transport, the incidence of adverse events, the clinical outcomes, the number of prehospital deaths, the case number of paralysis and the recovery of postoperative neural function between the two groups. RESULTS: Compared with the Control group, the Observation group showed significantly shorter time from injury to admission, from injury to receiving methylprednisolone pulse therapy, as well as from injury to receiving dehydrating agents and diuretics (all P<0.001). The proportion of patients received methylprednisolone treatment within 3 h after injury was significantly higher in the Observation group than that in the Control group (P<0.05). There was no significant change in the JOA score in the Observation group before and after the transport, while the score was significantly lower in the Control group after the transport (P<0.001). The JOA score was higher in the Observation group than that in the Control group at admission (P<0.001). The Observation group also showed decreased incidences of adverse events, mortality, and paralysis rate (all P<0.05) as well as better recovery of postoperative neural function (P<0.001) when compared with the Control group. CONCLUSION: Synchronized and integrated prehospital treatment has a significant effect in patients with acute cervical spinal cord injury through shortening the admission time, reducing the risk of adverse events, and improving the rescue effect and the prognosis of neural function.

Effects of multidisciplinary model of damage control on acute cervical spinal cord injury in winter Olympic sports.

PURPOSE: To investigate the feasibility of multidisciplinary model of damage control (MMDC) in patients with acute cervical spinal cord injury (ACSCI) in winter Olympic sports. METHODS: A total of 110 patients with ACSCI who participated in winter Olympic sports were selected as the study subjects, and were divided into the study group (SG, n=60, MMDC) and the control group (CG, n=50, conventional intervention) according to the intervention mode. The clinical effects of intervention, changes in neurological function and muscle tone before and after intervention, the changes in motor function and activity of daily living during intervention, and patient satisfaction towards intervention were compared between the two groups. RESULTS: The effective rate of intervention in the SG was 98.33%, higher than 88.00% in the CG (P < 0.05), and the percentage of patients with Grade E injuries in the SG after intervention was 30.00%, significantly higher than 12.00% in the CG (P < 0.05). The scores of all dimensions of Ashworth scale in the SG were lower than those in the CG (P < 0.05). The patients in the SG exhibited higher FMA scale and modified Barthel index (MBI) scores than the CG from 1 to 6 months of intervention (P < 0.05). CONCLUSION: MMDC showed better efficacy, the patients' neurological function, muscle tone and motor function could be better restored, and patients' abilities of daily activities were improved after intervention.

Laminoplasty versus conservative treatment for acute cervical spinal cord injury caused by ossification of the posterior longitudinal ligament after minor trauma.

BACKGROUND CONTEXT: No reports to date have accurately evaluated the management for acute spinal cord injury (SCI) caused by ossification of the posterior longitudinal ligament (OPLL) after minor trauma. PURPOSE: To assess whether outcomes of laminoplasty is better than conservative treatment. STUDY DESIGN/SETTING: A retrospective study. PATIENT SAMPLE: Thirty-one patients underwent surgery (L group) and 29 patients underwent conservative treatment (C group). OUTCOME MEASURES: Disability, muscle strength, sensation, and general health status. METHODS: Patients were managed according to routine clinical practice and the results between groups were compared. Clinical and radiographic outcomes were assessed at admission, discharge, 6 months and at the final visit. Causes for trauma, duration of hospital stay, and complication were also evaluated. RESULTS: Causes for trauma included falling, traffic accidents and sports. Mixed and segmental types were the most frequent cause of OPLL resulting into SCI. Duration of hospital stay and complications were less in the L group. Motor and sensory scores increased in the L group at discharge (p<.05) and at 6 months (p<.05), and maintained thereafter (p>.05); scores improved significantly in the C group at 6 months (p<.05), with a slight deterioration with time (p>.05); scores in the L group were higher than in the C group at each time point after surgery (p<.05). Bodily pain and mental health in SF-36 improved at discharge in the L group (p<.05); all scores improved at 6 months in both the groups (p<.05), with better improvements in the L group (p<.05). The canal diameter increased and occupation ratio decreased in the L group (p<.05), and maintained thereafter (p<.05); a slight increase of occupation ratio was observed in the C group (p>.05). Lordotic angle and range of motion were maintained in both the groups, with no significance between groups (p>.05). High-signal intensity decreased at 6 months (p<.05) in the L group; no significant change was found in the C group during the follow-up (p>.05); Significant difference was detected between the groups at 6 months and at the final visit (p<.05). CONCLUSIONS: Most of the OPLL patients displayed as incomplete SCI after minor trauma. Although spontaneous improvement of SCI without surgery is often observed, laminoplasty has more satisfactory outcomes, prevents late compression of cord, and reduces perioperative complications, although with no significant benefit in cervical alignment and range of motion.