Risk factors in iatrogenic spinal cord injury.

STUDY DESIGN: In the last years, there has been a change in the aetiology of spinal cord injury. There has been an increase in the number of elderly patients with spinal cord injuries caused by diseases or medical procedures. OBJECTIVE: The aim of this study is to investigate the frequency of the occurrence of iatrogenic spinal cord injury in our unit. The secondary aim is to study what variables can be associated with a higher risk of iatrogenesis. METHODS: A retrospective, descriptive, observational study of patients with acute spinal cord injury admitted from June 2009 to May 2014 was conducted. The information collected included the patient age, aetiology, neurological level and grade of injury when admitted and when discharged, cardiovascular risk factors, a previous history of depression and any prior treatment with anticoagulant or antiplatelet drugs. We applied a logistic regression. The grade of statistical significance was established as P<0.05. RESULTS: In total, 265 patients were included. In 48 of the cases, the cause was iatrogenic (18.18%±4.6% IC). The most frequent level of injury was the thoracic level (48%). The main aetiology of spinal cord injury caused by iatrogenesis was surgery for degenerative spine disease, in patients under the age of 30 were treated with intrathecal chemotherapy. CONCLUSIONS: Iatrogenic spinal cord injury is a frequent complication. A statistically significant association between a patient history of depression and iatrogenic spinal cord injury was found as well as with anticoagulant and antiplatelet drug use prior to iatrogenic spinal cord injury.

Are the characteristics of the patient with a spinal cord injury changing?

STUDY DESIGN: A retrospective analytical study. OBJECTIVE: To determine the epidemiologic pattern of spinal cord injury (SCI) over the last decade. SETTING: Patients admitted in the spinal cord injury unit at a university hospital between 1 January 2001 and 31 December 2013. METHODS: A review of the clinical history of the patients was conducted. Patients were allocated according to traumatic (traffic and non-traffic accidents) or non-traumatic origin (tumour and non-tumour disease). Information about gender, age, admission and discharge date and cause, level and grade of spinal cord injury was collected. An analysis using the time-trend series was performed. RESULTS: The average length of stay decreases 1.5 days quarterly, and the average patient's age increases 0.25 year quarterly. No trend was observed with respect to the number of cases. CONCLUSION: Although the number of patients with an SCI caused by an accident has decreased and the average age of patients with an SCI has increased, it cannot be said that there has been a paradigm shift in patients with SCI.

Lesión medular de origen iatrogénico ¿un diagnóstico a tener en cuenta? / Iatrogenic spinal cord injury. Should this diagnosis be considered?

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¿Está cambiando la etiología de la lesión medular? / Is the etiology of spinal cord injury changing?

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Iatrogenic spinal cord injury: an observational study.

STUDY DESIGN: Retrospective descriptive observational study. OBJECTIVE: The primary objective of this study was to quantify the incidence of iatrogenic spinal cord injury (SCI) at our SCI unit (SCIU). The secondary objective was to discover the surgical and medical procedures that cause iatrogenic SCI and to estimate the incidence with each procedure. SUBJECTS: Patients admitted to or seen at outpatient services of the SCIU at a university hospital. METHODS: Histories were compiled from 1 July 2005 to 30 June 2009. We included patients with SCI caused by any medical or surgical procedure. We collected age, sex, diagnosis leading to medical intervention, predominant clinical manifestations, medical-surgical procedure and level and grade of injury upon admission and discharge. RESULTS: Out of 250 patients admitted to the SCIU, 32 (14.7%) patients presented iatrogenic SCI. Average age was 56.2 (s.d. 17.3), ranging from 0 to 82 years old. The most frequent clinical manifestation was pain. The most common diagnosis was channel stenosis. Lumbar level grade C of American Spine Injury Association (ASIA) was the most frequently observed. CONCLUSION: The rise in the population's life expectancy entails an increase in elderly patients with vascular risk factors, who underwent invasive interventions leading to spinal cord iatrogenia.

Transdermal nitroglycerine treatment of shoulder tendinopathies in patients with spinal cord injuries.

STUDY DESIGN: A clinical blind study was conducted to determine the efficacy of transdermal nitroglycerine treatment on the awareness of shoulder pain. OBJECTIVE: This study aims to determine the effects of transdermal nitroglycerine on shoulder pain and on functional shoulder movement in patients with spinal cord injuries and shoulder tendinopathies. A second aim is to establish the side effects of the treatment. SETTING: Hospital "La Fe" in Valencia, Spain. METHODS: A total of 45 spinal cord injury patients, all of whom are wheelchair users with shoulder tendinopathy, were randomly divided into two groups: placebo (n=12) and experimental (n=33). The experimental group (EG) received transdermal treatment for 6 months in the form of a 1.25 mg nitroglycerine (NT) patch on the greater tubercle. A placebo patch was used with the placebo subjects. Functional shoulder movements were assessed by articular range of motion and pain, using a visual analogical scale. RESULTS: NT treatment reduced the awareness of shoulder pain and increased the functional movement and range of articular motion in the shoulders of the EG members (P<0.05). CONCLUSIONS: We conclude that transdermal NT is an efficient method for treating shoulder tendinopathies in wheelchair users with spinal cord injuries.