After an initial decrease in resting energy expenditure, body weight and percentage of body fat, these values levelled off during the rehabilitation period. After the end of the rehabilitation period, body weight and body fat mass increased again to the baseline levels, whereas resting energy expenditure decreased further. These results suggest that rehabilitation programmes should focus on adapting to these foreseeable changes.

Study design: Retrospective cross-sectional study. Objectives: To investigate the characteristics of posttraumatic symptomatic syringomyelia after spinal cord injury (SCI). Setting: Swiss Paraplegic Centre, Nottwil, Switzerland. Methods: The patient database was screened for patients diagnosed with posttraumatic syringomyelia. Syrinx characteristics were determined on T2-weighted magnetic resonance images. Binary logistic regression analysis was used to investigate the effects of age, injury level, injury severity and syrinx location on early syrinx formation, syrinx length and syrinx extending cranial to the lesion. Results: The data of 138 patients were analyzed. The majority of the patients (78.3%) suffered from motor and sensory complete SCI (American Spinal Injury Association Impairment Scale (AIS) A). Syringomyelia was diagnosed a median 15.0 years after SCI at a median age of 42 years. The cervical spine was involved in 457% of the patients, and syringomyelia extended over a median seven vertebral levels. Complete SCI (P = 0.035) and age (P = 0.001) were significant predictors of early syrinx formation. Syringomyelia occurred significantly earlier in older (430 years) patients (P ⩽ 0.002) and those with complete SCI (P = 0.027) compared with younger patients (⩽30 years) and those with incomplete SCI (AIS B-D), respectively. Age, injury level, injury severity (AIS A) and syrinx location did not have any significant (P40.9) effect on syrinx extending cranially or syrinx length. Conclusions: Posttraumatic syringomyelia mainly occurs in patients with complete SCI (AIS A) and involves the cervical spine in 6 of the 10 patients. Patients with complete SCI and those age 430 years have an increased risk of syrinx formation within 5 years after injury.

Study Design: Retrospective investigation. Objectives: To investigate the association of patient and injury characteristics with bladder evacuation by indwelling catheterization in patients with chronic neurogenic lower urinary tract dysfunction (NLUTD). Setting: Tertiary urologic referral center. Methods: The patient database was screened for patients with chronic (412 months) NLUTD. Patient characteristics and bladder management details were collected. Binary logistic regression analysis was used to investigate the effects of the investigated factors on bladder evacuation by indwelling catheterization. Results: The data of 1263 patients with a median age of 47 years (range 11-89 years) and a median NLTUD duration of 15.2 years (range 1.0-63.4 years) were investigated. The most common bladder evacuation method was intermittent catheterization (IC; 41.3%) followed by triggered reflex voiding (25.7%), suprapubic catheterization (11.8%), sacral anterior root stimulation (7.3%), spontaneous voiding (7.0%), abdominal straining (5.7%) and transurethral catheterization (1.3%). Female gender, tetraplegia, an age older than 45 years and injury duration were significant (o0.001) predictors of indwelling catheterization. The odds of bladder evacuation by indwelling catheterization were increased~2.5, 3 and 4 times in women, patients older than 45 years and tetraplegics, respectively. Conclusions: IC is the most common bladder evacuation method. However, the majority of individuals with NLUTD are using other evacuation methods, because factors such as functional deficiencies, mental impairment or the social situation are relevant for choosing a bladder evacuation method. Individuals at risk of indwelling catheterization can be identified based on female gender, age, injury severity and injury duration.

Vertebral cement augmentation is reported to be a safe and effective technique for providing stabilization and pain relief. However, adjacent intervertebral discs may be at risk of accelerated degeneration as a result of aggravated nutritional constraints. Therefore, we investigated the effects of injecting polymethylmethacrylate (PMMA) into three adjacent lumbar vertebrae on intervertebral disc and vertebral bone tissue in 12 skeletally mature sheep. After 6 and 12 months of augmentation, the sheep were euthanized and their spines were processes for histological evaluation. Semiquantitative histomorphological analysis of discs and endplates was conducted using published criteria. Histomorphological changes in the augmented bone were assessed qualitatively. Approximately 80% of the length of the endplates was in contact with PMMA. However, there was no significant difference between the histopathological score of the discs adjacent to augmented vertebrae and the score of the control discs. Bone tissue reaction to PMMA was characterized by a thin fibrous tissue layer and occasional foreign-body reactions. New bone formation was present in all augmented vertebrae. Concerns about aggravation of disc degeneration as a result of vertebral cement augmentation seem to be unsubstantiated. Furthermore, adverse effects of PMMA cement on bone biology do not seem to be a relevant issue.

Retrospective cohort study. OBJECTIVES: To analyze characteristics and treatment of osteomyelitis (OM) in the treatment of grade IV pressure injury (PI) in patients with spinal cord injury/disorder (SCI/D) following the Basel Decubitus Concept. SETTING: Acute care and rehabilitation clinic specialized in SCI/D. METHODS: Patients with SCI/D were admitted for grade IV PI treatment between 1st January 2010 and 28th February 2015.Patients, SCI/D, and PI characteristics were collected from chart reviews. Descriptive statistics and differences between groups with and without OM were evaluated. RESULTS: In total, 117 patients (87 male, 30 female) with 130 PI grade IV were included. In 95 patients (81%), OM was diagnosed histologically. In 87 cases, more than one bacterial species was involved. Out of 49 different bacterial species, Enterococcus faecalis and Staphylococus aureus were most frequently observed. Amoxicillin/clavulanic acid and ciprofloxacin were the most frequently used out of 24 different antibiotics. Length of antibiotic treatment varied between <8 days and >91 days with 31 patients receiving antibiotics for about 8 weeks. Complications occurred in all groups of antibiotic duration. Having a paraplegia, no OM and sacral PI was associated with increased complication rates, but the number of patients did not allow comprehensive risk factor analysis. CONCLUSION: Because the variety of patients concerning SCI/D, PI, and OM characteristics did not show a conclusive relation between length of antibiotic treatment and complication rates, the development of a subgroup specific treatment concept for PI in patients with SCI/D would be favorable to further optimize antibiotic treatment.