Intermediate-Term Outcome of Cervical Spinal Cord-Injured Patients Older Than 50 Years of Age

Alander, Dirk H.; Parker, Jane; Stauffer, Edouard

doi:10.1097/00007632-199706010-00003

Cited by 36 publications

(23 citation statements)

References 4 publications

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“…This rate of improvement was higher than rates reported by Alander et al, 9 in which none of the patients with complete cord injury improved, and all required extensive care. Fisher et al 19 concluded that the motor recovery does not occur below the zone of injury for patients with complete spinal cord injury, and Marino et al 20 suggested that the recovery of neurological deficit after spinal cord injury is dependent on the aetiology and the severity of the injury and so is the improvement in the motor scores.…”

Section: Spinal Cord Injuries In Elderly Patientscontrasting

confidence: 58%

“…1,2,[5][6][7][8] Injuries are compounded by coexisting morbidities, reduced independence and poor tolerance of immobilization. [9][10][11][12] These problems can complicate the rehabilitation of elderly patients and health-care systems are facing challenges in effectively and efficiently treating the injuries of these patients. 1,2,7,13 We had noted an increasing number of elderly patients with spinal injury and had found difficulties in their rehabilitation and safe discharge because of the problems described above.…”

Section: Introductionmentioning

confidence: 99%

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Functional outcome and discharge destination in elderly patients with spinal cord injuries

et al. 2010

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Study design: Retrospective cohort study. Objective: To describe functional outcome and discharge destination of elderly patients with traumatic spinal cord injuries. Setting: National Spinal Injuries Unit, Glasgow, UK. Methods: We collected data for 5 years on all patients 465 years old with a traumatic spinal cord injury treated at the National Spinal Injuries Unit. Results: We identified 39 patients. Of these, nine patients died during admission; all had cervical spine injuries. The mean age of the 30 survivors was 73 years (range 65-88). The most common cause of injury was a fall: 26 patients (87%). In addition, 21 (70%) sustained injury to cervical cord, 3 (10%) had thoracic and 6 (20%) had lumbar spine fractures. In all, 23 patients (77%) were treated by orthosis and 7 (23%) underwent surgical intervention. Twelve (40%) patients showed an improvement in American Spinal Injury Association impairment scale. The median hospital stay was 136 days. Thus, 11 patients (37%), all with incomplete injuries, were discharged home, 10 (33%) were transferred to nursing homes/community hospitals and 9 patients (30%) were discharged back to the referring hospital, while they were awaiting adjustments at home. Patients who were discharged home had significantly higher Functional Independence Measure scores, both at the onset of rehabilitation and at discharge, than those who were discharged to a nursing home or other hospitals (Po0.01 and o0.001, respectively). Discussion and conclusion: Although the elderly patients may benefit from the services of a dedicated spinal injuries centre, they should be carefully selected. The patient, relatives as well as the referring doctors should be alerted to the likely long-term outcomes early in the course of the injury. Elderly patients with complete lesions of the spinal cord will almost certainly remain institutionalized. Early endeavour should be made to find alternate rehabilitation settings with a lower-intensity treatment.

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Section: Spinal Cord Injuries In Elderly Patientscontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Functional outcome and discharge destination in elderly patients with spinal cord injuries

et al. 2010

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“…There were 12 paraplegics, 10 with thoracic and two with lumbar lesions. The mechanisms of cord insult were trauma (26), spinal arterio-venous malformation (2) and transverse myelitis (1). Analysis was by retrospective review of medical records.…”

Section: Methodsmentioning

confidence: 99%

“…The indications for insertion ( Figure 2) were for dysreflexic symptoms (15), high residual urine volumes and subsequent recurrent or persistent urinary tract infection (UTI) (17), for protection of the upper tracts (6) or to predict outcome following TUS (1). All stents ( Figure 1) were inserted under direct vision using a rigid (028T, 028TW, 045TW) or a flexible cystoscope (028SW).…”

Section: Methodsmentioning

confidence: 99%

“…Up to half of these patients with DSD can develop serious complications if appropriate intervention is not instituted. 1 The ideal management of a hostile bladder is the reduction of the intravesical pressure to a safe level and efficient drainage with intermittent self catheterization: 2 the patient is rendered 'safe and dry'. An alternative, particularly for those with poor dexterity, is to make the patient 'safe and wet' by reducing the bladder outlet resistance.…”

Section: Introductionmentioning

confidence: 99%

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Memokath® stents for the treatment of detrusor sphincter dyssynergia (DSD) in men with spinal cord injury: The Princess Royal Spinal Injuries Unit 10-year experience

Mehta

Tophill

2005

Spinal Cord

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thermosensitive stent as a 'nondestructive' means of reducing bladder outlet resistance by treating detrusor sphincter dyssynergia (DSD) of neurogenic bladder dysfunction associated with spinal cord injury. Setting: Spinal Injuries Unit, Sheffield, England. Methods: A medical records review was performed to examine our experience of Memokaths over the last 10 years. During this time, 29 patients with spinal cord injury (17 tetraplegic and 12 paraplegic) underwent stenting of the external urethral sphincter either for prevention of dysreflexic symptoms, high residual urine volumes and subsequent urinary tract infection (UTI) or for protection of the upper tracts. Results: A total of 33 stents were inserted into 29 men (25-77 years) with suprasacral spinal cord injury. Initial results showed that the Memokath was effective in almost all for relief of dysreflexic symptoms and elimination of DSD on pressure flow urodynamics. However, to date, 30 of the 33 stents have been removed. The overall mean working life of the Memokath was 21 months. Four stents were removed electively and 23 for complications, which included stent migration (seven) and blockage (14). Single-ended stents were more prone to migration, which was rare after 1 year (1-13 months, median 3 months, mean 5.5 months). Stent blockage by encrustation or prostatic ingrowth did not occur before 12 months (12-45 months, median 30, mean 27.9 months). Conclusions: In selected patients, temporary, thermo-expandable (Memokath) stents are effective in the treatment of DSD. The 'working life' of a Memokath stent is 21 months; however, complications do occur which may necessitate removal. Our overall experience with Memokath stents was disappointing. In future, Memokath stents will only be inserted after careful consideration in patients with prior 'failed' transurethral sphincterotomy or with caution in patients suitable for reconstructive surgery.

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Cervical spinal injury in elderly: report of 20 cases

Hancı

Gençosmanoğlu²,

Uzan

et al. 2000

Eur J Orthop Surg Traumatol

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Intermediate-Term Outcome of Cervical Spinal Cord-Injured Patients Older Than 50 Years of Age

Cited by 36 publications

References 4 publications

Functional outcome and discharge destination in elderly patients with spinal cord injuries

Functional outcome and discharge destination in elderly patients with spinal cord injuries

Memokath® stents for the treatment of detrusor sphincter dyssynergia (DSD) in men with spinal cord injury: The Princess Royal Spinal Injuries Unit 10-year experience

Cervical spinal injury in elderly: report of 20 cases

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