Rehabilitation outcomes following infections causing spinal cord myelopathy

Abstract

Study design:Retrospective, open-cohort, consecutive case series. Objective: To describe the demographic characteristics, clinical features and outcomes in patients undergoing initial in-patient rehabilitation after an infectious cause of spinal cord myelopathy. Setting: Spinal Rehabilitation Unit, Melbourne, Victoria, Australia. Admissions between 1 January 1995 and 31 December 2010. Methods: The following data were recorded: aetiology of spinal cord infection, risk factors, rehabilitation length of stay (LOS), level of injury (paraplegia vs tetraplegia), complications related to spinal cord damage and discharge destination. The American Spinal Injury Association (ASIA) Impairment Scale (AIS) and functional independence measure (FIM) were assessed at admission and at discharge. Results: Fifty-one patients were admitted (men ¼ 32, 62.7%) with a median age of 65 years (interquartile range (IQR) 52-72, range 22-89). On admission, 37 (73%) had paraplegic level of injury and most patients (n ¼ 46, 90%) had an incomplete grade of spinal damage. Infections were most commonly bacterial (n ¼ 47, 92%); the other causes were viral (n ¼ 3, 6%) and tuberculosis (n ¼ 1, 2%). The median LOS was 106 days . The most common complications were pain (n ¼ 47, 92%), urinary tract infection (n ¼ 27, 53%), spasticity (n ¼ 25, 49%) and pressure ulcer during acute hospital admission (n ¼ 19, 37%). By the time of discharge from rehabilitation, patients typically showed a significant change in their AIS grade of spinal damage (Po0.001). They also showed significant improvement (Po0.001) in their FIM motor score (at admission: median ¼ 27, IQR 20-34; at discharge: median ¼ 66, IQR 41-75). Conclusion: Most patients returned home with a good level of functioning with respect to mobility, bladder and bowel status, and their disability improved significantly.

Clinical features and inpatient rehabilitation outcomes of infection-related myelopathy

“…This factor may contribute to their findings of higher FIM motor scores at discharge and a greater percentage of patients discharged home. 6 Demographic characteristics of our IRM group, including age and gender, mostly confirm those of prior studies 6,11,[13][14][15][16] with a couple of exceptions. Morillo-Leco et al 12 in Spain and Nas et al 28 in Turkey studied populations with a higher proportion of cases due to spinal tuberculosis and found their subjects to be younger, with mean age at admission of 37.3 and 37.9 years, respectively.…”

“…Risk factors for infection were identified on the basis of those reported in prior studies 6,11,[13][14][15][16] (Table 2). The patient with schistosomiasis myelitis had no identifiable risk factors, but all other patients had at least one risk factor.…”

“…[1][2][3][4][5] This variation is largely because of geographic and environmental factors, different health systems and access to health care. 4,6,7 IRM involving spinal epidural abscesses or tuberculosis is thought to cause injury through several mechanisms, including direct compression of the spinal cord, vascular occlusion causing ischemic injury and vertebral collapse with associated myelitis, whereas viral infections involve a more diffuse neural injury process. [8][9][10] IRM appears to affect more men than women and typically occurs during the fourth through seventh decades of life.…”

“…[8][9][10] IRM appears to affect more men than women and typically occurs during the fourth through seventh decades of life. 6,[11][12][13][14][15][16] Studies performed in the United States, Spain, Australia, Singapore and Israel have shown that the most common cause of IRM is epidural abscess, 6,16 with Staphylococcus aureus being the most commonly isolated organism. 6,[11][12][13]15,16 Mycobacterium tuberculosis is another common pathogen found to be a more prevalent cause of infectious myelopathy in Africa, Singapore and India, accounting for 30%, 46% and 25%, respectively, of reported IRM.…”

“…6,[11][12][13][14][15][16] Studies performed in the United States, Spain, Australia, Singapore and Israel have shown that the most common cause of IRM is epidural abscess, 6,16 with Staphylococcus aureus being the most commonly isolated organism. 6,[11][12][13]15,16 Mycobacterium tuberculosis is another common pathogen found to be a more prevalent cause of infectious myelopathy in Africa, Singapore and India, accounting for 30%, 46% and 25%, respectively, of reported IRM. 5,11,[17][18][19][20] Although the literature regarding rehabilitation outcomes of NTM is becoming more robust, it continues to be suboptimal for IRM.…”