Complications in patients with spinal cord injuries: a clinical study from a third level rehabilitation center in Turkey

Year 2019, Volume: 5 Issue: 3, 550 - 556, 04.05.2019

Tuba Tülay Koca , Burhan Fatih Koçyiğit , Ejder Berk , Vedat Nacitarhan

https://doi.org/10.18621/eurj.395651

Abstract

Objectives: Normal lifespan can be achieved by avoiding
complications in patients with spinal cord injuries (SCIs). We aimed to characterize our
spinal cord injured patients and to obtain necessary information to prevent
complications.

Methods: This retrospective,
cross-sectional study included 44 patients with subacute/chronic SCIs, who were
included in an inpatient rehabilitation program from 2012 to 2017. The
patients’ epidemiological data, etiology, neurological examinations,
complications, and accompaying conditions were analyzed. The neurological
level, functional ambulatory scale (FAS), and American Spinal Cord Injury
Association (ASIA) impairment scale were used for the classification of
patients.

Results: A total of 44 patients between 16 and 81 years of age
(median: 35) were included in the study. Of these, 65.9% were male. The most
common etiologies were falling down from a height (31.8%), spinal surgery
(29.5%), and traffic accidents (15.9%) respectively. When we look the
neurological status of these patients, FAS: 0 (38.6%) and ASIA: C (40.9%) were
the most common cases seen in the
population. Eighteen patients (40.9%) were wheelchair-bound. Urinary (34.1%),
dermatologic (29.5%), and psychiatric (22.7%) complications were the most
common in the patients. Patients with low FAS levels were young (in early
period), and their spasticity, urinary incontinence, and urinary and
dermatological pathologies were found to be high. The wheelchair-bound patients
were mostly young, and they had significantly high
urinary incontinence, urinary and dermatological pathologies.

Conclusions.
In our rehabilitation clinic, subacute/chronic
SCI diagnosis is most commonly seen in young men, with thoracic vertebrae being
the most common, followed by falling from a height. The most common
complications were urinary and dermatological pathologies. The present study found higher rates of
complications in patients with higher grades of injuries and in patients with
lower functional levels. 

Keywords

complication, morbidity, rehabilitation, spinal cord injury

References

• [1] Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine (Phila Pa 1976) 2001;26(24 Suppl):S2-12.
• [2] Hagen EM, Rekand T, Gilhus NE, Grønning M. Traumatic spinal cord injuries--incidence, mechanisms and course. Tidsskr Nor Laegeforen 2012;132:831-7.
• [3] Kristinsdottir EA, Knutsdottir S, Sigvaldason K, Jonsson H Jr, Ingvarsson PE. [Epidemiology of spinal cord injury in Iceland from 1975 to 2014]. Laeknabladid 2016;102:491-6. [Article in Icelandic]
• [4] Hagen EM. Acute complications of spinal cord injuries. World J Orthop 2015;6:17-23.
• [5] Holden MK, Gill KM, Maglıozzı MR, Nathan J, Baker LP. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther 1984;64:35-40.
• [6] American Spinal Injury Association. International Standards for Neurological Classifications of Spinal Cord Injury. revised ed. Chicago, Ill: American Spinal Injury Association, 2000., pp. 1-23.
• [7] Bohannon R, Smith M. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987;67: 206-7.
• [8] Karacan I, Koyuncu H, Pekel O, Sümbüloglu G, Kirnap M, Dursun H, et al. Traumatic spinal cord injuries in Turkey: a nation-wide epidemiological study. Spinal Cord 2000;38:697-701.
• [9] Koçyiğit BF, Akaltun MS, Altındağ Ö, Aydeniz A, Gürsoy S, Gür A. Epidemiological and clinical data of patients with spinal cord injury: Five-year experience of our center. J Clin Exp Invest 2015;6:140-3.
• [10] Hagen EM, Rekand T, Grønning M, Færestrand S. Cardiovascular complications of spinal cord injury. Tidsskr Nor Laegeforen 2012;132:1115-20.
• [11] Wang H, Xiang Q, Li C, Zhou Y. Epidemiology of traumatic cervical spinal fractures and risk factors for traumatic cervical spinal cord injury in China. J Spinal Disord Tech 2013;26:E306-13.
• [12] Aito S, Tucci L, Zidarich V, Werhagen L. Traumatic spinal cord injuries: evidence from 30 years in a single centre. Spinal Cord 2014;52:268-71.
• [13] Chishtie J, Chishtie F, Yoshida K, Balogh R. Spinal cord injury rehabilitation and pressure ulcer prevention after the 2005 South Asian Earthquake: a CBR case study from Pakistan. Disabil Rehabil 2018 Mar 7:1-9. doi: 10.1080/09638288.2018.1445783. [Epub ahead of print]
• [14] van Weert KC, Schouten EJ, Hofstede J, van de Meent H, Holtslag HR, van den Berg-Emons RJ. Acute phase complications following traumatic spinal cord injury in Dutch level 1 trauma centres. J Rehabil Med 2014;46:882-5.
• [15] Joseph C, Nilsson Wikmar L. Prevalence of secondary medical complications and risk factors for pressure ulcers after traumatic spinal cord injury during acute care in South Africa. Spinal Cord 2016;54:535-9.
• [16] Scheel-Sailer A, Wyss A, Boldt C, Post MW, Lay V. Prevalence, location, grade of pressure ulcers and association with specific patient characteristics in adult spinal cord injury patients during the hospital stay: a prospective cohort study. Spinal Cord 2013;51:828-33.
• [17] Werhagen L, Aito S, Tucci L, Strayer J, Hultling C. 25 years or more after spinal cord injury: clinical conditions of individuals in the Florence and Stockholm areas. Spinal Cord 2012;50:243-6.
• [18] Siddall PJ, Middleton JW. Spinal cord injury-induced pain: mechanisms and treatments. Pain Manag 2015;5:493-507.
• [19] Tollefsen E, Fondenes O. Respiratory complications associated with spinal cord injury. Tidsskr Nor Laegeforen 2012;132:1111-4.
• [20] Spreyermann R, Michel F. [Long-term follow-up in patients with spinal cord injury - prevention and comprehensive care]. Praxis (Bern 1994) 2014;103:95-104. [Article in German]
• [21] Saunders LL, Krause JS. Injuries and falls in an aging cohort with spinal cord injury: SCI Aging Study. Top Spinal Cord Inj Rehabil 2015;21:201-7.
• [22] Rekand T, Hagen EM, Grønning M. Spasticity following spinal cord injury. Tidsskr Nor Laegeforen 2012;132:970-3.
• [23] Chhabra HS, Arora M. Demographic profile of traumatic spinal cord injuries admitted at Indian Spinal Injuries Centre with special emphasis on mode of injury: a retrospective study. Spinal Cord 2012;50:745-54.
• [24] Alshahri SS, Cripps RA, Lee BB, Al-Jadid MS. Traumatic spinal cord injury in Saudi Arabia: an epidemiological estimate from Riyadh. Spinal Cord 2012;50:882-4.
• [25] Matsumoto S, Suda K, Iimoto S, Yasui K, Komatsu M, Ushiku C, et al. Prospective study of deep vein thrombosis in patients with spinal cord injury not receiving anticoagulant therapy. Spinal Cord 2015;53:306-9.
• [26] Ullrich PM, Smith BM, Blow FC, Valenstein M, Weaver FM. Depression, healthcare utilization, and comorbid psychiatric disorders after spinal cord injury. J Spinal Cord Med 2014;37:40-5.
• [27] Suarez NC, Levi R, Bullington J. Regaining health and wellbeing after traumatic spinal cord injury. J Rehabil Med 2013;45:1023-7.
• [28] Shah N, Shrestha B, Subba K. Spinal cord injury rehabilitation in Nepal. JNMA J Nepal Med Assoc 2013;52:427-31.
• [29] Stahel PF, VanderHeiden T, Finn MA. Management strategies for acute spinal cord injury: current options and future perspectives. Curr Opin Crit Care 2012;18:651-60.
• [30] Knútsdóttir S, Thórisdóttir H, Sigvaldason K, Jónsson H Jr, Björnsson A, Ingvarsson P. Epidemiology of traumatic spinal cord injuries in Iceland from 1975 to 2009. Spinal Cord 2012;50:123-6.
• [31] Alsaleh K, Bednar D, Farrokhyar F. Acute traumatic quadriplegia in adults: predictors of acute in-hospital mortality. Turk Neurosurg 2017;27:942-5.
• [32] Ma DN, Zhang XQ, Ying J, Chen ZJ, Li LX. Efficacy and safety of 9 nonoperative regimens for the treatment of spinal cord injury: A network meta-analysis. Medicine (Baltimore) 2017;96:e8679.
• [33] Portnova AA, Mukherjee G, Peters KM, Yamane A, Steele KM. Design of a 3D-printed, open-source wrist-driven orthosis for individuals with spinal cord injury. PLoS One 2018;13:e0193106.
• [34] Arazpour M, Gholami M, Bahramizadeh M, Sharifi G, Bani MA. Influence of reciprocating link when using an isocentric reciprocating gait orthosis (IRGO) on walking in patients with spinal cord injury: a pilot study. Top Spinal Cord Inj Rehabil 2017;23:256-62.