The journal of spinal cord medicine
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Comparative Study
Intrathecal baclofen for spasticity management: a comparative analysis of spasticity of spinal vs cortical origin.
To examine the differences in intrathecal baclofen management of individuals with spasticity of cortical vs spinal etiologies. ⋯ Cortical and spinal spasticity appear to parallel each other with no significant differences in daily dosing, dosing changes, and mode of delivery of intrathecal baclofen. This did not hold true at all time points for the multiple sclerosis subgroup. The significant difference noted within groups for daily dosing over the first 3 years challenges the notion of stable dosing over time. Focal injections of Botox/phenol in the upper extremities are an important adjunct therapy for patients with cortical spasticity, even after the placement of an intrathecal baclofen pump. Our complication rate was slightly lower than that reported in the literature.
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Mechanical insufflation-exsufflation (MIE) is an option for secretion mobilization in outpatients with spinal cord injury (SCI) who lack an effective cough and are at high risk for developing pneumonia. ⋯ Mechanical insufflation-exsufflation was typically prescribed for people with motor-complete tetraplegia. Outpatient MIE usage may reduce respiratory hospitalizations in smokers with SCI. Further research of this alternative, noninvasive method is warranted in the outpatient SCI population.
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Case Reports
Spinal schistosomiasis: differential diagnosis for acute paraparesis in a U.S. resident.
Spinal schistosomiasis is a severe presentation of Schistosoma mansoni infection, which is endemic in South America, the Middle East, and sub-Saharan Africa. With increasing international travel, a disease can spread from an endemic area to another part of the world easily. ⋯ An increasing incidence of international travel is increasing the likelihood of US physicians' encountering this treatable condition. Travelers with spinal schistosomiasis may not have symptoms of systemic infection. Therefore, it is important to include spinal schistosomiasis in the differential diagnosis of acute inflammatory myelopathy, particularly with a history of travel to endemic areas.
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Case Reports
Vulnerability of the femoral nerve during complex anterior and posterior spinal surgery.
Femoral nerve palsy is not a common adverse effect of lumbar spinal surgery. ⋯ Use of motor evoked potential monitoring of the femoral nerve during surgery is vital for the prevention of future neuropathies, an avoidable complication of spinal surgery.
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Multicenter Study Clinical Trial
Nutrient intake and body habitus after spinal cord injury: an analysis by sex and level of injury.
To examine nutrient intake and body mass index (BMI) in the spinal cord injury (SCI) population according to level of injury and sex. ⋯ Women with paraplegia tended to maintain healthier diets, reflected by lower caloric and fat intakes, fewer key nutrients falling outside recommended guidelines, and less overweight or obesity. Individuals with tetraplegia tended to take in more calories and had higher BMIs, and using adjusted BMI, the majority of the population was overweight or obese. The majority of people with SCI would benefit from nutritional counseling to prevent emerging secondary conditions as the population with SCI ages.