The journal of spinal cord medicine
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Pain following spinal cord injury (SCI) is a common problem and can interfere with functional recovery. Radicular pain (pain at the level of injury) is one type of SCI pain. Traditional analgesic agents are sometimes ineffective and can have significant systemic side effects. ⋯ Based on these favorable results and minimal side effects, topical capsaicin should be considered in the treatment of localized radicular pain secondary to SCI.
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Case Reports Comparative Study
A comparison of FES with KAFO for providing ambulation and upright mobility in a child with a complete thoracic spinal cord injury.
This study compared functional and physiologic measures of ambulation and upright mobility with functional electrical stimulation (FES) versus knee-ankle-foot-orthoses (KAFO) in an 11-year-old boy with a T-10 level spinal cord injury. The child was a limited community ambulator with bilateral KAFO and loftstrand crutches. The FES system consisted of percutaneous intramuscular electrodes controlled by a portable stimulator and thumbswitch, an AFO for ankle and foot support, and loftstrand crutches. ⋯ Maximum ambulation distances were relatively equal while the subject's velocity was significantly faster with FES. Of note, the subject reported ceasing ambulation during maximum distance trials due to general fatigue when using FES and due to shoulder pain with KAFO ambulation. For this subject, FES provided a means of performing upright mobility tasks independently, comparable with that of KAFO, while providing a faster ambulation velocity and a potential means of cardiovascular training.
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This concerns a patient with compression myelopathy following passive hyperextension of the cervical spine during a dental procedure. Although he had been asymptomatic prior to the procedure, subsequent cervical spinal imaging revealed advanced spondylosis and spinal stenosis. Spinal stenosis is often asymptomatic for a long time. ⋯ As the size of the elderly population continues to increase the prevalence of cervical spondylotic radiculo-myelopathy will likely increase as well. Since appropriate precautions against potential neurologic damage can be undertaken, we suggest radiographic screening for pre-existing spinal stenosis prior to a procedure requiring hyperextension of the neck. Preventive measures for individuals with asymptomatic spondylotic changes and education of all health-care professionals to avoid abrupt or prolonged hyperextension of the cervical spine is emphasized.
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Interruption of autonomic pathways by spinal cord injury (SCI) causes dysfunctional autonomic dysreflexia (AD), which was first described in 1917, still remains unrecognized by those in the medical profession not involved in SCI care. Autonomic dysreflexia is a syndrome generally manifest by cardiovascular symptoms and characterized by paroxysmal hypertension. ⋯ Since patients with high level SCI are usually hypotensive, the high blood pressures that develop during AD represent pressure changes of a magnitude that can cause cerebrovascular accidents and death of the subject. We discuss the therapeutic interventions that abate and curtail the symptoms and prevent the catastrophic sequelae of autonomic dysreflexia.