Spinal cord
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Epidural spinal cord stimulation has been used to decrease spasticity and spasms in spinal cord injury patients. However, the long-term benefits of this procedure have not been determined. We therefore conducted a retrospective study of the possible long-term efficacy of the epidural spinal cord stimulator for the relief of symptoms. ⋯ The total number of implantations in these seventeen patients was 24, (seven patients had undergone a second implantation) costing a total of $566,400. In only one of the patients was the epidural stimulator providing symptomatic relief. The epidural spinal cord stimulator lacks long-term efficacy for the relief of spasticity and pain and is not cost effective.
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Some patients with spinal cord injury (SCI) complain of severe pain. The purpose of this study was to investigate the prevalence and classification of SCI-related pain, in terms of severity, location, aggravating and alleviating factors. 47 SCI individuals were studied between 15 and 67 years of age. Sixty-one percent of subjects experienced pain of moderate to severe intensity. 32 subjects complained of pain in the lower limbs, five patients had pain in the visceral region, eight in the pelvic and perineal areas. ⋯ The incidence of pain was higher in patients with thoracolumbar and incomplete spinal cord lesions. Inactivity, stress, weather change, overactivity were identified as aggravating factors. Sleep and rest were demonstrated as alleviating factors.
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Clinical Trial
SCIM--spinal cord independence measure: a new disability scale for patients with spinal cord lesions.
The Spinal Cord Independence Measure (SCIM) is a new disability scale developed specifically for patients with spinal cord lesions in order to make the functional assessments of patients with paraplegia or tetraplegia more sensitive to changes. The SCIM includes the following areas of function: self-care (subscore (0-20), respiration and sphincter management (0-40) and mobility (0-40). Each area is scored according to its proportional weight in these patients' general activity. ⋯ The mean difference between consecutive scores was higher for the SCIM (P < 0.01). We conclude that the SCIM is a reliable disability scale and is more sensitive to changes in function in spinal cord lesion patients than the FIM. The SCIM when administered by a multidisciplinary team, may be a useful instrument for assessing changes in everyday performance in patients with spinal cord lesion.
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Multicenter Study
Causes and costs of spinal cord injury in the United States.
A cross-sectional multicenter study was conducted to estimate the direct costs for each cause of spinal cord injury in the United States. Random samples of 227 new injuries and 508 persons 2-16 years postinjury were selected. Prospective data were collected during one year on all charges for emergency medical services, hospitalizations, attendant care, equipment, supplies, medications, environmental modifications, physician and outpatient services, nursing homes, household assistance, vocational rehabilitation, and miscellaneous items. ⋯ Using average age at time of injury for each cause, a 2% real discount rate, and the most recent survival data from the National Spinal Cord Injury Statistical Center, average lifetime charges for each cause were $969,659, $613,345, $950,973, $630,453 and $673,749, respectively. Given an estimated 10,000 new cases of spinal cord injury occurring each year of which 35.9% are caused by vehicle crashes, 29.5% are caused by violence, 20.3% are caused by falls, 7.3% are caused by sports, and 7% result from other causes, annual aggregate direct costs of traumatic spinal cord injury in the United States are $3.48 billion for vehicle crashes, $1.81 billion for violence, $1.28 billion for falls, $694 million for sports and $472 million for other causes. Total direct costs for all causes of SCI in the United States are $7.736 billion.
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Clinical Trial
Lumbar cerebrospinal fluid pulse wave rising from pulsations of both the spinal cord and the brain in humans.
There are two theories regarding the origin of the lumbar cerebrospinal fluid pulse wave (L-CSFPW): that it arises from the arteries supplying the spinal cord, and that it is due to the pulsations of the brain transmitted through the subarachnoid space of the spine. We investigated L-CSFPW of 11 myelopathic patients with a complete (five patients, CB-group) or an incomplete spinal block (six, ICB-group) on myelography to determine the origin of L-CSFPW. Since arterial pressure amplitude (APA), the energy source of L-CSFPW, is not the same between individuals or between before and after operation, not only L-CSFPW itself but also the transfer function between the arterial pressure wave and the L-CSFPW calculated by the system analysis method was analyzed to eliminate the influence of hemodynamic fluctuations. ⋯ It has been reported that the spinal cord blood flow is decreased 20% or more by laminectomy, therefore, L-CSFPW measurement may be sensitive enough to detect a 20% or higher decrease in this flow. This suggests that L-CSFPW could possibly be used clinically as a non-invasive method of monitoring the spinal cord blood flow. For broad clinical application of CSFPW, however, further studies are needed, especially on the direct relationship between CSFPW and spinal cord blood flow itself.