Spinal cord
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Randomized Controlled Trial Clinical Trial
Gabapentin for the treatment of spasticity in patients with spinal cord injury.
Our serendipitous observations suggested that some patients with spasticity appeared to have improved following the administration of the anticonvulsant drug gabapentin. As some patients with spasticity are either refractory to or intolerant of established medical treatments, we conducted this study to investigate the effect of gabapentin on spasticity in patients with spinal cord injury. Twenty-five patients with spinal cord injury and spasticity received oral gabapentin (2400 mg over 48 h) in a randomized, double blind, placebo-controlled crossover study. ⋯ Administration of gabapentin, but not placebo, was associated with an 11% reduction in spasticity as measured by the Ashworth Scale (P = 0.04) and by a 20% reduction in the Likert Scale (P = 0.0013). Significant changes were not obtained for the other measures. The data obtained suggest that gabapentin may be useful in the management of spasticity associated with spinal cord injury.
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Clinical Trial
Three-dimensional computed tomography for evaluation of cervical spinal canal enlargement after en bloc open-door laminoplasty.
We evaluated the use of three-dimensional (spiral) computed tomography (CT) to assess widening of the bony cervical spinal canal following en bloc open-door C3-C7 laminoplasty in 31 patients. Measurements were performed using a computerised image processing system. The increment in the anteroposterior spinal canal axis and volume of the bony spinal canal was investigated in relation to changes in cervical spine lordosis as well as postoperative neurological improvement. ⋯ Postoperatively, cervical spine lordosis correlated with increments in the volume of the enlarged bony canal rather than the anteroposterior axis. Postoperative neurological improvement correlated significantly with the increase in the canal volume. Our results indicate that spiral CT is useful for the assessment of the magnitude of cervical canal enlargement and evaluating the space available for the spinal cord following the relief of compression.
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We report our experience utilizing the technique of phenol block of the pudendal nerve in the treatment of voiding dysfunction due to hypertonicity of the external urethral sphincter. We have performed 13 pudendal nerve blocks using a 7% phenol solution in seven patients with spinal cord injury who could not obtain relaxation of the external urethral sphincter with a large postvoid urine residual (150 ml to 600 ml) despite large doses of antispasticity drugs and intermittent catheterisations over three weeks. These drugs were discontinued at least 48 hours before this procedure. ⋯ The mean difference of the postvoid residual volume and the intravesical leak pressure before and after pudendal nerve block was 255.7 ml and 57.5 cmH2O, respectively. We conclude that pudendal nerve block with a phenol solution as a treatment of external urethral sphincter hypertonicity was effective, easy to perform, and had no complication. This treatment should be considered as a possible alternative to more invasive surgical procedures.
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Pain is a significant problem following spinal cord injury (SCI) and has a major influence on quality of life and the ability to engage in rehabilitation. Surgery is often indicated in the management of spinal cord injury to stabilise the spine and prevent further neurological deficit. However, the relationship between surgical intervention and the presence of pain following SCI is unclear. ⋯ We found that surgical intervention was associated with a significantly higher prevalence of musculoskeletal pain at 2 weeks but not at 4, 8, 13, 26 and 52 weeks following injury, when compared with those who did not have surgery. There were no significant differences in the prevalence of visceral, neuropathic at level or neuropathic below level pain in the surgical and non-surgical groups at any stage. The results from this study suggest that apart from an increased prevalence of musculoskeletal pain at 2 weeks following SCI in those who undergo surgery, there is no significant relationship between surgical intervention and the presence of SCI pain.
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Multicenter Study Clinical Trial
Chronic pain/dysaesthesiae in spinal cord injury patients: results of a multicentre study.
The aim of the multicentre study entitled 'Description and Documentation of Painful States in Spinal Cord Injury Patients', in addition to the description and documentation of chronic pain and stressful dysaesthesiae in SCI patients, was the search for correlations between these symptoms and medical and psychosocial variables. To this end, the sample was selected to be as representative as possible. All patients referred for in-patient or out-patient treatment at the centres taking part were enrolled in the study in order of presentation, providing they gave consent and met the inclusion criteria. ⋯ There were significant correlations between the presence of P/D and age on questioning and at onset of the paraplegia/tetraplegia, problems with rectal paralysis, expectations of life as a paraplegic/tetraplegic, and subjective assessment of changes in working life. Highly significant correlations were found with subjective distress resulting of paraplegia/tetraplegia as such, depressed mood and psychosomatic disturbances of wellbeing. Overall, among the selected variables of our study, we found that correlations between P/D and psychosocial variables were more frequent and closer than those between P/D and medical variables.