Paraplegia
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Case Reports
Pathology of spinal cord injuries due to fracture-dislocations of the thoracic and lumbar spine.
The pathology of intervertebral disc injuries, hyper-extension injuries and spinal cord injuries due to fracture-dislocations of the cervical spine has been reported previously. Between 1957 and 1987, autopsy was performed on 4 patients with fracture-dislocation of the thoracic spine and on one patient with that of the lumbar spine. This paper presents the results of a clinicopathologic study conducted on two patients with a fracture-dislocation of the thoracic spine and on one patient with that pathology of the lumbar spine. The methods employed in the present study are the same as those that were described in my previous report on the pathology of cervical inter-vertebral disc injuries.
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Patients suffering from a spinal cord injury often present with a pain syndrome. Although the reflex sympathetic syndrome is a common diagnosis in some forms of neurological disease such as patients with a stroke, it is less frequent in those with a spinal lesion. The authors report eight patients with reflex sympathetic dystrophy who had a spinal cord injury. The diagnosis and treatment are discussed along with a review of literature.
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Many long term wheelchair users develop shoulder pain. The purpose of this study was to examine the reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI), an instrument which measures shoulder pain associated with the functional activities of wheelchair users. This 15-item functional index was developed to access shoulder pain during transfers, self care, wheelchair mobility and general activities. ⋯ There were statistically significant negative correlations of total index scores to range of motion measurements of shoulder abduction (r = -0.485), flexion (r = -0.479) and shoulder extension (r = -0.304), indicating that there is a significant relationship of total index score to loss of shoulder range of motion in this sample. The Wheelchair User's Shoulder Pain Index shows high levels of reliability and internal consistency, as well as concurrent validity with loss of shoulder range of motion. As a valid and reliable instrument, this tool may be useful to both clinicians and researchers in documenting baseline shoulder dysfunction and for periodic measurement in longitudinal studies of musculoskeletal complications in wheelchair users.
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The present study deals with the results of the medical-surgical treatment of 22 patients with Pott's tetraplegia or paraplegia. Seventeen had progressive tetraplegia-paraplegia which failed to respond solely to medical treatment. On admission, four patients exhibited an acute onset tetraplegia-paraplegia, and one had a 'spinal tumour syndrome'. ⋯ Two patients were able to get about on crutches. The onset of objective improvement soon after surgical decompression suggests a causal effect. It was concluded that early neural decompression and spinal stabilisation provided the maximum potential for neurological recovery.
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In a patient wounded by a gunshot in the abdomen, the bullet was radiologically located intradurally at S1 level. Although she had no neurological deficit at admission, she developed pain and motor weakness a few days later. At operation the bullet was found at L4 level and its removal resulted in complete neurological recovery.