Paraplegia
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Comparative Study
Comparative study of electrophrenic nerve stimulation and mechanical ventilatory support in traumatic spinal cord injury.
Over the past two decades, the number of surviving apneic spinal cord injured patients has been increasing. Mechanical ventilation for home maintenance has been supplemented by electrophrenic respiration (EPR) since 1970. Nineteen patients who were totally mechanical ventilator dependent at discharge from rehabilitation in a spinal cord centre are compared with 18 patients discharged on EPR. ⋯ The mortality rates were approximately equal although the mechanical ventilator dependent patients expired earlier than the EPR group. Survivors on mechanical ventilation lived longer on an average and the vast majority of both groups were discharged to their home. There needs to be the establishment of a ventilatory dependent registry for spinal cord injury.
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Within a 12-year period, 44 (9.4%) of 466 patients had spinal cord injury complicating cervical spondylosis. A history of alcoholic use preceding the accident was obtained in 12 (54.5%) of 22 patients whose cord injury was due to a minor fall. The initial myelopathy was complete in 10 patients and incomplete in 34. ⋯ No patient developed acute neurological deterioration after injury but seven expired. The mortality rate was much higher in the patients whose initial cord lesion was complete (50% or 5/10) than in those with incomplete myelopathy (5.9% or 2/34). There was no delayed neurological deterioration due to progressive spondylosis of the spine but three patients developed post-traumatic syringomyelia several months to several years after the injury.
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The results of the treatment of 89 consecutive cases of Pott's paraplegia admitted to care in Korea are reported. Eighty-five patients were treated conservatively. Four patients underwent costo-transversectomy, three of them in the later stages of treatment without apparent benefit. ⋯ The place of chemotherapy as the basis of the treatment of Pott's disease is emphasised. A comparison is made with the published results of other series. The place of operative intervention is discussed and it is argued that the case for urgent early surgical intervention in the treatment of Pott's paraplegia may have been overstated.
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This survey of spinal cord injuries in Taipei city from January 1978 to December 1981 was carried out by a review of the hospital records. During these four years 560 patients with acute spinal cord injury (SCI) were admitted to the hospitals in the city of Taipei. Of these, 123 were inhabitants of Taipei city, showing the annual incidence of SCI in Taipei to be 14.6 per million population. ⋯ The causes of SCI were traffic accidents (44.5%), accidental falls (28.5%), struck by object (14.6%) and sports injury (3.4%). The mortality rate was 6.0%. Respiratory complication was the leading cause of death, accounting for 58% of the total deaths.