Paraplegia
-
Comparative Study
Tracheostomy ventilation versus diaphragmatic pacemaker ventilation in high spinal cord injury.
We have made a retrospective comparative study of patients with spinal cord injury, nine with a diaphragmatic pacemaker and 13 with mechanical ventilation. Clinical outcome, cost and subjective satisfaction with both modalities have been evaluated. ⋯ The rate of hospital discharge and satisfaction with the treatment were significantly better for pacers. The time devoted to ventilatory assistance and cost were also more favourable in this group.
-
A case of post traumatic thoracic syringomyelia is reported which presented with an acute and severe worsening of the spinal cord condition after extracorporeal shock wave lithotripsy was performed for ureteral stone. The worsening was probably caused by the shock waves reverberating the fluid within the intramedullary cavity producing further damage to the spinal cord.
-
Post-traumatic syringomyelia is now a well known entity and occurs months or years after a spinal cord injury. The presenting symptoms are usually pain, progressive motor weakness, sensory changes, and increased spasticity. ⋯ We present two patients with cervical spine fractures whose presenting symptom of post-traumatic syringomyelia was hyperhidrosis affected by posture. The pathophysiology involved and the management of these patients is discussed.
-
Despite an increasing realisation that patients with acute spinal cord injuries require a multidisciplinary approach for their management, which can only be satisfactorily provided in spinal injuries units, these units are still not being used to their full potential in the United Kingdom. Not surprisingly, the initial admission of patients to other hospitals has inevitably led to delays in transfer to such units, with a high incidence of complications. ⋯ Furthermore, the longer the delay in transfer, the higher the incidence of pressure sores. Suggestions are made as to how complications can be avoided in future.
-
A patient with a cervical spinal cord injury receiving intrathecal baclofen for spasticity control underwent a 7 week course of hyperbaric oxygen therapy to induce healing of an ischial decubitus ulcer. After completion of this treatment and during a routine baclofen infusion pump refill, the actual pump reservoir volume exceeded computer measurements obtained with telemetry. Examination of the physiology of hyperbaric oxygen therapy in relation to infusion pump function revealed that the intraspinal pressures attained during hyperbaric oxygen therapy produced retrograde leakage of cerebrospinal fluid into the infusion pump reservoir.