Incidence of non-traumatic spinal cord injury in Victoria, Australia: a population-based study and literature review

STUDY DESIGN: Data extraction from a state-wide, population-based, health-administration database of hospital admissions. OBJECTIVE: To determine the incidence of non-traumatic spinal cord injury (NTSCI).Setting:Victoria, Australia. METHODS: All patients admitted to hospital with a new onset of NTSCI, or who developed NTSCI after hospitalization, between 1 July 2000 and 30 June 2006, were identified using a population-based database. Age and gender of NTSCI patients were recorded. RESULTS: The number of adults aged 15 years and older with NTSCI in each of the 12-month periods was 82, 111, 96, 108, 133 and 101. The average age-adjusted incidence rate of NTSCI in adults was 26.3 cases per million per year. There was no statistically significant increase in the age-adjusted incidence of NTSCI over the study period (Spearman's rho=0.35, P=0.5). The incidence of NTSCI was significantly greater than the reported incidence for traumatic spinal cord injury (chi2 (1)=19.5, P<0.0000). There was a very strong correlation between age and the incidence of NTSCI, for both men (Spearman's rho=1, P<0.0000) and women (Spearman's rho=0.98, P=0.0000). Men had a statistically significantly (chi2 (1)=13.1, P=0.000) higher incidence of NTSCI (30.5 million adults per year) compared to women (22.9 million adults per year). The average incidence of NTSCI in children <15 years was 0.7 cases per million per year. CONCLUSION: NTSCI is strongly correlated with age and is more common than traumatic spinal cord injury. The method used in this study to calculate the incidence of NTSCI can be used to monitor the anticipated increase in the incidence of NTSCI in the years ahead, and can be used to in comparative studies.     

Traumatic vs non-traumatic spinal cord injury: A comparison of primary rehabilitation outcomes and complications during hospitalization

Objective: To compare outcome for patients with traumatic (TSCI) and non-traumatic spinal cord injuries (NTSCI) after primary rehabilitation regarding neurological improvement measured by the American Spinal Injury Association Impairment Scale (AIS), length of stay and complications.

Design: Retrospective comparative cohort study on patients with TSCI and NTSCI, hospitalized during a ten-year period at Haukeland University Hospital, Norway. Impairment, length of stay and complications during first in-patient rehabilitation period were analyzed. Uni- and multivariate analysis was performed.

Setting: Spinal Cord Rehabilitation Unit, Haukeland University Hospital, Norway

Participants: A total of 174 persons with a spinal cord injury (SCI) were included; 102 with TSCI and 72 with NTSCI.

Outcome measures: Neurological improvement measured by AIS from admission to discharge, number of weeks in the hospital, frequency and significance of complications were compared.

Results: Improvement in AIS after primary rehabilitation did not differ between TSCI and NTSCI. Length of stay was in average 3.4 weeks longer for TSCI. Urinary tract infections and pressure ulcers significantly influenced length of stay in both groups. Urinary tract infections were more frequent in TSCI (67%) vs NTSCI (42%). Pressure ulcers were more frequent among NTSCI (24%) vs TSCI (14%). Pneumonia and neuropathic pain did not depend on etiology and did not influence length of stay.

Conclusions: Patients with SCI have a rehabilitation potential regardless of etiology. Complications are frequent in both groups and often prolong hospitalization. Complication patterns differ in the two groups, and specific prevention and optimal treatment will shorten and optimize the length of primary rehabilitation.     

2015至2020年广西医科大学第一附属医院老年脊髓损伤的特征分析

目的回顾2015至2020年就诊于广西医科大学第一附属医院的老年脊髓损伤的临床资料,分析老年脊髓损伤的流行病学特征。 方法利用电子病历查询系统对患者的相关数据进行提取,我们收集了2015~2017年与2018~2020年相同时间区域内患者的性别、年龄、病因、职业、损伤部位、并发症、是否为完全性损伤、是否合并高血压和糖尿病等数据,比较两个时间段患者流行病学特征的差异。 结果本研究共收集患者269例,男183例（68.0%）,女86例（32.0%）。2018~2020年157例,其中男101例（64.3%）,女56例（35.7%）,中位年龄67岁（62~72岁）;2015~2017年112例,其中男82例（73.2%）,女30例（26.8%）,中位年龄66岁（62.5~70岁）。79岁以下患者达263例（97.8%）,两个时间段内颈段脊髓损伤发生率最高,2015~2017年为70例（62.5%）,2018~2020年为77例（49.0%）,近年有下降趋势;两个时间段最常见致伤因素为外伤,2015~2017年为60例（53.6%）,2018~2020年为60例（38.20%）,近年发病有下降趋势;两个时间段中占比最高的职业均为农民,其中2015~2017年57例（50.1%）、2018~2020年94例（59.9%）,近年来农民发病率有上升的趋势;两个时间段的患者在性别、年龄、脊髓损伤部位、合并高血压和糖尿病方面的差异无统计学意义,在致伤因素、职业、并发症的差异有统计学意义。 结论老年患者发病数量有增加的趋势,主要人群为79岁以下的老年患者,颈段脊髓损伤最常见,多为不完全性脊髓损伤,最常见并发症为肺炎,深静脉血栓有增加的趋势,农民占比最高,主要致伤因素为外伤。     

The prevalence of neuropathic pain after non-traumatic spinal cord lesion

STUDY DESIGN: Retrospective register study. OBJECTIVE: To investigate the predictive value of the following parameters for the development of neuropathic pain after non-traumatic spinal cord lesion: that is age at onset of spinal cord disease, gender, completeness of lesion, level of lesion, and aetiology. SETTING: A unit for patients with post-acute traumatic and non-traumatic spinal cord lesions in the greater area of Stockholm, Sweden. METHOD: All patients with non-traumatic spinal cord lesions visiting the unit between 1995 and 2000 were classified according to the following: that is neuropathic pain at or below lesion level according to IASP criteria, age at time of the onset of the spinal cord symptoms, injury level, complete/incomplete injury, and aetiology. Results were analysed with chi(2) - analysis and logistic regression. RESULTS: In total, 38% had neuropathic pain, 15% had pain predominantly at the level of lesion, and 23% predominantly below the level of lesion. Of those with pain, 67% reported that the pain affected daily life. Women reported neuropathic pain below the level of lesion more often (40%) than men (13%). The prevalence was particularly high (64%) for patients with malignant spinal cord diseases. Neither age at onset of the spinal cord symptoms, nor complete/incomplete injury nor injury level had significant influence on the prevalence. CONCLUSION: Neuropathic pain is common among patients with acquired non-traumatic spinal cord lesions regardless of aetiology, often causing severe problems in daily life.     

Posterior cord syndrome: Demographics and rehabilitation outcomes

Context/Objectives: To describe demographics, clinical characteristics, and functional outcomes of patients with incomplete spinal cord injuries and posterior cord syndrome (PCS).Design: Five-year retrospective case series.Setting: Spinal cord injury (SCI) rehabilitation unit at a Level 1 tertiary university medical center.Participants: 9 patients with incomplete cord injuries diagnosed with PCS admitted to rehabilitation within the past 5 years.Outcome measures: Functional Independence Measure (FIM) motor scores, length of stay (LOS), discharge disposition.Results: Incidence of PCS was 2% with an average age of 62.0 years. The most common etiology for PCS was spinal cord compression from localized tumors (78%). Seven (78%) patients had paraparesis. All patients had an American Spinal Injury Association impairment scale (AIS) classification of AIS D. SCI-related complications most commonly included: neuropathic pain (78%), spasticity (44%), and neurogenic bladder (78%). Average LOS on the rehabilitation unit was 28 days. Average admission and discharge FIM motor scores were significantly improved (P = 0.001) from 41 to 65, respectively. Two-thirds (67%) of patients were able to walk at least 150 feet with a rolling walker prior to discharge. Most (78%) patients were discharged to home. Continence improved from admission to discharge from 22% vs 56% (bladder) and 67% vs 78% (bowel).Conclusions: We can conclude that PCS most often results in paraparesis due to tumor compression. Typical SCI-related medical complications are encountered. These patients often experience significant functional improvements during SCI rehabilitation with the majority also having bladder and bowel continence allowing them to return home at discharge.     

青少年特发性脊柱侧凸患者顶椎区脊髓位置变化及其临床意义

目的:分析青少年特发性脊柱侧凸(AIS)患者顶椎区脊髓偏移和旋转情况,并探讨其临床意义.方法:在28例AIS患者横断面MRI图像上测量顶椎区脊髓中心到椎管前、后内壁及凹、凸侧内壁的距离和脊髓、椎体的旋转角度,将脊髓旋转与椎体旋转的关系按Maruta分型分为O型、U型和R型,并分析脊髓在椎管内的位置及脊髓位置与Cobb角、脊髓旋转角度、椎体旋转角度之间的相关性.结果:顶椎区脊髓中心距脊柱凹侧、凸侧椎管内壁距离分别为7.13±1.89mm、13.68±2.93mm,距凹侧距离明显小于距凸侧距离(t=-9.56,P<0.01);距椎管内壁前、后缘距离分别为7.50±1.63mm、6.99±1.61mm,两者比较无显著性差异(t=1.22.p=0.23).椎体旋转角度为17,53°±6.70°,脊髓旋转角度为16.46°±9.16°,O型8例,U型13例,R型7例.脊髓旋转角度与椎体旋转角度、Cobb角及脊髓中心到凸凹侧椎管内壁的差值之间均呈正相关(分别为r=0.45,P=0.01;r=0.43,P=0.02;r:0.64,P<0.01),与脊髓中心列椎管内壁前后缘的差值之间无显著相关性(r=0.28,P=0.15).结论:AIS患者顶椎区脊髓向凹侧偏移,椎体与脊髓都存在旋转,脊髓的旋转方向因人而异.在行后路脊柱矫形椎弓根螺钉置入时,应特别注意凹侧脊髓及神经根,避免损伤.     

Secondary conditions in a community sample of people with spinal cord damage

Objective: To compare secondary conditions in people with traumatic spinal cord injury (SCI) and non-traumatic spinal cord dysfunction (SCDys).

Design: Survey; completed August 2012 – June 2013.

Setting: Community, Australia.

Participants: Adults with spinal cord damage from any cause.

Interventions: Nil.

Outcome Measures: Demographic and clinical variables and the SCI-Secondary Conditions Scale (SCI-SCS).

Results: Survey completed by 150 people: 112 (74.7%) with traumatic SCI and 38 (25.3%) with non-traumatic SCDys a median of 10 years post onset. No significant difference (t?=?–0.6, P?=?0.6) in the total SCI-SCS score between those with SCI (mean 13.7) and SCDys (mean 14.4). Except for bladder problems (SCDys mean?=?1.5, SD?=?1.1; SCI mean?=?1.0, SD=1.1; t?=?–2.6, P?=?0.01) there were no significant differences between the aetiology groups regarding the conditions comprising the SCI-SCS (all other P values >0.1). The most common significant or chronic problems from the SCI-SCS were: sexual problems 41%; chronic pain 24%; bladder dysfunction 17%; spasms 17%; joint and muscle pain 15%; bowel dysfunction 14%; circulation problems 14%; contractures 9%; urinary tract infections 9%; pressure ulcer 7% and postural hypotension 5%. A linear regression analysis found that tetraplegia and higher disability were the only variables that significantly influenced (R²?=?0.13; P?=?0.005) the total SCI-SCS score and that sex, age, years post injury and etiology of spinal cord damage had no influence.

Conclusions: Secondary conditions following spinal cord damage do not appear to be influenced by etiology. Prevention and management of secondary conditions following need to consider people with non-traumatic SCDys as well as those with traumatic SCI.     

脊髓损伤的MR表现

研究脊髓损伤的MR表现。采用GESigna0．5T超导型磁共振检查机，用脊柱表面线圈，对55例脊柱创伤病人做MR检查。所有病例做轮位和矢状位检查，用自旋回波序列和快速自旋回波序列。脊髓损伤表现为脊髓水肿23例次（41．8％），髓内出血10例次（18．1％），脊髓不完全性和完全性断裂7例次（12．7％），椎间盘值22例次（364％），脊柱韧带断裂30例次（545％）。脊髓损伤多见于爆裂型和骨折脱位型脊柱骨折。MR是脊髓损伤最有效的检查方法，MR对发现和评估脊髓损伤优于CT扫描。     

Early Surgical Management of Acute Spinal Cord Injury

ABSTRACT

Fibrocartilaginous emboli to spinal cord vessels is an apparently rare cause of spinal cord injury. A review of the medical literature reveals only 24 reported cases, none of which were noted prior to 1961. The authors have reviewed an additional, but as yet unpublished, case. The majority of patients presented with the acute onset of pain located around the vertebral column which was followed by progressive paresis/paralysis and respiratory insufficiency. Minor trauma to the vertebrae prior to onset was noted in most cases. The time to maximum neurologic deficit (typically paraplegia or quadriplegia) ranged from minutes to 24 to 48 hours. In all but one case the spinal cord injury resulted in death within 11 months of onset with a median of 2.5 to 4 months. One patient lived six years and seven months with respiratory support. In yet another case, a fibrocartilaginous embolus to a sacral nerve root was found as an incidental finding at autopsy. The incidence of both asymptomatic and clinically significant emboli may be more common and depends on the awareness of the medical community to consider this in the differential diagnosis of spinal cord injury. (J Am Paraplegia Soc 1990; 13: 18–23)     

多节段脊柱骨折的治疗

目的探讨多节段脊柱骨折的损伤机制，伤情特点及诊治方法。方法对于1998年10月至2003年12月期间脊柱多阶段骨折进行回顾性分析。52例多节段骨折，相邻型33例（63．5％），非相邻型19例（36．5％），其中胸腰段损伤30例（57．5％），50例（96％）伴有神经损伤，脊髓功能按Frankel分级，A级11例，B级17例，C级15例。D级7例。E级2例，平均年龄38岁，延迟诊断19例。损伤原因以高处坠落（55．8％），交通事故（25％）为主。保守治疗28例，手术治疗24例，除7例行胸椎单纯减压以外，颈椎、胸腰段、胸椎均行切开减压并不同内固定器械固定。计有Orion1例。TSRH1例，Dick4例，SF2例，RF3例，AF2例，CD4例。固定椎体跨2节到4节不等。结果经过平均16．5个月随访。52例多节段骨折均获骨性愈合，脊髓功能改善1级者21例，改善2级者11例，无改善者20例。其中FrankelA级11例，仅有2例有改善。结论多发性脊柱骨折发生率较低，易漏诊。伤情重，合并伤多，多伴有脊髓损伤，以青壮年男性多发。高空坠落，交通事故是常见原因。损伤的康复取决于脊髓受伤程度，手术积极干预，对患者康复有帮助。     

What to call spinal cord damage not due to trauma? Implications for literature searching

Abstract

Objectives

To illustrate the importance of multiple search terms and databases when searching publications on spinal cord damage not due to trauma. To develop comprehensive search filter for this subject, compare the results for 2000–2009 with the Medical Subject Headings (MeSH) and Emtree term ‘spinal cord diseases’ and determine changes in the number of articles over this period.

Design

Literature searches and search filter development.

Setting

Australia.

Interventions

Titles and abstracts searched in MEDLINE and EMBASE (2000–2009) for articles involving humans using search terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ (concise search). Develop comprehensive search filter for ‘spinal cord damage not due to trauma’ and compare the results with the MeSH term ‘spinal cord diseases.’

Outcome measures

Annual publications (2000–2009) identified in MEDLINE and EMBASE literature searches.

Results

Concise search identified 35 articles published during 2000–2009. More publications were identified using the term ‘nontraumatic spinal cord injury’ (n = 20) than ‘non-traumatic spinal cord injury’ (n = 16). Publications increased for both terms ‘spinal cord diseases’ (2000 = 279; 2009 = 415) and ‘spinal cord damage not due to trauma’ identified by the comprehensive search filter (2000 = 1251; 2009 = 1921).

Conclusions

Concise searches using terms ‘non-traumatic spinal cord injury’ and ‘nontraumatic spinal cord injury’ fail to identify relevant articles unless combinations of terms and databases are used. These are inadequate search terms for a comprehensive search. Further research is needed to validate our comprehensive search filter. An international consensus process is required to establish an agreed term for ‘spinal cord damage not due to trauma.’     

无骨折脱位型颈脊髓损伤诊断和治疗

目的：探讨无骨折脱位型颈髓损伤的诊断及治疗方法。方法：回顾性分析56例确诊无骨折脱位型脊髓损伤病例的临床资料。男24例，女32例；年龄21～73岁，平均54岁。脊髓损伤平面与类型：C2 2例，C3 1例，C4 5例，C5 18例，C6 15例，C7 11例，C8 4例。完全性脊髓损伤11例，不完全性脊髓损伤45例。在不完全性脊髓损伤中，表现为脊髓中央综合征的29例，脊髓前侧综合征为10例，BrownSepuard综合征3例，脊髓后部损伤的为3例。结果：56例无颈椎骨折或脱位的颈髓损伤患者中，48例伤后1周之内接受颈椎CT扫描检查，颈髓病变的检出率为79．17％。52例在伤后1周之内、4周后接受MRI检查，脊髓病变阳性检出率为90．38％。A组：26例在伤后1周之内接受手术治疗，完全改善2例，明显改善15例，部分改善6例，无改善3例。B组：3例在2周内接受手术治疗，明显改善1例，部分改善1例，无改善1例。C组：5例在2个月内接受手术治疗，脊髓功能均无改善。D组：17例进行非手术治疗，完全改善1例，明显改善9例，部分改善2例，无改善5例。有5例患者在治疗过程中因并发症死亡。结论：MRI对了解脊髓病变部位与程度，原发病病变的情况，预测病理变化的转归，都明显优于CT检查。治疗方面非手术治疗不可缺少，但适时选择手术治疗会取得更好的治疗结果。     

颈椎手术中皮层体感诱发电位(CSEP)监护的临床研究

目的：通过开展皮层体感诱发电位（CSEP）术中监护脊髓功能的临床研究，有效的预防医源性脊髓损伤。杜绝截瘫的发生。方法：71例手术患者按Frankel分级术前属B级5例，C级24例，D级27例。E级15例，CSEP术中连续动态监测。作者经实验研究并结合临床提出CSEP术中监护临界值为，D、E级患者术中波幅较麻醉后下降不超过50%；B，C级患者术中波幅较麻醉后下降不超过40%，结果：39例未达到监护临界值，术后无脊髓损伤，超过临界值发出警告32例，其中31例接受警告术后脊髓功能无损害。1例不顾警告继续手术。术后发生完全性截瘫。结论：CSEP术中监护脊髓损伤准确可靠。值得推广应用。     

Demographic and clinical characteristics of persons with spinal cord injury in Turkey: One-year experience of a primary referral rehabilitation center

Objective: To define the demographic and clinical characteristics of persons with spinal cord injury, rehabilitated in a primary referral rehabilitation center in Turkey.

Design: Retrospective study.

Setting: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey.

Methods: Medical records of all patients with spinal cord injury (acute-subacute-chronic) at a single academic referral center over the course of one year were reviewed. Variables of each patient were recorded, including: age, sex, etiology, length of rehabilitation stay, neurological level of injury, level of neurological impairment and severity of injury.

Results: Among 262 persons with spinal cord injury, 69.8% were male (male:female ratio is 2.31?:?1). Mean age was 38.3?±?17.6 years. Falls were the most common cause of injury. The majority of falls were falls from a height (93.3%). More than 20% of falls from a height were related to occupational injury. The most common neurological level of injury was L1. Of all persons 46.2% had thoracic, 27.5% had lumbar and 26.3% had cervical lesions. The mean length of rehabilitation stay was 52.1?±?25.5 days. Persons with motor complete injury and with a shorter (<12 months) time since injury had longer length of rehabilitation stay.

Conclusion: The mean age of SCI population is increasing. Falls constitute the majority of etiologic factors and are more common in persons >60 years old. More than 20% of falls from a height are related to occupational injury. Male-female ratio is decreasing. Thoraco-lumbar injures are more common than cervical injuries.     

Spinal and spinal cord injuries in horse riding: the New South Wales experience 1976-1996

Objectives: The objective of the present study was to determine the incidence of acute spinal cord injuries (ASCI) in all forms of horse riding in New South Wales (NSW) for the period 1976?1996. Other aims of the present study were to compare and contrast ASCI with vertebral column injuries (VCI) without neurological damage and to define appropriate safety measures in relation to spinal injury in horse‐riding. Design: A retrospective review was done of all ASCI cases (n = 32) admitted to the two acute spinal cord injury units in NSW for the cited period. A comparable review of VCI cases (n = 30) admitted to these centres for the period 1987?1995 was also undertaken. Results: A fall in flight was the commonest mode of injury in both groups. Occupational and leisure riding accounted for 88% of ASCI and VCI. The incidence of ASCI is very low in those riding under the aegis of the Equestrian Federation of Australia ? two cases in 21 years; and there were no cases in the Pony Club Riders or in Riding for the Disabled. The difference in the spinal damage caused by ASCI and VCI is in degree rather than kind. Associated appendicular/visceral injuries were common. Conclusions: No measures were defined to improve spinal safety in any form of horse riding. The possible role of body protectors warrants formal evaluation. Continued safety education for all horse riders is strongly recommended.     

颈髓损伤患者低渗血症的原因及治疗

目的：探讨急性颈髓损伤后低渗血症的相关因素及治疗方法.方法：1998年10月～2002年2月共收治114例急性颈髓损伤患者,其中完全性颈髓损伤患者42例（A组）;不完全性颈髓损伤72例（B组）;同期收治的不伴颈髓损伤的其它损伤患者41例（C组）.测定各组患者的血浆渗透压、Na^＋、K^＋、Cl^-、Ca^2＋、二氧化碳结合力（CO2CP）、血糖（Glu）、血尿素氮（Bun）、血浆蛋白质总量（TP）、白蛋白（ALB）及球蛋白（GLB）含量.对42例完全性颈髓损伤患者中35例严重低钠血症患者（血钠=120～125mmol/L）20例每天采用3%氯化钠盐水400ml静脉点滴（D组）,15例每天采用3%氯化钠盐水400ml加血浆200ml静脉点滴（E组）进行1周治疗.结果：A、B、C三组间血浆渗透压、Na^＋、Cl^-、TP及ALB、GLB含量存在显著性差异（P＜0.05）.D、E组间治疗效果存在显著性差异（P＜0.05）,E组优于D组.结论：急性颈髓损伤易并发低渗血症,其发生率与损伤的程度、低钠及低蛋白有关.同时补充盐和血浆治疗效果较好.     

实验性胚胎脊髓移植进展

目的：研究胚胎脊髓移植治疗脊髓损伤的作用。方法：将胚胎脊髓移植到各种动物模型,以及在临床的初步应用。结果和结论：胚肿脊髓移植能够促进脊髓环路的再生和功能恢复。     

山莨菪碱对牵张性脊髓损伤的防治作用

目的：探讨山莨菪碱（６５４２）对牵张性脊髓损伤的防治效果。方法：日本大耳白兔４８只,随机分为对照组、实验组。实验组于伤前１２、８、４ｈ各肌注６５４２１ｍｇ／ｋｇ;伤后１５ｍｉｎ开始每１ｈ静脉滴注６５４２０３ｍｇ／ｋｇ,持续５ｈ,此后每间隔４ｈ肌注６５４２１ｍｇ／ｋｇ到２ｄ。对照组用等量体积的生理盐水替代６５４２。采用脊髓功能监护、形态学、脊髓组织生化测定、运动功能评定等方法评定６５４２对牵张性脊髓损伤的防治作用。结果：实验组动物伤后８ｈ运动功能障碍率低于对照组,丙二醛（ＭＤＡ）含量低于对照组,过氧化物岐化酶（ＳＯＤ）含量高于对照组（Ｐ＜００５）;神经元及神经纤维变性、坏死,灰质出血范围轻于对照组。结论：伤前应用６５４２能保护脊髓微血管,抑制脊髓继发病理损害,促进脊髓功能恢复。     

Epidural cooling for regional spinal cord hypothermia during most or all of descending thoracic or thoracoabdominal aneurysm repair

Purpose: Hypothermia has some protective effect against ischemia of the spinal cord in thoracoabdominal aneurysm repair. Its method is divided into systemic or regional cooling. Several experimental studies of the regional cooling of the spinal cord have been performed, however, clinical reports are few. The purpose of this study is to evaluate the effect and safety of perfusion cooling of the epidural space during thoracic or thoracoabdominal aortic replacement. Methods: Between January 1998 to June 2001 37 patients (True aneurysm: 18 patients, type B aortic dissection: 19 patients) underwent thoracic or thoracoabdominal aortic replacement with an aid of epidural perfusion cooling. The age ranged from 23 to 78 years old with a mean age of 61 years old. Separate perfusion of upper and lower body was used in all cases. Temperature was lowered to around a 31°C or 32°C. In cases where proximal cross-clamping was danger, deep hypothermic circulatory arrest was used.

Results: Ten patients underwent most or all of descending thoracic aneurysm repair with no spinal cord injury and hospital death. Number of patients of the Crawford type I, type II, and type III were 14, 8 and 5 patients, respectively. One Crawford type II patient was complicated with postoperative spinal cord injury (2.7%). There was one hospital death (2.7%) in Crawford type III. The mean epidural cooling time was 150 minutes, and mean infusion volume of cold saline was 981 cc. The mean lowest cerebrospinal fluid (CSF) temperature was 24.3°C, and mean temperature differences between nasopharynx and CSF was 6.3°C.

Conclusion: Perfusion cooling of the epidural space during most or all of the descending thoracic or thoracoabdominal aneurysm repair was effective in reducing postoperative spinal cord injury and a safe method in clinical situations.     

Profile of patients with spinal cord injuries in Kwazulu-Natal,South Africa: Implications for vocational rehabilitation

Objectives: To describe the demographic and socio-economic profiles, and injury related characteristics of people who sustain SCIs in KZN in order to provide baseline information to instigate a model that guides employment outcomes amongst PLWSCI.

Design: Retrospective analysis of medical files was done.

Setting: King Dinizulu Hospital Spinal Unit (KDHSU), this being the biggest provider of acute care for people who sustain SCI in KwaZulu-Natal and the Eastern Cape Provinces, South Africa was the setting for our study.

Participants: Medical files of individuals who sustained SCI between 2009 and 2012 were perused (n?=?1049) were perused and 188 met the inclusion criteria.

Outcome Measures: Key information from the KDHSU patient’s files were extracted using a tool developed using literature and the international spinal cord injury core data set.

Results: The average annual incidence rate was 12.3 per 100 000 population. The male to female ratio was 6:4 with the mean age of 36.69 years, ranging from 16-64. Out of those employed (34%), 72% were working fulltime, mostly in the service industry (31%) and 59% were classified as laborers. The majority (61%) of the participants completed high school. The major cause of SCI was non-traumatic (54%) and 66% were classified as incomplete (ASIA). Furthermore, 80% were classified as paraplegia and 19% tetraplegia. The mean LOS was 42.9 days, ranging from 1-764 days, influenced by level of injury, completeness and classification of injury and surgical intervention.

Conclusion: The profile of SCI in KwaZulu-Natal is slightly different when compared to other provinces in South Africa and the rest of Africa. There is a need to use epidemiological information (including factors that influence employment) to develop rehabilitation models to guide employment outcomes amongst people living with spinal cord injuries in KZN.