ABSTRACTS for 2004 meeting



POSTER PRESENTATIONS

 P11
Functional improvement of patients with excessive spasticity after botulin toxin injection
Author(s): N. Roussos, J. Sioutis, D. Patatoukas, G. Vasiliades, G. Kakarantza, G. Karantonis, N. Lagogiannis.
Name of ISCoS Member (Author): G. Karantonis
Main institution where the work was done: PMR Department Asklipeion General Hospital Voula.

AIM:
To investigate the ratio of functional improvement of patients with excessive spasticity after botulin toxin injection.

MATERIAL AND METHOD:
Six patients three men and three women with excessive included in the study. Two women and a man suffered from TBI while two men and a woman suffered from CVA. Four patients were injected in upper and lower limbs, one in upper and one in lower limb. Passive range of motion and spasticity were reported, as well as functional ability, before and after the injection. Patients were followed-up monthly up to six months.

RESULTS:
All patients presented reduction of spasticity and increase of passive range of motion. Four patients improved considerably their functional abilities, either by increasing the speed of gait, or by incorporating the upper limb in the activities of daily life. One patient managed to stand up and improved passive mobilization of his upper limb, while one patient improved marginally his gait. Patients with pain due to spasticity, were improved considerably so that they collaborate better in the Occupational therapy department.

CONCLUSION:
Botulinum toxin injection improves functional abilities of patients about 67% and improves their collaboration in the OT programs. The study is continued.


P12
Effects of methylprednisolone and erythropoietin on experimental spinal cord injuries
Author(s): Abdurrahman ÇETIN, Kemal NAS, Cahfer GÜLOGLU, Hüseyin BÜYÜKBAYRAM, Adnan CEVIZ
Name of ISCoS Member (Author): Kemal NAS
Main institution where the work was done: Dicle University, School of Medicine

Objectives:
to evaluate the effect of methylprednisolone (MPD) and recombinant human erythropoietin (rHu-EPO) on degree of neurological improvement by using a neurological function test and histopathological examination in spinal cord injured rats.

Methods:
Experimental study was designed to evaluate acute beneficial effects on behavioral (motor) assessments by the systemic administration of rHu-EPO (1000 unit./kg, i.p.) and MPD (30 mg/kg i.p.) in the setting of traumatic spinal cord injury (TSCI). The damaged spinal cord was also evaluated histopathologically.

Results:
Significant differences were found in neurological function scores between control groups and MPD and rHu-EPO 1000 u and rHu-EPO 1000 u + MPD groups (p<0.001). There was also statistically significant difference between MDP and rHu-EPO 1000 u + MPD groups (p<0.01). Histopathological findings of severe ishcemia were found in control group. There was significant decrease in ischemic injury in rHu-EPO 1000 u and rHu-EPO 1000 u + MPD group compared to the control group (p<0.001).

Conclusions:
Significant improvements were found by using RHu-EPO 1000 ünite + MPD in neurological function deficits and histopathological findings of spinal cord injuries.


P13
The effects of systemically administered of methylprednisolone and recombinant human erythropoietin in rats after spinal cord ischemic injury
Author(s): Kemal NAS, Abdurrahman ÇETIN, Hüseyin BÜYÜKBAYRAM, Adnan CEVIZ
Name of ISCoS Member (Author): Kemal NAS
Main institution where the work was done: Dicle University, School of Medicine

Objective:
To evaluate whether recombinant human erythropoetin (rHu-EPO) and methylprednisolone (MPD) improves neurological function and histopathological outcome if systemically administered after traumatic spinal cord injury.

Methods:
Animals constituted a moderate compression of 0.6 N which was produced by application of an aneurysm clip at level T3 for 1 minute. RHu-EPO (1000 and 3000 units per kg of body weight i.p.) and MPD (30 mg/kg) administered 5 minutes after trauma.

Results:
Statistically significant improvements between the control group and the groups that taken medical treatment have been observed according to the neurological function test scores (p<0.001). When rHu-EPO 3000 units group and rHu-EPO 3000 units + MPD group were compared with each other, the difference was statistically significant (p<0.029). In the control group, histopathologically severe ischemic findings have been observed. A significant decrease in ischemic damage has been detected when MPD + rHu-EPO 3000 units group was compared with the control group (p<0.001).

Conclusions:
There has been most significant neurological functional and histophatological improvements after systematical administration of rHu-EPO 1000 units and/or MPD and MPD + rHu-EPO 3000 units in the spinal cord injury. Furthermore, the MPD + rHu-EPO 3000 units group provides early neurological function and histopathological recovery.

P14
Critical evulation of the modern guidelines for spinal tauma management.
Author(s): Pentelényi T., Zsolczai S., Klauber A.
Name of ISCoS Member (Author): Pentelényi T., Zsolczai S., Klauber A.
Main institution where the work was done: National Institute of Traumatology, Department of Neurosurgery, Budapest , Hungary

This is a keynote lecture on up-to-date treatment of severe spinal injuries in the mirror of the latest evidence-based guidelines for spinal trauma management. There are no standards, no guidelines, all modalities are options. We have chosen among them those options by which proper modern treatment-strategy can be constructed.

Severe spinal trauma cases must be operated on in 60-80 %. There are emergency, absolute and relative indications for surgery.

Emergency operations and neuroprotective treatment must be started in 6-8 hours.

Local treatment includes reduction, decompression and stabilization.

Their conservative and operative methods as up-to-date options are skeletal traction , halo fixation, odontoid screw fixation, C 1-2 transarticular screw fixation, ventral spondylodesis with plate or cage implants, rarely posterior softwire or long rod fixations in the cervical spine, and transpedicle screw, plate or rod fixation, ventral plate and cage fixation or combined posterior-anterior dynamical long rod stabilization with ventral butressing in the Th-L spine.

Titanium implants and dynamical stabilization are preferred. Long lasting neurorehabilitation is compulsory. Surgical decompression must be done always from the side where compression occurs.

Conclusion:
1. In spinal trauma all treatment modalities are only options.
2. Neurological improvement after surgery must be at least as good or even better then that after conservative treatment.
3. If surgical decompression is indicated it has to be performed among all conditions on the contrary that no proving prospective randomized clinical trial is available for its statistical effectivity!


P15
A New Idea for less Invasive Stabilisation in Spinal cord injury Patients
Author(s): Röhl Klaus, Weidt Friedrich, Mall Volker (Halle)
Name of ISCoS Member (Author): Röhl, Klaus
Main institution where the work was done: Centre for Spinal Injuries and Spinal Trauma / Trauma Centre Berufsgenossenschaftliche Unfallklinik „Bergmannstrost“

Aim:
One of the questions we have is the using of the optimesh system comfortable for patient and orthopaedic surgeon and we need some information about the fusion rate in using in 3 cases: osteoporotic burst fractures, intervertebral fusion in cases of spondylolisthesis and A-B types of fractures.

Material & methods:
Optimesh is a three dimensional knittered system with a polymeric mesh, designed to contain and reinforce bone graft and bone graft substitute materials at an osseous implant. The implantation instrument is designed with a diameter of 6 mm allowed through a small portal a implant a large, expandable mesh in a collapse state to improve stability immediately post op. In this cases of treatment we look for the outcome using a VAS scale prae and post op and the kyphosis angle after 3 month. 12 patients was undergoing this new method with filling the optimesh with allograft granular materials. There are no non fusion and no infect situation after using optimesh. In using the VAS scale there is a increase from 8,7 (prae) to 4,3 (post) operative.

Conclusion:
The optimesh system is a new alternative for the inter and intrabody fusion of thoracic and lumbar spine using the advantages of granular materials and improve immediately stability post op.


P16
The influence of factors associated with deterioration of respiratory function in the Acute Cervical Spinal Cord Injured patients, requiring early intervention
Author(s): Dr Juliette M Stander
Name of ISCoS Member (Author): Dr Juliette M Stander
Main institution where the work was done: Groote Schuur Hospital

OBJECTIVES
To determine the influence of factors associated with deterioration of respiratory function in the Acute Cervical Spinal Cord Injured patients, requiring various types of early respiratory support and intervention.

DESIGN
The study comprises Acute Cervical Spinal Cord Injured patients admitted to the ICU requiring early respiratory support and intervention. The following factors were recorded: neurological diagnosis, mode of injury, delay in admission, smoking history, underlying lung pathology, aspiration, distended abdomen, period of inotropic support, timing of surgery, period of non invasive ventilatory support, period of ventilatory support, lung collapse, etc.

SETTING
Acute Spinal Cord Injury UnitGroote Schuur HospitalSouth Africa

SUBJECTS
50 Acute Cervical Spinal Cord Injured patients admitted to the ASCI Unit, Groote Schuur Hospital


P17
Five years of experience in the treatment of spasticity in spinal cord injuries with intrathecal baclofen
Author(s): Klaus Röhl, Thomas Richter, Volker Mall
Name of ISCoS Member (Author): Röhl, Klaus
Main institution where the work was done: Centre for Spinal Injuries and Spinal Trauma / Trauma Centre Berufsgenossenschaftliche Unfallklinik „Bergmannstrost“

Aim:
In this retrospective study we wanted to evaluated the functional benefit of spaticity before and after continous intrathecal baclofen infusion via a subcutaneously implanted pump.

Objektives:
To evaluate the effect of continous intrathecal baclofen infusion via a subcutaneously implanted pumps on spasticity of spinal cord injured patients.

Settings:
Center of spinal cord injuries and clinic for orthopaedic surgery Bergmannstrost Halle Germany.

Method:
33 patients resistant to oral medication an with implanted baclofen pump were retrospectively, by phonecall or through examination during the pump refillment, graded using the Ashworth scale. Spasticity of the lower extremities was scored according to the Ashworth Scale.

Results:
In the patients Ashworth values after pump implantation were significantly lower than before (Wilcoxon`s test: p<0.001).

Conclusion:
Continuous intrathecal baclofen infusion via a subcutaneously implanted programmable pump significantly reduces spasticity of lower extremities


P18
Spinal Cord Injury (SCI) – Care Guidelines for the First 72 Hours
Author(s): Wing PC, Belanger L, Jebson H, Dvorak MD, Fisher CF, Boyd M, Keynan O
Name of ISCoS Member (Author): Peter Wing
Main institution where the work was done: Combined Neurosurgical and Orthopaedic Spine Program, Vancouver Hospital and Health Sciences Centre, BC, Canada

The Consortium for Spinal Cord Acute Management of SCI Clinical Practice Guideline is expected in 2005. There are some excellent sources available to promote sound and often evidence-based care during the first 72 hours.

This paper reviews the current evidence base for the following topics

  • Neurologic classification; the current status of neuroprotective strategies
  • Spinal imaging after acute trauma. Protection of the potentially injured spine.
  • Respiratory management including mechanical ventilation
  • Hemodynamic stabilization.
  • Thromboprophylaxis
  • Gastrointestinal System
  • Genitourinary System

A handout will be provided with an up-to-date reference list and links to high-quality downloadable educational material. Sample references and links are provided here:

(Another abstract describes a parallel project (Belanger et al) presenting on a CD and web-downloadable resource this information and relevant procedures.)


P19
Complications in Early Rehabilitation Period of Patients with Spinal Cord Injuries
Author(s): Aleksandras Krisciunas, Tomas Morkevicius
Main institution where the work was done: Department of Rehabilitation, Kaunas University of Medicine

Aim.
To determine most often occurring complications during early rehabilitation period in patients with spinal cord injuries.

Method and Material.
The study was based on analysis of medical documents of the patients with spinal cord injuries hospitalized in the Subdivision of Neurorehabilitation, Kaunas University of Medicine. The total number of the studied cases was 114: 78 men (68.4 %) and 36 women (31.6 %) at the age from 14 to 94 years (average age, 14 years).

Results:
There were 36 cases (31.6 %) with spinal cord injury at the level of cervical segments; 37 (32.4 %), at the level of thoracic segments; 40 (35.1 %), at the level of lumbar segments; and 1 (0.9 %), at the level of the sacrum. The most often documented complications were as follows: pains, 85 (74.6 %) cases; uroinfection, 51(44.7 %); spasticity, 36 (31.6 %); mental and psychosomatic problems, 25 (21.9%); decubitus ulcers, 20 (17.5 %).

Conclusion.
The most often occurring complications during early rehabilitation period, which can influence the duration and efficacy of rehabilitation, are pains, uroinfection, and spasticity.


P20
INCOMPLETE SPINAL CORD INJURIES: SOME DATA AND CONSIDERATIONS ON WALKING RECOVERY
C. Pistarini, A. Caroli, G. Bertotti, S. Eretti, G.Robbiani

Recovery of the ability to walk after a spinal cord injury, particularly one that is incomplete, is one of the primary aims of rehabilitation treatment, even if it is a functional goal that can only be reached in some cases because of the complexity of the neuromotor skills required.

Some studies have reported that, in those subjects with a spinal cord injury who have retained some ability to walk, the improvement in the quality of walking is greater than that in bowel, bladder and sexual functions.

The recent developments in the field of physical medicine and rehabilitation, and the increase in the number of individuals with an incomplete spinal cord injury who have retained sufficient neuromotor skills for “deambulation”, highIight the importance of studying walking in this population.

A study in the Istituto Scientifico di Montescano – Fondazione S.Maugeri- between 1999 and 2002 about incomplete spinal cord injury (ASIA, CDE) demonstrated that the subjects have good potential for functional recovery, up to the point of deambulation with assistance and/or physical aids or even autonomous walking.
It was found that there are changes in the clinical profile of subjects with C5-C6 cervical lesions about 5-8 months after the acute event. It is therefore necessary to improve the walking tests in incomplete spinal cord injuries. In fact, although there are very precise kinematic measures of each step, these are often very difficult to use in clinical practice.

We therefore carried out a first clinical evaluation using the ASIA scale and then followed the neuromotor recovery of the people we were treating also using a “photographic”, filming all the progresses achieved by the patient.
This allowed us to have a clear perception of a therapeutic pathway that must be undertaken by the whole multiprofessional team.

Moreover, the person with spinal cord injury lives his current situation with serious difficulties, since it completely destroys self-perception of body schema.

This “new situation” also modifies the relationship between the subjects and the team because prognosis is not always clear and the team is called upon to face new requests and try to reach the objectives which gradually become outlined.

In this situation the treatments are prolonged and the patient often finds that he has to postpone other aspects of personal life, such as return to work.

There are also difficulties at the time of discharge because it is necessary to continue the rehabilitation treatment in an outpatient setting and “walking” often becomes the goal of the person with a spinal cord injury.

Achieving the maximum function possible is an unequivocal aim, but are therapists ready to modify their therapeutic approaches in front of these new problems?


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