Gunshot Wounds to the Spine
Alexander R. Vaccaro in Fractures of the Cervical, Thoracic, and Lumbar Spine, 2002
I INTRODUCTION With the rise of violence throughout the world, the incidence of gunshot wound injuries continues to increase (1). Among the most troublesome are gunshot wounds to the spine, which account for 13 to 17% of all spinal cord injuries (SCIs) each year (2,3). Most common in the thoracic region, they are perhaps most devastating in the cervical spine where the potential for severe neurological impairment is greatest (2,4). Spinal gunshot wounds occur most frequently in young males between the ages of 15 and 34 years (3,5,6). Spinal cord injuries resulting from gunshot wounds are more likely to result in complete sensorimotor paralysis compared with SCIs from blunt trauma (1). Of victims of gunshot wounds resulting in SCI, approximately half result in paraplegia and half in tetraplegia (7). Like spinal cord injuries in general, incomplete injuries from gunshot wounds have much better prognoses (8).
Spinal cord compression
Wesley C. Finegan, Angela McGurk, Wilma O’Donnell, Jan Pederson, Elizabeth Rogerson in Care of the Cancer Patient, 2018
Spinal cord compression is seen in about 5% of cancer patients overall, with an incidence of about 15% in myeloma sufferers and around 10% in patients with prostate cancer. The spinal column is the commonest site for bone secondary deposits. At autopsy, 70% of cancer patients will have a vertebral column deposit. There is ascending loss of sensation with numbness which usually stops about one vertebral body below the level of the cord compression. Radiation treatment can be used if there is no spinal instability and the tumour is known to be radiosensitive. Plain X-ray of the spine detects about 85% of spinal lesions, but a negative result does not exclude metastases. Paraplegia due to malignant spinal cord compression is always irreversible and therefore is not an emergency as such.
Neurological rehabilitation of gait and balance disorders
Adolfo Bronstein, T. Brandt, T. Brandt in Clinical Disorders of Balance, Posture and Gait, 2Ed, 2004
Restoration of mobility is a major goal in neurological rehabilitation, preventing long-term disability and handicap. Mobility includes walking, standing up, sitting down, weight shifting from one leg to the other, turning around, initiating and stopping locomotion, as well as climbing stairs. Therapeutic methods to retrain gait functions in the most common syndromes will be presented (i.e. in hemiplegia caused by stroke or traumatic brain injury, paraplegia caused by spinal cord injuries and in Parkinson’s disease). Goals of therapy include security and safety, speed and endurance, accuracy and low variability, flexibility and adaptability to the surroundings.
Post-laminectomy rotokyphoscoliosis causing paraplegia in long term: Case report
Published in The Journal of Spinal Cord Medicine, 2012
Iltekin Duman, Umut Guzelkucuk, Bilge Yilmaz, Arif Kenan Tan
Context Childhood laminectomy can lead to spinal deformity. This is a report of a case of paraplegia caused by rotokyphoscoliosis, a late complication of laminectomy. Findings A 55-year-old woman developed paraplegia due to post-laminectomy kyphoscoliosis. She had surgery for a spinal tumor at age 13 years. She developed kyphosis 2 years after the laminectomy, which has been gradually progressing over the years. She experienced weakness of lower limbs that progressed to paraplegia. There was no evidence for tumor recurrence. To our knowledge, this is the first reported case of post-laminectomy kyphoscoliosis causing late-onset paraplegia. Conclusions/clinical relevance This case highlights a possible long-term complication of laminectomy without stabilization or untreated kyphoscoliosis. Children should be followed closely after laminectomy because development of spinal deformity is very common. Without intervention, the kyphosis might progress and in the long term, serious neurological complications may result, including paraplegia.
Evidence for an Exaggerated Postprandial Lipemia in Chronic Paraplegia
Published in The Journal of Spinal Cord Medicine, 2005
Mark Nash, Joris deGroot, Alberto Martinez-Arizala, Armando J. Mendez
Background/Objective: Excessive delay in triglyceride (TG) metabolism after ingestion of dietary fatrepresents a significant cardiovascular disease (CVD) risk. The objective of this study was to compare thepostprandial lipemic responses of individuals with paraplegia with those of healthy nondisabled individuals. Methods: The ability of 3 recreationally active individuals with paraplegia having normal fasting TG(mean= 103 mg/dl) to metabolize TG after ingestion of a high-fat test meal was compared with apreviously published cohort of 21 recreationally active individuals without paraplegia (TG mean= 86 mg/dl)who underwent identical testing. The subjects with paraplegia had venous blood taken under fastingconditions, and then ingested a milkshake containing premium ice cream blended with heavy whippingcream(~ 92% of calories from fat). Additional blood samples were obtained at 2, 4, and 6 hours afteringestion. The area under the curve (AUC) for TG clearance for both subject groups was measured with anarea planimeter. Results: TG uptake for both groups was almost identical for the first 2 hours after ingestion. At 4 and 6 hoursafter ingestion, the TG levels were 50 and 35 mg/dl higher, respectively, in subjects with paraplegia than innondisabled subjects. When corrected for small baseline differences in TG concentrations (16 mg/dl), theAUC was 46.5% greater for the group with paraplegia than in the nondisabled group. A near mirrorassociation across time was observed between postprandial serum high-density lipoprotein cholesterol(HDL-C) and TG levels in subjects with paraplegia. Conclusion: This case series finds an exaggerated postprandial lipemia (PPL) in persons with paraplegiawith normal fasting TGs. This finding is the first evidence, in a small population, of an unreported potentialCVD risk in persons with paraplegia.
Brake response time between male drivers with and without paraplegia: Association between sociodemographic, motor and neurological characteristics
Published in Traffic Injury Prevention, 2021
Sileno Santos, Guilherme Carlos Brech, Angélica Castilho Alonso, Julia Maria D’Andréa Greve
Objective: The objective of this study was to compare the brake response time of drivers with paraplegia (who use hand control) with drivers without paraplegia (who use their feet) in a virtual driving simulator brake test. Additionally, we aimed to predict and evaluate the association of virtual brake response time with sociodemographic, motor and cognitive variables. Methods: 40 male adult drivers, with paraplegia (n = 20, mean age 38.1 ± 3.6 years) and without paraplegia (n = 20, mean age 38.0 ± 5.8 years), with valid driver licenses, had their brake response time evaluated in an automatic transmission car simulator. Non-disabled drivers were tested with conventional foot controls, while paraplegic drivers used hand controls. Drivers with paraplegia performed simple, choice and go/no-go reaction time tests as neuropsychological evaluations. Student’s t-test was used to examine the differences of driving simulator brake response time between groups. Pearson coefficient verified the correlation of driving simulator brake response time with years of driving, length of disability, handgrip strength and neuropsychological tests of the paraplegic drivers. A regression model was developed to describe the mean of driving simulator brake response time using the backward elimination method for model adjustment selecting the explanatory variables. Results: Differences of simulator brake response time between groups were not statistically significant (non-paraplegic drivers = 0.90 seconds; paraplegic drivers = 0.92 seconds, p > 0.05). Years of driving significantly correlates with brake response time of paraplegic driver (r= −58, p = 0.009). Linear regression analyses indicated that years of schooling and years of driving (explanatory variables) explained 60.2% of driving simulator brake response time for the drivers with paraplegia. Driving simulator brake response time showed no difference between drivers with and without paraplegia. Years of driving and schooling were the main predictors of braking performance in drivers with paraplegia measured in a driving simulator.