Our findings provide proof-of-principle that subdural intraspinal pressure at the injury site can be measured safely after traumatic spinal cord injury.

Thirty patients with spinal cord injury (SCI) were randomly selected to participate in this study which evaluated the inter rater reliability of the original and of the modified Ashworth scale for the assessment of spasticity in the lower limbs. A doctor and a physiotherapist rated the muscle tone of hip adductors, hip extensors, hip flexors and ankle plantarflexors according to the original and to the modified Ashworth scale. The results were analyzed using a Cohen's Kappa statistical test and showed varying levels of reliability for different muscle groups and limbs. Kappa values ranged between 0.21 and 0.61 (mean 0.37). The original scale was slightly more reliable than was the modified scale. However, this difference was not significant (P>0.05), and was not consistent between the two limbs and between different muscle groups.It was concluded that the Ashworth scale is of limited use in the assessment of spasticity in the lower limb of patients with SCI. Further work is required to establish a standardised speed of muscle stretching during the test, or to find more appropriate grades and descriptions of spasticity for this patient group. The effects of training of the raters in the use of the scales also warrants further investigation.

Study design: Case report. Objective: To describe the clinical benefit of a spinal cordectomy with the aim of limiting neurological deterioration related to the development of a subacute posttraumatic ascending myelopathy (SPAM) supporting previously described mechanism for SPAM formation. Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, UK. Method and results: A 38-year old patient presented 6 months after spinal cord injury substantial neurological deterioration expanding from the initial T4-injury level through C4. Magnetic resonance imaging revealed intra-medullary haemorrhage at the site of injury and subsequent-ascending cord oedema. A cordectomy was performed leading to neurological stabilisation and complete resolution of SPAM. Conclusion: Cordectomy can be an effective intervention in case of rapid progressive neurological deterioration.

SUMMARY Twenty eight patients with severe, intractable spasticity have been treated by chronic intrathecal administration of baclofen. An implantable programmable drug-administration-device (DAD) was used with a permanent intrathecal catheter. Infusion of 50 to 800 ug//day of baclofen completely abolished spasticity. Follow-up was up to two years. Therapeutic effect was documented by clinical assessment of tone, spasms and reflexes and by electrophysiological recordings of monoand polysynaptic reflex activity. Complications and untoward side-effects of the procedure were few. This procedure is recommended for spasticity of spinal origin refractory to physiotherapy and oral medication. It is a preferable alternative to ablative surgical intervention.After an upper motoneuron lesion in man, a spastic syndrome often develops with a delay of weeks or months. This is characterised by hyperactive monoand polysynaptic reflexes and a velocity dependent increase in muscle tone. Depending on the site of the lesion, the features of the motor disorder can vary considerably. In spinal cord transection the powerful inhibitory action of the vestibulo-spinal pathway (projecting from the lateral vestibular nucleus) on the tonic innervation offlexors is eliminated, leading to an increase in flexor muscle tone of the legs. Lesions of the reticulo-spinal pathways cause loss of inhibition of the flexion reflex, resulting in spontaneous and sometimes painful flexor spasms. On the other hand, extensor spasms can also occur. All these patients suffer frequently from severe disability having their legs in a fixed, usually flexed, position causing nursing problems and severe handicap in daily life.Flexor spasticity is often resistant to drugs in tolerable doses. Microsurgical procedures like selective peripheral neurotomy, posterior rhizotomy' and longitudinal myelotomy have been used. These interventions are designed to interrupt the spinal reflex arc or to reduce the afferent input to the dorsal horn.

Data on the prevalence of malnutrition among patients with spinal cord injuries (SCI) are lacking. The aim of the present study was to assess nutritional risk at admission, and the status of nutritional support in the UK SCI Centres (SCIC); a cross-sectional, multicentre study in four SCIC. A standardised questionnaire was used and distributed to the participating SCIC. After obtaining informed consent, baseline demographic data, nutritional risk score by the 'Malnutrition Universal Screening Tool', BMI and routine blood biochemistry were collected from every patient admitted to an SCIC. The four SCIC, comprising 48·2 % of the total UK SCI beds, contributed data from 150 patients. On admission, 44·3 % of patients were malnourished or at risk of undernutrition. Nutritional risk was more common in patients with acute high cervical SCI than those with lower SCI (60·7 v. 34·5 %), and nutritional risk was more common in those with additional complications including ventilatory support (with tracheostomy, 56·3 v. 38·7 %). Also, 45 % of patients were at risk of overnutrition (BMI $ 25 kg/m 2 ). The prevalence of malnutrition in SCI patients admitted to SCIC is higher than national figures focused on general hospitalised patients, indicating that SCI patients are particularly vulnerable to malnutrition. Patients with SCI who have a tracheostomy may need additional attention. Given the potential negative impact of malnutrition on clinical outcomes, an emphasis on mandatory nutrition screening, followed by detailed assessment for at-risk individuals should be in place in the SCIC.