Heterotopic ossification (H O) is a frequent complication in patients with a spinal cord injury (SCI), although the aetiology is unknown. A study was undertaken of 654 SCI patients with traumatic aetiology, admitted for the first time to the Hospital Nacional de Paraplejicos, Toledo, during 1988 and. Of the total number of patients, 85 (13%) were diagnosed HO and 569 without HO. The diagnosis was mainly achieved by x-ray studies and clinical signs. From the 569 patients with traumatic aetiology without HO, 44 were selected at random, as were 44 of the 85 patients with HO. The mean time lapse between the occurrence of the accident and admission for patients with HO was 40.79 days (typical deviation (TD) = 45.2), and for patients without HO was 32. 84 (TD = 38) days, resulting in a value of F = 0.796 through analysis of variance, which is not a statistically significant variation between the 2 groups. In both groups we have taken account of the following variables: age at time of lesion, lesion level, type of lesion (complete or incomplete), spasticity, urinary tract complications, deep vein thrombosis, important associated injuries occurring at the moment of lesion, time elapsed before admission and the existence of pressure sores. In those SCI patients with HO the number of ossifications and their localisations were also verified.By use of the chi square test (X 2 ) over all 9 variables which were studied, we found that 3 variables (complete spinal lesion, presence of pressure sores and spasticity) were significantly related to HO formation. The risk factors appear to be cumulative: the presence of 2 risk factors in the same patient was found to result in HO appearing in 65 ± 8% (P ± SP), and when all the risk factors are present in the same patient, 85 ± 7.9% had heterotopic ossification.Eighty two per cent of the patients who presented pressure sores had a time lapse to admission of more than 15 days, against 18% of those whose time lapse to admission was less than 15 days X 2 [1] = 17.8, p < 0.001. For those patients whose time to admission was less than 15 days, and whose progress we could follow from the start, from a total of 7 patients with sores, 6 developed HO while one did not, X 2 [1] = 4.2, p < 0.05.
We present our series of patients with chronic ventilatory failure treated with electrophrenic respiration: 13 males and nine females with a mean age of 12+11.5 years. The etiology was, 13 tetraplegia, ®ve sequelae of surgical treatment of intracranial lesions, and four central alveolar hypoventilation. The mean duration of the conditioning period were 3 ± 4 months. Eighteen patients (81.8%) achieved permanent, diaphragmatically-paced breathing with bilateral stimulation and in four (18.2%) patients, pacing was only during sleep. Five patients died (22.7%): two during the hospital stay and three at home; two deaths had unknown cause and three were due respectively to, lack of at-home care, recurrence of an epidermoid tumor, and sequelae of accidental disconnection of the mechanical ventilation before beginning the conditioning period. Two cases were considered failures: One patient had transitory neurapraxia lasting 80 days, and the other had an ischemic spinal cord syndrome with progressive deterioration of the left-side response to stimulation. One patient had right phrenic nerve entrapment by scar tissue and four suered infections. The follow-up periods since pacemaker implantation are currently: 1, 11 years; 4, 10 years, and 17, less than 5 years. The results of our experience demonstrate that complete stable ventilation can be achieved using diaphragmatic pacing and that it improves the prognosis and life quality of patients with severe chronic respiratory failure.
In order to assess some of the variables associated with neurological recovery after traumatic spinal cord injury with vertebral fracture, a randomised sample of 100 patients (50 without neurological recovery, and 50 with several degrees of recovery) were selected out of 245 patients admitted to our hospital. Both groups were homogeneous with respect to time lapse to admission, hospitalization time and level of lesion. Of the variables considered, the intensity of the lesion (incomplete) and vertebral displacement (under 30%) were statistically associated with neurological recovery. An age under 30 years at the moment of the injury was also associated with neurological recovery but only in those patients with an incomplete lesion. No correlation was found between the other variables studied such as the degree of vertebral wedging, type of fracture (compression, flexion-rotation) and management (conservative, surgical) and the neurological evolution.
Out of 245 patients with spinal cord injury admitted to the Hospital Nacional de Paraplejicos of Toledo (110 treated conservatively, 135 treated surgically), randomised samples of 48 cases treated conservatively and 75 treated surgically were selected for comparison. Improved neurological status according to the Frankel scale was achieved in 37. 5% after conservative treatment, and in 23% after surgery. Reduction and stabilisation were achieved by both conservative and surgical methods, and the functional outcome was the same for both treatments. The mean hospitalisation time was 198 ± 10 (mean ± SE) days for patients treated with conservative measures, and 222 ± 9 days for patients treated surgically. No correlation was found between the type of fracture and severity of the neurological lesion. The neurological outcome by type of fracture was also similar for both treatments. No correlation was found between the degree of vertebral wedging and neurological evolution. Patients with greater vertebral displacement showed a worse neurological outcome.Taking both groups as a whole, incomplete lesions showed improvement in 66%, and complete in 14%. Neurological improvement after incomplete lesions was found in 87. 5% of patients under 25 years of age and in 47% of those over 25 years. The poorest rate of improvement was found in those with thoracic lesions (17%), while those with cervical lesions improved most (48%). Further more, the neurological outcome in patients who were surgically treated within the first 24 hours after the injury was not statistically different from those who were treated later.
conclusions. IAD improves overall quality of life of patients at 18 months of stopping treatment.
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