No abstract

Study design: Retrospective register study. Objective: To investigate the predictive value of age at the time of injury, gender, level of injury, and completeness of injury for the development of at level and below level neuropathic pain. Setting: 'Spinalis', a postacute spinal cord injury (SCI) outpatient clinic, serving the greater Stockholm area (Sweden). Method: All patients who visited the clinic in 1995-2000 (402 patients) for the first time were examined. The following items were selected: at-level and below-level neuropathic pain according to the International Association for the Study of Pain (IASP) criteria, age at the time of injury, gender, level of injury according to ASIA, and completeness of injury. Mean time of 6 years after the injury. Results were analysed with w 2 analysis and logistic regression. Results: Of all patients examined, 13% had at level pain and 27% had below level pain. Neuropathic pain was less than half as frequent (26%) in the group aged less than 20 years at the time of injury as in the oldest group (58%). The increasing trend was mainly due to belowlevel pain up to 39 years of age, and due to at-level pain at ages 40 and above at the time of injury. No correlation was observed to gender, level of injury or completeness of injury, except for below level pain, which was associated with complete injury. Conclusion:The results show that neuropathic pain after SCI is common and occurs much more often in patients injured at higher ages. This indicates the importance of neuroanalgetic intervention, in particular for patients injured in higher ages.

Study design: Retrospective analysis of in-patient stay and prospective follow-up. Objectives: To study neurological and functional outcomes after traumatic central cord syndrome (TCCS). Setting: Regional Spinal Unit of Florence, Italy. Methods: In total, 82 patients, admitted for acute rehabilitation to our Centre (1996Centre ( -2002 with a diagnosis of TCCS entered the study. Data on admission and discharge were collected for assessments performed at 18 months of injury or later. Data included: cause of injury, gender, type of vertebral lesion, treatment, time of hospitalisation (LoS), ASIA/ISCOS Impairment Scale, neurological examination, functional independence measure (FIM) on admission and discharge. Additional measures included the walking index for spinal cord injuries (WISCI), bladder management, FIM, spasticity on discharge/follow-up and neuropathic pain at followup. Correlations were performed on outcome measures in relation to age, treatment, LoS, spasticity and neuropathic pain. Results: Average age was 52 (16-82) years. Causes included falls (47%), road traffic accidents (36%) and sport (7%). Of patients, 45% were treated surgically and 55% conservatively. LoS was 120 days (24-390), but less for those treated without surgery. Patients under 65 years had better outcomes with less neuropathic pain. Neurological and functional recovery was observed on discharge from rehabilitation, which continued in the period following discharge. Spasticity was equally present in all age groups. No difference in outcome was found as a result of spine surgery. Conclusions: Patients with TCCS are older than other spinal cord injured patients, but often show improvement after discharge. Improvement in subjects under 65 years was significantly better than for those over 65 years.

Material and methods: A retrospective study was conducted by analysing data stored in our local computerized database. We considered the vertebral injury, ASIA-ISCOS neurological classification on admission and discharge, gender, age at the time of injury, month of injury, treatment of vertebral lesion, length of stay in the Spinal Unit, neurological outcome, and complications. Data were analysed statistically by using the Fisher's exact test and logistic regression. Results: In all, 62/65 patients were males (95%). Mean age at injury time: 22 years. On admission, 35/65 were neurologically complete ASIA A (54%), while 16 were classified ASIA B, 7 ASIA C and 7 ASIA D, according to the ASIA-ISCOS neurological standard of classification. C6 was the most common neurological motor level (40%) and C5 the most common vertebral injury level. In all, 36/65 (55%) patients underwent surgical treatment. Mean hospitalization time was 5 months. No neurological deterioration was recorded. In all, 20/65 (31%) patients improved neurologically and 16/20 (80%) of those had received surgical treatment. In all, 15/65 (23%) patients had complications and one patient died during the hospitalization period. Conclusions and discussion: Patients whose vertebral lesions were surgically treated had a better neurological outcome than conservatively treated ones. Teardrop fractures showed worse neurological outcome as compared with burst fractures. Neurological improvement was more present in initially incomplete lesions. Treatment with high dose methylprednisolone during the first 8 h after trauma seemed to influence the neurological outcome positively. Age was also an important factor in influencing the neurological outcome.