Clinical prognostic factors for bladder function recovery of patients with spinal cord and cauda equina lesions

Scivoletto, Giorgio; Cosentino, Elena; Morganti, Barbara; Farchi, Sara; Molinari, Marco

doi:10.1080/09638280701265596

Cited by 17 publications

(12 citation statements)

References 32 publications

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“…By logistic regression, etiology was not a determinant of improved bladder control. AIS level at admission was the chief predictor of good bladder control at discharge; these findings are consistent with other studiesFScivoletto 25 found that patients with AIS D grade and, in particular, those with Brown-Sequard and central cord syndromes experience the greatest recovery in bladder function. The two populations had comparable discharge destination rates, with B80% of patients returning home.…”

Section: Discussionsupporting

confidence: 90%

Recovery following ischemic myelopathies and traumatic spinal cord lesions

et al. 2011

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Background: As the general population ages, the rising prevalence of vascular lesions of the spinal cord will become significant. The aim of this study was to compare the neurological and functional outcomes of patients with ischemic spinal cord injury (ISCI) and traumatic spinal cord injury (TSCI). Setting: Spinal cord unit of a rehabilitation hospital in Italy. Study design: Retrospective study. Patients and methods:We studied 179 patients with a TSCI and 68 with an ISCI. At admission and discharge, patients were examined by American Spinal Injury Association (ASIA) standards, Barthel Index, Rivermead Mobility Index and Walking Index for Spinal Cord Injury. Bowel and bladder management and discharge destination were recorded at discharge. Analysis of covariance (ANCOVA) and logistic regression models were used to analyze the effects of the etiology of the lesion, AIS level at admission, site of the lesion and the presence of complications on measured outcomes. Results: Patients with an ISCI were older and experienced fewer cervical lesions and complications at admission. By ANCOVA and logistic regression, age, AIS level and lesion level were the chief predictors of neurological and functional outcome, whereas etiology had no effect on outcome. Conclusions: A diagnosis of ischemia and trauma is not a determinant of neurological and functional recovery in spinal cord injury patients. Instead, the outcome of these patients is influenced by age, lesion level and AIS level.

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Section: Discussionsupporting

confidence: 90%

Recovery following ischemic myelopathies and traumatic spinal cord lesions

et al. 2011

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“…In the present study, the finding of PRV-labeled neurons descending in the crossed pathway provides neuroanatomical evidence for the bilateral reflex modulation of the spared bulbospinal connections following chronic spinal hemisection injury, and implicates their potential role in the rapid recovery of sexual and bladder function seen in animals with lateral hemisection injury Little et al, 1991;Pritchard et al, 2010). A lateral hemisection injury in humans, sometimes referred to as Brown-Séquard syndrome, also results in a good prognosis for pudendal function, with return to voluntary voiding and less occurrence of detrusor-sphincter dyssynergia (Scivoletto et al, 2008). As is true for locomotor ability after hemisection, only a percentage of the pathway fibers in the spared lateral funiculus appear to be necessary for functional recovery (Schucht et al, 2002), particularly if the spared pathway is strengthened through plasticity (Babu and Namasivayam, 2008).…”

Section: Discussionmentioning

confidence: 91%

Bilateral Bulbospinal Projections to Pudendal Motoneuron Circuitry after Chronic Spinal Cord Hemisection Injury as Revealed by Transsynaptic Tracing with Pseudorabies Virus

Johnson

Chadha

Dugan

et al. 2011

Journal of Neurotrauma

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Complications of spinal cord injury in males include losing brainstem control of pudendal nerve-innervated perineal muscles involved in erection and ejaculation. We previously described, in adult male rats, a bulbospinal pathway originating in a discrete area within the medullary gigantocellularis (GiA/Gi), and lateral paragigantocellularis (LPGi) nuclei, which when electrically microstimulated unilaterally, produces a bilateral inhibition of pudendal motoneuron reflex circuitry after crossing to the contralateral spinal cord below T8. Microstimulation following a long-term lateral hemisection, however, revealed reflex inhibition from both sides of the medulla, suggesting the development or unmasking of an injury-induced bulbospinal pathway crossing the midline cranial to the spinal lesion. In the present study, we investigated this pathway anatomically using the transsynaptic neuronal tracer pseudorabies virus (PRV) injected unilaterally into the bulbospongiosus muscle in uninjured controls, and ipsilateral to a chronic (1-2 months) unilateral lesion of the lateral funiculus. At 4.75 days post-injection, PRV-labeled cells were found bilaterally in the GiA/Gi/LPGi with equal side-to-side labeling in uninjured controls, and with significantly greater labeling contralateral to the lesion/injection in lesioned animals. The finding of PRV-labeled neurons on both sides of the medulla after removing the mid-thoracic spinal pathway on one side provides anatomical evidence for the bilaterality in both the brainstem origin and the lumbosacral pudendal circuit termination of the spared lateral funicular bulbospinal pathway. This also suggests that this bilaterality may contribute to the quick functional recovery of bladder and sexual functions observed in animals and humans with lateral hemisection injury.

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“…Both Akkoc et al [12] and Moslavac et al [13] concluded that patients with SCI should be followed with the same care regardless of the type of SCI (complete or incomplete). In contrast, Scivoletto et al [14], after analyzing 269 patients with SCI con- cluded that patients ASIA B achieved better functionality than ASIA A.…”

Section: Discussion/conclusionmentioning

confidence: 89%

Urodynamic Differences between Complete and Incomplete Spinal Cord Injuries with Neurogenic Detrusor Overactivity

et al. 2019

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Objective: To analyze if there are urodynamic differences in patients with neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI) depending on whether the SCI is complete or incomplete according to the American Spinal Injury Association (ASIA) classification. Methods: A retrospective and comparative study was carried out, including 194 patients with suprasacral SCI and NDO. Maximum cystometric capacity (MCC), volume at first involuntary contraction (VIC), compliance, maximum pressure of the detrusor during filling cystometry (MaxDetP), detrusor leak point pressure (LeakDetP) and postvoid residual urine volume (PVR) were analysed. Means were compared with Student t test for independent samples, with statistical significance p < 0.05. Results: SCI was complete (ASIA A) in 51 patients (26.3%) and incomplete (ASIA B-E) in 143 (73.7%). The comparison of means showed significant differences regarding MCC (278.5 ± 102.6 mL in ASIA A vs. 321.6 ± 127.1 mL in ASIA B-E; p = 0. 018) and VIC (161 ± 85.1 and 210 ± 114.4 mL respectively; p = 0.006). There were no differences regarding MaxDetP (58.8 ± 26.9 vs. 49.3 ± 35.6 cm H 2 O), LeakDetP (44.6 ± 25.3 vs. 48.3 ± 26.7 cm H 2 O), PVR (155.3 ± 94.2 vs. 118.5 ± 129.8) or compliance (29.9 ± 25.3 vs. 48.3 ± 26.7 cm H 2 O). Conclusions: In our serie incomplete SCI (ASIA B-E) showed differences from complete ones (ASIA A) regarding MCC and VIC, but not regarding LeakDetP, MaxDetP, PVR or compliance.

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Clinical prognostic factors for bladder function recovery of patients with spinal cord and cauda equina lesions

Cited by 17 publications

References 32 publications

Recovery following ischemic myelopathies and traumatic spinal cord lesions

Recovery following ischemic myelopathies and traumatic spinal cord lesions

Bilateral Bulbospinal Projections to Pudendal Motoneuron Circuitry after Chronic Spinal Cord Hemisection Injury as Revealed by Transsynaptic Tracing with Pseudorabies Virus

Urodynamic Differences between Complete and Incomplete Spinal Cord Injuries with Neurogenic Detrusor Overactivity

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