The Correlation of Radiological Examination and Volitional Voiding in Thoraco - Lumbar Fractures and Spinal Injury

Abstract

BACKGROUND: Spinal Cord Injury (SCI) is a devastating medical condition which results in paraplegia with decreased bladder and bowel control. Investigation used to predict volitional voiding in persons with acute SCI include clinical examination, X-rays of the spine, CT scan, MRI, even though the later ones are not available in every medical center and all cannot afford. AIM: To determine if those with a mild narrowing of the vertebral canal have a better prognosis for volitional voiding. SETTINGS AND DESIGN: Prospective study of 20 consecutive patients with thoracolumbar fractures and spinal injury, admitted in the Department of Physical Medicine Rehabilitation, Christian Medical College, and Vellore within three weeks of injury, were recruited into the study. METHODS AND MATERIALS: Initial neurological examination was performed on admission and final between 16 -20 weeks after the injury. Lateral and anteroposterior X-rays of the spine were done to measure the antero-posterior and transverse diameters of the spinal canal as well as the canal-body ratio at the level of the lesion. Bladder function was assessed between 16 -20 weeks following the injury by Urodynamic study. The bladder outcome was divided into first category was assisted bladder emptying, which included intermittent catheterization, indwelling catheterization and second category was with volitional voiding. STATISTICAL ANALYSIS: Data collection was subjected to statistical analysis using SPSS Version 11.0. Fisher's exact test, Independent t-test and Mann-Whitney test were used. RESULTS AND CONCLUSIONS: The level of fracture did not correspond to the type of bladder. The use of Canal body ratio at the level of vertebral fracture on plain radiographs was not useful in prediction of volitional voiding. (P> 0.05). Therefore plain radiography was not found to be a good predictor of bladder function in persons with spinal injuries. KEYWORDS: Spinal cord injury, neurogenic bladder, urodynamics, x-rays, thoraco-lumbar fratcures. INTRODUCTION:Spinal Cord Injury (SCI) is a devastating medical condition which results in decreased bladder and bowel control. SCI has long-term effects in many aspects of an individual's life. Anxiety about one's urinary continence is often one of the major preoccupations of a person with spinal cord injury. The degree of bladder dysfunction may be related to the injury itself, the level of the spinal cord affected by the injury, and the severity of neurological impairment. Investigation techniques used to help address the issue of predicting bladder outcome in persons with acute SCI include clinical examination, X-rays of the spine, CT scan, MRI and electrophysiological examinations. CT scan, MRI and electrophysiological examinations are not available in every medical center in our country and all cannot afford these investigations. This study was done to evaluate the use of X-rays, modalities widely available in our country, to predict urinary continence in persons with acute SCI.