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Types of Plegia Paralysis in a Spinal Cord Injury

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (18 February 2022) | Viewed by 15180

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Special Issue Editors

Prof. Dr. Arash Moghaddam

E-Mail Website
Guest Editor

Klinikum Aschaffenburg-Alzenau, Center of Orthopaedics, Trauma Surgery and Sport Medicine, Aschaffenburg, Germany
Interests: spinal cord injury; neurotrauma; classification; surgery; rehabilitation; regeneration; complication; biomarker

Dr. Raban Heller

E-Mail Website
Co-Guest Editor

Department of Trauma and Reconstructive Surgery, University of Heidelberg, Heidelberg, Germany
Interests: spinal cord injury; neurotrauma; classification; surgery; rehabilitation; regeneration; complication; biomarker

Special Issue Information

Dear Colleagues,

Spinal cord injury (TSCI) marks one of the most devastating injuries in traumatology and is still one of the most significant challenges in the field of modern medicine. As it predominantly affects young patients, it requires a lot of experience, practice, and knowledge to assure the best possible care and improve the likelihood of a fortunate outcome for the patient. The physical, psychosocial, and financial consequences are severe on both the individual and macrosocial level.

The phenomenon of paralysis presents itself to the clinical practice in many forms, not only differing in the extent to which a person is paralyzed, but also in the way the patient’s holistic sensation of health and quality of life is affected.

There are many different causes of paralysis, each leading to a different type, such as quadriplegia, paraplegia, monoplegia or hemiplegia. High-speed trauma such as car accidents, falls, sports injuries, and interpersonal violence are the causes of most spinal cord injuries in younger patients. In contrast, other possible causes are tumorous diseases, bacterial/viral infections, ankylosing spondylitis (Morbus Bechterew), or osteoporotic fractures in the elderly. The already extensive range of types of paraplegia is accompanied by a similarly broad spectrum of resulting problems.

In recent years, many research groups around the world have been working on different approaches to reduce the consequences of spinal paralysis after the injury. Even improvement by one AIS step means an enormous gain in quality of life and positive prospects for the individual patient.

Against this background, this Special Issue is intended to record both the types of plegia paralysis in spinal cord injury and the most common causes. Hence, we wish to provide an overview of existing modern rehabilitation and concepts to support and mobilize patients as early as possible and to present promising ideas to reduce complications such as decubital ulcer or sepsis.

Furthermore, this Special Issue is intended to provide the most relevant information on the current state of research approaches that provide the best results for future monitoring and therapeutic concepts.

We look forward to this outstanding issue.

Sincerely yours,

Prof. Dr. Arash Moghaddam
Dr. Raban Heller
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

spinal cord injury
neurotrauma
classification
surgery
rehabilitation
regeneration
complication
biomarker

Published Papers (4 papers)

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Research

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10 pages, 2558 KiB

Open AccessArticle

A New Subform? Fast-Progressing, Severe Neurological Deterioration Caused by Spinal Epidural Lipomatosis

by Thiemo Florin Dinger, Maija Susanna Eerikäinen, Anna Michel, Oliver Gembruch, Marvin Darkwah Oppong, Mehdi Chihi, Tobias Blau, Anne-Kathrin Uerschels, Daniela Pierscianek, Cornelius Deuschl, Ramazan Jabbarli, Ulrich Sure and Karsten Henning Wrede

J. Clin. Med. 2022, 11(2), 366; https://doi.org/10.3390/jcm11020366 - 12 Jan 2022

Cited by 2 | Viewed by 3101

Abstract

Spinal epidural lipomatosis (SEL) is a rare condition caused by hypertrophic growth of epidural fat. The prevalence of SEL in the Western world is approximately 1 in 40 patients and is likely to increase due to current medical and socio-economic developments. Rarely, SEL can lead to rapid severe neurological deterioration. The pathophysiology, optimal treatment, and outcome of these patients remain unclear. This study aims to widen current knowledge about this “SEL subform” and to improve its clinical management. A systematic literature review according to the PRISMA guidelines using PubMed, Scopus, Web of Science, and Cochrane Library was used to identify publications before 7 November 2021 reporting on acute/rapidly progressing, severe SEL. The final analysis comprised 12 patients with acute, severe SEL. The majority of the patients were male (9/12) and multimorbid (10/12). SEL mainly affected the thoracic part of the spinal cord (11/12), extending a median number of 7 spinal levels (range: 4–19). Surgery was the only chosen therapy (11/12), except for one critically ill patient. Regarding the outcome, half of the patients regained independence (6/11; = modified McCormick Scale ≤ II). Acute, severe SEL is a rare condition, mainly affecting multimorbid patients. The prognosis is poor in nearly 50% of the patients, even with maximum therapy. Further research is needed to stratify patients for conservative or surgical treatment. Full article

(This article belongs to the Special Issue Types of Plegia Paralysis in a Spinal Cord Injury)

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Graphical abstract

16 pages, 399 KiB

Open AccessArticle

Pursuing More Aggressive Timelines in the Surgical Treatment of Traumatic Spinal Cord Injury (TSCI): A Retrospective Cohort Study with Subgroup Analysis

by Tobias Bock, Raban Arved Heller, Patrick Haubruck, Tim Friedrich Raven, Maximilian Pilz, Arash Moghaddam and Bahram Biglari

J. Clin. Med. 2021, 10(24), 5977; https://doi.org/10.3390/jcm10245977 - 20 Dec 2021

Cited by 6 | Viewed by 2170

Abstract

Background: The optimal timing of surgical therapy for traumatic spinal cord injury (TSCI) remains unclear. The purpose of this study is to evaluate the impact of “ultra-early” (<4 h) versus “early” (4–24 h) time from injury to surgery in terms of the likelihood of neurologic recovery. Methods: The effect of surgery on neurological recovery was investigated by comparing the assessed initial and final values of the American Spinal Injury Association (ASIA) Impairment Scale (AIS). A post hoc analysis was performed to gain insight into different subgroup regeneration behaviors concerning neurological injury levels. Results: Datasets from 69 cases with traumatic spinal cord injury were analyzed. Overall, 19/46 (41.3%) patients of the “ultra-early” cohort saw neurological recovery compared to 5/23 (21.7%) patients from the “early” cohort (p = 0.112). The subgroup analysis revealed differences based on the neurological level of injury (NLI) of a patient. An optimal cutpoint for patients with a cervical lesion was estimated at 234 min. Regarding the prediction of neurological improvement, sensitivity was 90.9% with a specificity of 68.4%, resulting in an AUC (area under the curve) of 84.2%. In thoracically and lumbar injured cases, the estimate was lower, ranging from 284 (thoracic) to 245 min (lumbar) with an AUC of 51.6% and 54.3%. Conclusions: Treatment within 24 h after TSCI is associated with neurological recovery. Our hypothesis that intervention within 4 h is related to an improvement in the neurological outcome was not confirmed in our collective. In a clinical context, this suggests that after TSCI there is a time frame to get the right patient to the right hospital according to advanced trauma life support (ATLS) guidelines. Full article

(This article belongs to the Special Issue Types of Plegia Paralysis in a Spinal Cord Injury)

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15 pages, 280 KiB

Open AccessArticle

Usefulness of D-dimer and Ultrasonography Screening for Detecting Deep Vein Thrombosis in Patients with Spinal Cord Injury Undergoing Rehabilitation

by Magdalena Mackiewicz-Milewska, Małgorzata Cisowska-Adamiak, Jerzy Pyskir and Iwona Świątkiewicz

J. Clin. Med. 2021, 10(4), 689; https://doi.org/10.3390/jcm10040689 - 10 Feb 2021

Cited by 8 | Viewed by 1794

Abstract

Patients with spinal cord injury (SCI) are at an increased risk of deep vein thrombosis (DVT). This study aims at assessing usefulness of D-dimer and compressive Doppler ultrasonography (CDUS) for detecting DVT in patients undergoing rehabilitation at various time-points post-SCI. One-hundred forty-five patients were divided into three groups based on time elapsed since SCI: I (≥3 weeks to 3 months), II (≥3 to 6 months), and III (≥6 months). On admission, D-dimer plasma level measurement and CDUS of the lower limbs venous system were performed. DVT was diagnosed using CDUS in 15 patients (10.3% of entire group), more frequently in group I (22.2% of group) and II (11.7%) compared to group III (1.5%). Most DVT patients received thromboprophylaxis (80%) and were asymptomatic or mildly symptomatic (60%). Median D-dimer was elevated in patients with DVT from all groups, and also patients without DVT from groups I and II, but not group III. D-dimers were higher in patients with DVT than without DVT in the entire group (p = 0.001) and group I (p = 0.02), but not in groups II and III. The risk of DVT in SCI patients undergoing rehabilitation and thromboprophylaxis including asymptomatic or mildly symptomatic cases, is high within 6 months post-injury, and especially within 3 months. Measurement of D-dimer level should be complemented by routine CDUS for detecting DVT within 6 months post-SCI. Over 6 months, the usefulness of D-dimer screening alone is better for DVT detection. Full article

(This article belongs to the Special Issue Types of Plegia Paralysis in a Spinal Cord Injury)

Review

Jump to: Research

20 pages, 1719 KiB

Open AccessReview

Body Composition According to Spinal Cord Injury Level: A Systematic Review and Meta-Analysis

by Peter Francis Raguindin, Alessandro Bertolo, Ramona Maria Zeh, Gion Fränkl, Oche Adam Itodo, Simona Capossela, Lia Bally, Beatrice Minder, Mirjam Brach, Inge Eriks-Hoogland, Jivko Stoyanov, Taulant Muka and Marija Glisic

J. Clin. Med. 2021, 10(17), 3911; https://doi.org/10.3390/jcm10173911 - 30 Aug 2021

Cited by 15 | Viewed by 5066

Abstract

The level of injury is linked with biochemical alterations and limitations in physical activity among individuals with spinal cord injury (SCI), which are crucial determinants of body composition. We searched five electronic databases from inception until 22 July 2021. The pooled effect estimates were computed using random-effects models, and heterogeneity was calculated using I² statistics and the chi-squared test. Study quality was assessed using the Newcastle–Ottawa Scale. We pooled 40 studies comprising 4872 individuals with SCI (3991 males, 825 females, and 56 sex-unknown) in addition to chronic SCI (median injury duration 12.3 y, IQR 8.03–14.8). Individuals with tetraplegia had a higher fat percentage (weighted mean difference (WMD) 1.9%, 95% CI 0.6, 3.1) and lower lean mass (WMD −3.0 kg, 95% CI −5.9, −0.2) compared to those with paraplegia. Those with tetraplegia also had higher indicators of central adiposity (WMD, visceral adipose tissue area 0.24 dm² 95% CI 0.05, 0.43 and volume 1.05 L 95% CI 0.14, 1.95), whereas body mass index was lower in individuals with tetraplegia than paraplegia (WMD −0.9 kg/mg², 95% CI −1.4, −0.5). Sex, age, and injury characteristics were observed to be sources of heterogeneity. Thus, individuals with tetraplegia have higher fat composition compared to paraplegia. Anthropometric measures, such as body mass index, may be inaccurate in describing adiposity in SCI individuals. Full article

(This article belongs to the Special Issue Types of Plegia Paralysis in a Spinal Cord Injury)

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