Initial management after spinal cord injury is crucial in saving lives. It is often characterized by early transfer to specialized centers and early initiation of treatments.
Long-term management is, however, almost as important. New research focuses on both of these and stresses the importance of early prevention of chronic complications, as these are common health problems affecting the quality of live for people living with a spinal cord injury
In fact, during the first year after discharge, a person with spinal cord injury may suffer from 4-5 complications. The most frequently reported complication is urinary tract infection (UTI). Interestingly, an Australian research team has demonstrated that the occurrence of UTI in people with spinal cord injury is linked to bacteria normally present in their urinary tract. Each person seems to have a unique bacterial flora or microbiome, and this is altered by the UTI. This finding is potentially useful for monitoring urinary health, developing targeted treatment with probiotics, and avoiding occurrence of UTI.
Another common complication experienced by people with spinal cord injury is bowel problems. A newly published clinical guideline from the Neurologic Incontinence Committee identifies how best to manage neurogenic bowel dysfunction. The committee recommends treatment alternatives that can optimize stool consistency and achieve regular bowel evacuation. A primary aim of this is to avoid fecal incontinence.
It is impossible to say what treatment alternatives the future holds for people with spinal cord injury. The extent and amount of research is, however, encouraging. A new meta-analysis involving 377 patients and 10 studies summarizes the latest findings around stem cell therapy in spinal cord injury. The study concludes that stem cell transplantation can improve sensory and bladder functions, but that there is as yet no evidence for an impact on motor function or activities of daily living.
Complications of Spinal Cord Injury Over the First Year After Discharge From Inpatient Rehabilitation.
http://www.archives-pmr.org/article/S0003-9993(17)30013-8/fulltext
Author and Origin
Stillman MD, Barber J, Burns S, Williams S, Hoffman JM. US
Summary
Observational study of complications of spinal cord injury one year after discharge. Includes 169 patients.
Conclusions
A mean of 4.7 complications per patient were observed over 12 months. The most frequently reported complication was urinary tract infection, with an incidence of 62%. Bowel problems were also common, with an incidence of 33%.
Comments
Epidemiological data on complication rates during the first year after spinal cord injury indicate significant bladder and bowel problems.
Assessment and management of acute spinal cord injury: From point of injury to rehabilitation.
http://www.tandfonline.com/doi/full/10.1080/10790268.2017.1329076
Author and Origin
Hachem LD, Ahuja CS, Fehlings MG. Canada
Summary
Review of pathophysiology, management, and long-term rehabilitation of individuals with traumatic SCI.
Conclusions
Early transfer to specialized centers and early treatment is key after spinal cord injury. Prevention of chronic complications such as bladder dysfunction and early physical rehabilitation and mobilization are examples of important interventions.
Comments
Review highlighting the treatment alternatives and important considerations for initial management after spinal cord injury.
Urinary catheter-associated microbiota change in accordance with treatment and infection status.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0177633
Author and Origin
Bossa L, Kline K, McDougald D, Lee BB, Rice SA. Australia
Summary
Observational prospective study of the urinary tract microbiome during 12 months in 3 catheterized individuals with spinal cord injury.
Conclusions
The microbial flora of the urinary tract was highly individual and changes with probiotic therapy and during a urinary tract infection. Changes in the microbiota due to probiotic treatment or infection were transient.
Comments
Study observing changes in bacterial flora in the urinary tract linked to infection in people. It suggests that monitoring of microbial status in people with spinal cord injury using catheters may help to track their health.
Open access.
Neurogenic bowel dysfunction: Clinical management recommendations of the Neurologic Incontinence Committe of the Fifth International Consultation on Incontinence 2013.
https://www.ncbi.nlm.nih.gov/pubmed/28640977
Author and Origin
Cotterill N, Madersbacher H, Wyndaele J, Apostolidis A, Drake M, Gajewski J, Heesakkers J, Panicker J, Radziszewski P, Sakakibara R, Sievert KD, Hamid R, Kessler T, Emmanuel A. EU
Summary
An update of the evidence-based clinical guidelines from 2009, for management of neurogenic bowel dysfunction.
Conclusions
Treatment primarily focuses on optimizing stool consistency and achieving bowel evacuation according to a regular schedule, to avoid fecal incontinence. Education is key to success in reaching optimal management of bowel symptoms.
Comments
Evidence-based clinical guidelines from 2013 including algorithms for initial to more specialized management of fecal incontinence.
This article is described further in the highlight section.
A cross-sectional study of the catheter management of neurogenic bladder after traumatic spinal cord injury.
https://www.ncbi.nlm.nih.gov/pubmed/28580635
Author and Origin
Lane GI, Driscoll A, Tawfik K, Chrouser K. US
Summary
Observational survey investigating catheter management in 100 patients with spinal cord injury and neurogenic bladder.
Conclusions
Patients were 94% male with a median age of 61 years. Reported catheter use was 54% intermittent, 25% suprapubic, and 21% transurethral indwelling catheter. Patients using an indwelling catheter were older that those using intermittent catheterization.
Comments
Study showing catheter use among men with spinal cord injury in the US. The results indicate that transitions between catheter types are common and intermittent catheterization is sometimes abandoned due to inconvenience.
Stem cell transplantation for spinal cord injury: A meta-analysis of treatment effectiveness and safety.
Author and Origin
Fan X, Wang J-Z, Lin X-M, Zhang L. China
Summary
Meta-analysis of 377 patients in 10 studies investigating stem cell therapy in spinal cord injury.
Conclusions
Compared with rehabilitation therapy, stem cell transplantation seems to improve sensory and bladder functions but not motor functions or daily living activities.
Comments
Review showing the impact of stem cell therapy on spinal cord injury.
Open access.
This blog post is an extract of the Science Alert from July 2017 (76070-USX-1707)
