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.
http://www.archives-pmr.org/article/S0003-9993(17)30013-8/fulltext
Stillman MD, Barber J, Burns S, Williams S, Hoffman JM. US
Observational study of complications of spinal cord injury one year after discharge. Includes 169 patients.
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%.
Epidemiological data on complication rates during the first year after spinal cord injury indicate significant bladder and bowel problems.
http://www.tandfonline.com/doi/full/10.1080/10790268.2017.1329076
Hachem LD, Ahuja CS, Fehlings MG. Canada
Review of pathophysiology, management, and long-term rehabilitation of individuals with traumatic SCI.
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.
Review highlighting the treatment alternatives and important considerations for initial management after spinal cord injury.
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0177633
Bossa L, Kline K, McDougald D, Lee BB, Rice SA. Australia
Observational prospective study of the urinary tract microbiome during 12 months in 3 catheterized individuals with spinal cord injury.
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.
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.
https://www.ncbi.nlm.nih.gov/pubmed/28640977
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
An update of the evidence-based clinical guidelines from 2009, for management of neurogenic bowel dysfunction.
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.
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.
https://www.ncbi.nlm.nih.gov/pubmed/28580635
Lane GI, Driscoll A, Tawfik K, Chrouser K. US
Observational survey investigating catheter management in 100 patients with spinal cord injury and neurogenic bladder.
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.
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.
Fan X, Wang J-Z, Lin X-M, Zhang L. China
Meta-analysis of 377 patients in 10 studies investigating stem cell therapy in spinal cord injury.
Compared with rehabilitation therapy, stem cell transplantation seems to improve sensory and bladder functions but not motor functions or daily living activities.
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)