Improving current understanding of cognitive impairment in patients with a spinal cord injury: A UK-based clinician survey.

Context: Emerging data suggests that patients with a spinal cord injury (SCI) have a higher risk of developing cognitive impairment. The true incidence of cognitive impairment in this group is unclear due to the difficulty in administering commonly used assessment tools, which are dependent on functional abilities e.g.

Cannabis use by individuals with spinal cord injury in the UK: a call for improved patient education and physician awareness for pain and spasticity management.

Study Design: Prospective observational qualitative study.

Objective: Cannabis is used by patients for the treatment of chronic pain, spasticity, sleep issues or mood disorders such as anxiety and depression. Since 2018, it has been authorised in the United Kingdom for medical use as an unlicensed medicine.

Value and Limitations of Urethrotech Catheterisation Device to Manage Difficult Urethral Catheterisation in Male Spinal Cord Injury Patients.

Methods: We used a Urethrotech catheterisation device in 57 male patients with spinal cord injury, in whom urethral catheterisation was unsuccessful or previous catheterisation was difficult.

Results: Urethrotech catheter could be inserted in 51 patients. No patient developed urinary tract infection.

Psychological Screening, Standards and Spinal Cord Injury: Introducing Change in NHS England Commissioned Services.

Psychologist resourcing across the United Kingdom (UK) spinal cord injury centres (SCICs) varies considerably, which has detrimentally impacted standardising service provision for people with spinal cord injuries/disorders (PwSCI/D) compared with other nations. This paper presents the outcome of a project involving the Spinal Cord Injury Psychology Advisory Group (SCIPAG) and NHS England Clinical Reference Group/SCI transformation groups to agree upon screening and standards and shares data from the National Spinal Injuries Centre (NSIC) and the Yorkshire and Midlands Regional SCICs. Inpatients completed the GAD-7, the PHQ-9, and the short form of the Appraisals of DisAbility: Primary and Secondary Scale (ADAPSSsf), assessing adjustment.

Delay in diagnosis of urethral perforation due to catheterisation in a person with cervical spinal cord injury. Importance of (1) imaging studies done promptly for detection and documentation of urethral trauma, (2) Urethrotech catheterisation device to minimise urethral trauma and achieve successful catheterisation: A case report.

Introduction And Importance: Spinal cord injury patients are at risk for urethral trauma during catheterisation. We report a patient in whom urethral perforation due to catheterisation was not recognised for ∼ four days.

Case Presentation: Following a routine catheter change by community nurses in a male person with tetraplegia, the catheter drained only a small amount of urine.

Milk of calcium in renal calyces, renal pelvis, and ureter in a person with tetraplegia.

Milk of calcium is a colloidal suspension of precipitated calcium salts which lies in a dependent manner and imaging reveals a horizontal upper edge. We report a 44-year-old male person with tetraplegia, who had been staying in bed for prolonged periods due to ischial and trochanteric pressure sores. Ultrasound scan of the kidneys revealed numerous variable-sized stones in the left kidney.

Is procalcitonin a reliable indicator of sepsis in spinal cord injury patients: an observational cohort study.

Study Design: Prospective observational cohort study.

Objective: To understand if serum procalcitonin (PCT) is a reliable indicator of sepsis in spinal cord injury (SCI) patients for better prognosis and earlier diagnosis when compared with other common biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cells (WBC), blood culture and body temperature.

Methods: From March 2021 to August 2022, data were collected for SCI patients who developed septicaemia.

Possible Use of a Safety-Valve with a Foley Catheter During Catheterisation of Male Spinal Cord Injury Patients for Prevention of Urethral Trauma Caused by Inflation of the Catheter Balloon in the Urethra.

We used a safety-valve (Trans-Urethral Catheterisation Safety Valve, Class Medical, Limerick, Ireland) to prevent urethral trauma due to inflation of the anchoring balloon in the urethra during catheterisation of male spinal cord injury patients in a spinal unit. The safety-valve is attached to the balloon channel of a Foley catheter. If the balloon is inflated when it is in the urethra, the pressure valve is activated.

Oropharyngeal Dysphagia in Acute Cervical Spinal Cord Injury: A Literature Review.

Dysphagia (swallowing impairment) is a frequent complication of cervical spinal cord injury (cSCI). Recently published national guidance in the UK on rehabilitation after traumatic injury confirmed that people with cSCI are at risk for dysphagia and require early evaluation while remaining nil by mouth [National Institute for Health and Care Excellence. Rehabilitation after traumatic injury (NG211), 2022, https://www.

Value of serial ultrasound imaging in conservative management of epididymo-cutaneous fistula in a person with cervical spinal cord injury.

Epididymo-cutaneous fistula was seen in a person with cervical spinal cord injury and neuropathic bladder. This patient developed left epididymitis; then he formed an abscess superficial to the tail of the epididymis, which burst open to the skin discharging pus; subsequently, this progressed to epididymo-cutaneous fistula. A few drops of urine would leak through the fistula.

Large amounts of debris in the neuropathic bladder in persons with spinal cord injury; value of ultrasound scan in detection and management of vesical debris.

Persons with spinal cord injury are at risk for developing debris in the neuropathic bladder. Ultrasound scan of the urinary bladder helps to (1) detect debris, (2) differentiate debris from other bladder lesions, (3) alert the spinal cord physician to review bladder management, and (4) monitor the effect of various treatment regime to clear the debris. We present 4 cases to illustrate the sonographic appearances of debris in the neuropathic bladder and how treatment plans tailored to the needs of the individual patient helped to clear the debris.

Nephrogenic metaplasia in a female person with spinal cord injury: chronic irritation caused by Foley balloon was aggravated by a large uterine fibroid pressing upon the bladder wall for several years: a case report.

Introduction: Chronic irritation caused by urinary catheter may predispose to metaplastic changes in the bladder and very rarely, nephrogenic metaplasia.

Case Presentation: A 53-year-old lady with T-2 paraplegia and urethral catheter drainage for 27 years presented with haematuria. MRI of pelvis, performed seven years ago, showed a 10 cm intramural fibroid within the anterior aspect of the uterine body which was pushing the collapsed urinary bladder containing the Foley catheter to the left.

Erosion of urethra by malleable penile prosthesis in a spinal cord injury patient with diabetes mellitus and repeated misplacement of Foley balloon in the urethra: lessons we learn: a case report.

Introduction: Spinal cord injury patients with indwelling urethral catheters are at high risk for erosion of urethra by penile prosthesis. Repeated misplacement of a Foley catheter with the balloon inflated in the urethra produces additional compression, thus predisposing to erosion of urethra by the prosthesis.

Case Presentation: A 22-year male sustained tetraplegia in 1980.

Dysbaric osteonecrosis of the humeral head in a patient with type 2 decompressive sickness.

Introduction: Dysbaric osteonecrosis, albeit rare, have been reported in patients with decompression sickness. We report a patient with dysbaric osteonecrosis, diagnosed 60 days after presenting with decompression sickness.

Case Presentation: A 38-year-old, previously fit and healthy male, noted his tank running out of air at approximately 40-50 m while diving, surfaced rapidly before losing consciousness.

Missed bilateral radial head fractures in central cord syndrome.

Introduction: In 2012, 22 new major trauma centres were introduced in England. This followed evidence demonstrating that such units saved lives and reduced serious disability. Traumatic central cord syndrome is an example of spinal injury seen in major trauma centres.

Positive airway pressure for sleep-disordered breathing in acute quadriplegia: a randomised controlled trial.

Rationale: Highly prevalent and severe sleep-disordered breathing caused by acute cervical spinal cord injury (quadriplegia) is associated with neurocognitive dysfunction and sleepiness and is likely to impair rehabilitation.

Objective: To determine whether 3 months of autotitrating CPAP would improve neurocognitive function, sleepiness, quality of life, anxiety and depression more than usual care in acute quadriplegia.

Methods And Measurements: Multinational, randomised controlled trial (11 centres) from July 2009 to October 2015.

The effect of task symmetry on bimanual reach-to-grasp movements after cervical spinal cord injury.

Injury to the cervical spinal cord results in deficits in bimanual control, reducing functional independence and quality of life. Despite this, little research has investigated the control strategies which underpin bimanual arm/hand movements following cervical spinal cord injury (cSCI). Using kinematics and surface electromyography this study explored how task symmetry affects bimanual control, in patients with an acute cSCI (< 6 m post injury), as they performed naturalistic bimanual reach-to-grasp actions (to objects at 50% and 70% of their maximal reach distance), and how this differs compared to uninjured age-matched controls.

Participation restriction and assistance needs in people with spinal cord injuries of more than 40 year duration.

Study Design: Prospective observational.

Objectives: Examine changes in participation restriction and assistance needs in a sample of people with long-standing spinal cord injuries (SCIs).

Setting: Two British spinal centres.

Fatal cerebral hemorrhage in a tetraplegic patient due to autonomic dysreflexia triggered by delay in emptying urinary bladder after unsuccessful intermittent catheterization by carer: lessons learned.

Introduction: Over-distension of urinary bladder in a high spinal cord injury patient is a triggering factor for autonomic dysreflexia. Removing triggering factors is vital to prevent autonomic dysreflexia.

Case Presentation: A 36-year-old tetraplegic patient, who was managed by intermittent catheterizations performed by caregivers, developed recurrent autonomic dysreflexia during a week due to: 1) carers not performing intermittent catheterizations every night; 2) infrequent catheterizations during the day, leading to distension of urinary bladder.

Long-term bladder and bowel management after spinal cord injury: a 20-year longitudinal study.

Study Design: Prospective observational.

Aim: The aim of this study was to analyse changes in bladder and bowel management methods in persons with long-standing spinal cord injury (SCI).

Setting: Two spinal centres in UK.

Comparison of statistical methods for calculating life expectancy after spinal cord injury.

Study Design: Retrospective observational.

Objectives: To compare results of several different methods for calculating life expectancy in the same sample of people with spinal cord injury (SCI), and critically assess their advantages and disadvantages.

Setting: Two spinal centres in Great Britain.

Early Loosening of Spinal Rod in a Case of Degenerative Grade 1 Spondylolisthesis treated with Unilateral Pedicle Screw Fixation and Transforaminal Cage for Interbody Fusion.

Introduction: Unilateral pedicle screw fixation and transforaminal cage for interbody fusion are well-established form of treatment for lumbar spondylolisthesis. It is cost effective and has shown to have a comparable outcome to bilateral pedicle screw fixation. We present a case of unilateral pedicle screw fixation and transforaminal cage for interbody fusion in a patient of Grade 1 Degenerative spondylolisthesis who had an early implant failure, and try to assess the possible events leading to it.

Fatal collapse due to autonomic dysreflexia during manual self-evacuation of bowel in a tetraplegic patient living alone: lessons to learn.

Background: To identify areas for improvement, the National Health Service in England mandates the review of case reports of patients who have died, which should be translated into improved care for other patients.

Case Report: A 49-year-old Caucasian man sustained C-7 tetraplegia in a motorcycle accident in 1992. In 2009, he developed seizures and collapsed in the lavatory on a number of occasions during manual self-evacuation of his bowel.