Medical Interventions

Early rehabilitation efforts include measures to prevent and manage medical complications. The third NASCIS study prospectively monitored medical complications for 6 weeks after SCI. The rates have been similar for over 1400 patients in NASCIS trials. Table 10-4 shows the frequencies of the most common complications. Complications may differ in a patient population that includes victims of firearms. The NASCIS complication rates stand in some contrast to the medical comorbidities during rehabilitation (Table 10-5) and 2 years after a traumatic SCI (Table 10-6).

Patients with cervical and upper thoracic injuries and complete lesions have greater early morbidity than patients with lower spinal or in-

Figure 10-2. A 31-year-old woman slipped and fell down a flight of stairs, landed on her back, and was unable to move her legs. She recovered the ability to walk but had mild residual leg weakness, a drop foot, and dyses-thesias of the feet. At age 42, she suddenly felt pain in the upper back and urinary incontinence while cheering at a basketball game. Upper thoracic, cervical, and right arm pain recurred with sneezing. At age 44, her left hand became dry and walking and urinary urgency and constipation worsened. The MRI scan shows a wide sy-ringomyelia from T-12 to C-2 in the (A) sagittal and (B) axial planes. She had kyphotic angulation of the spine at T-12/L-1 and an L-1 fracture. A staged decompression of the subarachnoid space was carried out with an anterior spinal decompression and partial extradural vertebrec-tomy of L-1, followed by a T-12 and L-1 laminectomy with intradural lysis of adhesions and placement of a dural graft. The (C) sagittal and (D) axial scans a few months later reveal a marked decrease in the width of the syrinx. Her pain and ability to walk returned close to her level of function prior to age 40. (Courtesy of Ulrich Batzdorf, M.D., University of California Los Angeles.)

Table 10-4. Medical Complications in 500 Patients Within 6 Weeks of Acute Spinal Cord Injury

Complication

Percentage

Urinary tract infection

36

Musculoskeletal injury

20

Pneumonia

15

Decubiti

15

Respiratory failure

15

Head injury

10

Atelectasis

8

Sepsis

5

Phlebitis

5

Arrhythmia

4

Paralytic ileus

3

Incision, pin, halo infection

3

Gastrointestinal hemorrhage

2

Source: Adapted from Bracken et al., 1997.8

Source: Adapted from Bracken et al., 1997.8

complete lesions. Ventilatory dysfunction, aspiration, dysautonomia with upright hypotension or paroxysmal hypertension, a neurogenic bowel with impactions, a neurogenic bladder with retention and infections, a catabolic state, and gastric atony are especially likely to complicate early management. Prophylaxis for deep vein thrombosis and management of de-cubiti, soft tissue pain, central pain, and other commmon complications are reviewed in Chapter 8.

Table 10-5. Medical Complications During Inpatient Rehabilitation for Traumatic Spinal Cord Injury

Complication

Percentage

Pressure sore

21

Abnormal renal tests

11

Atelectasis/pneumonia

9

Autonomic dysreflexia

7

Deep vein thrombosis

5

Pulmonary embolus

1

Renal stone

0.5

Gastrointestinal hemorrhage

0.4

Cardiac arrest

0.4

Source: Adapted from Model Systems Program, 1998 data in Chen et al., 1999.244

Source: Adapted from Model Systems Program, 1998 data in Chen et al., 1999.244

Table 10-6. Medical Complications in the 2nd Year after Traumatic Spinal Cord Injury

Complication

Percentage

Pressure ulcer

18

Autonomic dysreflexia

11

Abnormal renal tests

8

Atelectasis/pneumonia

4

Renal calculi

2

Deep vein thrombosis

1

Leg long bone fracture

1

Pulmonary embolus

0.2

Source: Adapted from Model Systems Program, 1998 data in McKinley et al., 1999.61

Source: Adapted from Model Systems Program, 1998 data in McKinley et al., 1999.61

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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