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Study design:Survey of expert opinion, feedback and final consensus.Objective:To describe the development and the variables included in the International Spinal Cord Injury (SCI) Spinal Interventions and Surgical Procedures Basic Data set.Setting:International working group.Methods:A committee of experts was established to select and define data elements. The data set was then disseminated to the appropriate committees and organizations for comments. All suggested revisions were considered and both the International Spinal Cord Society and the American Spinal Injury Association endorsed the final version.Results:The data set consists of nine variables: (1) Intervention/Procedure Date and start time (2) Non-surgical bed rest and external immobilization, (3) Spinal intervention-closed manipulation and/or reduction of spinal elements, (4) Surgical procedure-approach, (5) Date and time of the completion of the intervention or surgical closure; (6) Surgical procedure-open reduction, (7) Surgical procedure-direct decompression of neural elements, and (8 and 9) Surgical procedure-stabilization and fusion (spinal segment number and level). All variables are coded using numbers or characters. Each spinal intervention and procedure is coded (variables 1 through 7) and the spinal segment level is described (variables 8 and 9). Sample clinical cases were developed to illustrate how to complete it.Conclusion:The International SCI Spinal Interventions and Surgical Procedures Basic Data Set was developed to facilitate comparisons of spinal interventions and surgical procedures among studies, centers and countries. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine whether implementation of a Pressure Ulcer Prevention Initiative (PUPI) changed the assessment and treatment of patients with a traumatic spinal cord injury (SCI) in an acute care setting, and improved patient outcomes. Method: The success of implementation was evaluated by examining the percentage of patients with completed occupational therapist (OT) skin care assessments and prescriptions for therapeutic support surfaces (TSS; i.e., mattresses) before implementation (historical, cohort 1) and after implementation (experimental, cohort 2). Patient outcomes were evaluated by examining changes in PU incidence, severity, timing and recurrence, as well as PU prevalence and satisfaction with life in the community. Results: Final analysis included 70 patients in cohort 1 and 73 in cohort 2. OT skin care assessment documentation (31% to 60%; p<0.001) and TSS prescriptions (31% to 60%; p=0.02) significantly increased following the implementation. The PU incidence based on patient charts (both nursing and OT assessments) did not increase significantly (26% to 36%; p=0.2). However, documented PU incidence according to OT assessments showed a substantial increase (14% to 33%; p=0.002). No effect of the PUPI was seen on immediate or long-term patient outcomes during the study period. Conclusion: PUPI was successful in changing clinical practice in PU prevention but no statistically significant improvements in PU-related patient outcomes were demonstrated. Results from this study identified facilitators and barriers to implementation and highlighted the complexity and difficulty of instituting effective preventative or therapeutic interventions for this population in an acute care setting. This information will assist with refinements of the PUPI and inform similar future initiatives. [ABSTRACT FROM AUTHOR]

Study design:Development of a prospective patient registry.Objective:To develop a patient registry for persons with traumatic spinal cord injuries (SCI), which can be used to answer research questions and improve patient outcomes.Setting:Nine provinces in Canada.Methods:The Rick Hansen Spinal Cord Injury Registry (RHSCIR) is part of the Translational Research Program of the Rick Hansen Institute. The launch of RHSCIR in 2004 heralded the initiation of the first nation-wide SCI patient registry within Canada. Currently, RHSCIR is being implemented in 14 cities located in 9 provinces, and there are over 1500 individuals who have sustained an acute traumatic SCI registered to date. Data are captured from the pre-hospital, acute and rehabilitation phases of care, and participants are followed in the community at 1, 2, 5 and then every 5 years post-injury.Results:During the development of RHSCIR, there were many challenges that were overcome in selecting data elements, establishing the governance structure, and creating a patient privacy and confidentiality framework across multiple provincial jurisdictions. The benefits of implementing a national registry are now being realized. The collection of an internationally standardized set of clinical information is helping inform clinicians of beneficial interventions and encouraging a shift towards evidence-based practices. Furthermore, through RHSCIR, a network is forming amongst SCI clinicians and researchers, which is fostering new collaborations and the launch of multi-center clinical trials.Conclusions:For networks that are establishing SCI registries, the experiences and lessons learned in the development of RHSCIR may provide useful insights and guidance. [ABSTRACT FROM AUTHOR]

Bringing evidence to practice is a key issue in modern medicine. The key barrier to information searching is time. Clinical decision support systems (CDSS) can improve guideline adherence. Mounting evidence exists that mobile CDSS on handheld computers support physicians in delivering appropriate care to their patients. Subaxial cervical spine injuries account for almost half of spine injuries, and a majority of spinal cord injuries. A valid and reliable classification exists, including evidence-based treatment algorithms. A mobile CDSS on this topic was not yet available. We developed and tested an iPhone application based on the Subaxial Injury Classification (SLIC) and 5 evidence-based treatment algorithms for the surgical approach to subaxial cervical spine injuries. The application can be downloaded for free. Users are cordially invited to provide feedback in order to direct further development and evaluation of CDSS for traumatic lesions of the spinal column. [ABSTRACT FROM AUTHOR]

Study Design:Retrospective data analysis.Objectives:To determine prevalence of orthostatic hypotension (OH) in patients with spinal cord injury (SCI) during the acute rehabilitation period.Setting:Quaternary care spinal unit, Vancouver General Hospital, British Columbia, CanadaMethods:Eighty-nine patients with acute SCI stratified by neurological level (cervical, 55 (62%); upper thoracic, 12 (13%); lower thoracic, 22 (25%)), and graded by American Spinal Injury Association standards. Non-invasive measurement of systolic and diastolic blood pressure and heart rate were made at baseline and 3 min following an orthostatic challenge test administered during the first month after SCI.Results:Patients with cervical or upper thoracic motor complete SCI more frequently experienced OH (P<0.01). OH persisted during the first month following SCI in 74% of cervical and only 20% of upper thoracic motor complete SCI patients.Conclusion:Patients with cervical and upper thoracic motor complete SCI are more likely to experience persistent OH than those with lower level or motor incomplete SCI during the first month of rehabilitation.Spinal Cord (2008) 46, 65–69; doi:10.1038/sj.sc.3102064; published online 10 April 2007 [ABSTRACT FROM AUTHOR]

Candida osteomyelitis is an uncommon complication of immunosuppressive therapy. Its radiographic manifestations are similar to those of other relatively indolent infectious agents. We report the CT and MR findings in a patient who developed this condition following treatment for acute myelogenous leukemia, and review the imaging literature covering similar cases. [ABSTRACT FROM AUTHOR]

Question: In patients with a burst fracture of the thoracolumbar spine, is treatment with a thoracolumbosacral orthosis (TLSO) equivalent to treatment without a TLSO? Design: Randomized (allocation concealed), blinded (outcome assessors), controlled trial with 24 months of follow-up. Setting: 3 Canadian tertiary spine centers. Patients: 96 neurologically intact patients who were 16 to 60 years of age (mean age, 40 years; 70% men) and had sustained, within the past 3 days, an isolated AO-A3 burst fracture between T10 and L3 with a kyphotic deformity of ,35°. Exclusion criteria included the inability to wear a brace, mobilization with or without a brace before recruitment, pathologic or open fracture, drug or alcohol dependence, and previous injury or surgery to the thoracolumbar region. Data were available for 92 patients (96%) for measurement of the primary outcome at 3months; the rate of follow-up was 71% at 24 months. Intervention: Patients were allocated to treatment with (n = 47) or without (n = 49) a TLSO. Patients in the TLSO group were on strict bed rest until fitted with the TLSO (Aspen Medical Products, Irvine, California), which was worn at all times except when in bed. Patients in the TLSO group were mobilized in the brace by a physiotherapist and were instructed to wear the brace for 10 weeks, with weaning from the brace begun at 8 weeks. No patient in the TLSO group was mobilized immediately by a physiotherapist with restrictions on bending and rotating through the trunk. Return to normal activities after 8 weeks was encouraged. Patients in both groups were cautioned to not exceed 90° of hip flexion or to lift and carry .5 kg. A graded functional rehabilitation program was followed for 3 months. Main outcome measures: The primary outcome measure was the Roland Morris Disability Questionnaire (RMDQ) for the assessment of physical disability secondary to low back pain at 3 months. This questionnaire includes 24 items, with scores ranging from 0 (no disability) to 24 (severe disability). Secondary outcome measures included the mental and physical component scores of the Short Form-36 (SF-36), pain, satisfaction, and kyphosis (as measured with the Cobb technique). Main results: The two treatments were considered equivalent if the confidence interval (CI) of the difference inRMDQscore at 3 months laywithin the predetermined margin of equivalence (25 to 15 points). A power of 90% was deemed appropriate to demonstrate equivalence. The RMDQ score at 3 months was 6.8 points in the TLSO group and 7.7 points in the no-TLSO group. The 95% CI for the 0.9-point difference was21.5 to 3.2, demonstrating equivalence of the 2 treatments. Over the 2-year follow-up period, the groups did not differ in terms of the RMDQ or any of the secondary outcome measures. Conclusion: In neurologically intact patients with a burst fracture of the thoracolumbar spine, treatment with a thoracolumbosacral orthosis was equivalent to treatment without a thoracolumbosacral orthosis at 3 months. [ABSTRACT FROM AUTHOR]

Background: A systematic review of the evidence pertaining to methylprednisolone infusion following acute spinal cord injury was conducted in order to address the persistent confusion about the utility of this treatment., Methods: A committee of neurosurgical and orthopedic spine specialists, emergency physicians and physiatrists engaged in active clinical practice conducted an electronic database search for articles about acute spinal cord injuries and steroids, from January 1, 1966 to April 2001, that was supplemented by a manual search of reference lists, requests for unpublished additional information, translations of foreign language references and study protocols from the author of a Cochrane systematic review and Pharmacia Inc. The evidence was graded and recommendations were developed by consensus., Results: One hundred and fifty-seven citations that specifically addressed spinal cord injuries and methylprednisolone were retrieved and 64 reviewed. Recommendations were based on one Cochrane systematic review, six Level I clinical studies and seven Level II clinical studies that addressed changes in neurological function and complications following methylprednisolone therapy., Conclusions: There is insufficient evidence to support the use of high-dose methylprednisolone within eight hours following an acute closed spinal cord injury as a treatment standard or as a guideline for treatment. Methylprednisolone, prescribed as a bolus intravenous infusion of 30 mg per kilogram of body weight over fifteen minutes within eight hours of closed spinal cord injury, followed 45 minutes later by an infusion of 5.4 mg per kilogram of body weight per hour for 23 hours, is only a treatment option for which there is weak clinical evidence (Level I- to II-1). There is insufficient evidence to support extending methylprednisolone infusion beyond 23 hours if chosen as a treatment option.

Spinal injuries are among the most devastating injuries associated with recreational sports. Snowboarding spinal injury patterns have not been described. During two seasons (1994 to 1995 and 1995 to 1996), 34 skiers and 22 snowboarders suffered serious spinal injuries (fracture or neurologic deficit or both) at two ski areas in British Columbia, Canada. Ski patrol records, the Provincial Trauma Database, and hospital records were reviewed. Injury rates were based on computerized lift-ticket data and a population estimate of 15% snowboarders (ski patrol observation). The incidence of spinal injury among skiers was 0.01 per 1000 skier-days, and among snowboarders was 0.04 per 1000 snowboarder-days. Mean age was 34.5 years for skiers and 22.4 years for snowboarders. Seventy percent of the skiers were men, whereas all of the snowboarders were men. Jumping (intentional jump > 2 meters) was the cause of injury in 20% of skiers and 77% of snowboarders. Neither age nor sex accounted for any significant portion of this difference. The rate of spinal injuries among snowboarders is fourfold that among skiers. Although jumping is the primary cause of injury, it is an intrinsic element of snowboarding. Until research defines effective injury-prevention strategies, knowledge of the risk of snowboarding should be disseminated and techniques for safe jumping should be taught.