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Online ISSN 1973-9095
SPINAL CORD INJURIES
Citterio A. 1, Franceschini M. 2, Reggio A. 3, Rossi B. 4, Spizzichino L. 5, Stampacchia G. 4
1 Laboratorio di Neuroepidemiologia - IRCCS “Fondazione Istituto Neurologico C. Mondino” - Pavia ;
2 Unità Operativa di Recupero e Rieducazione Funzionale, Azienda Ospedaliera di Parma;
3 Dipartimento di Scienze della Senescenza, Urologiche e Neurologiche, Università degli Studi di Catania;
4 Sezione Aggregata di Neuroriabilitazione, Dipartimento di Neuroscienze, Azienda Ospedaliera di Pisa;
5 Dipartimento di Prevenzione - Ministero della Sanità
BACKGROUND: Non traumatic spinal cord injuries (NT-SCI) may be caused by numerous pathologies and are treated within diverse medical and surgical branches during the acute phase. Descriptive epidemiological studies are scarce and often report inconsistent data. Retrospective Italian epidemiological studies in samples with spinal cord injuries have reported inconsistent rates of NT-SCI.
METHODS: Over a 2-year period, the Italian Group for the Epidemiological Study of Spinal Cord Injuries (GISEM) recorded data on all SCI patients admitted to 37 Italian rehabilitation centres using a multiple choice questionnaire to collect demographic and clinical information.
RESULTS: Of the 2210 admissions recorded, 719 (32.5%) were due to NT-SCI and of these, 330 were at their first rehabilitation admission.
NT-SCI were more frequent among men (1.6/1). The most common aetiology was neoplastic myelopathies. The lesion was cervical in 21.8% and thoraco-lumbar in 76.1%. Twenty per cent of the patients came from home. The presence of pressure sores at admission was correlated with a vascular aetiology, a complete lesion, and previous hospitalisation in a surgical ward.
In 32% of cases, predictors of improvement were incompleteness of lesion, absence of urological complications at admission and a longer hospital stay. Predictors of a return home, verified in 74.2% of cases, were a longer hospital stay, incompleteness of lesion, lumbar-sacral level, improvement and being married or cohabiting.
DISCUSSION: In the present study, the percentage of NT-SCI fell within the range described in the international literature. As expected, mean age was higher in cases of traumatic injury. The high incidence of pressure sores at admission and the high percentage of patients who came from home point to failings in acute care management and the organisation of the hospital network system. Not to be overlooked, however, is the capacity to achieve good results (one third of the patients improved on the ASIA impairment scale after initial rehabilitation) in individuals with chronic pathologies.