Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review

Author:

Adegeest Charlotte Y.12,van Gent Jort A. N.1,Stolwijk-Swüste Janneke M.3,Post Marcel W. M.34,Vandertop William P.5,Öner F. Cumhur6,Peul Wilco C.127,Wengel Paula V. ter27

Affiliation:

1. Department of Neurosurgery, Leiden University Medical Center, Leiden;

2. Department of Neurosurgery, Haaglanden Medical Center, The Hague;

3. Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht;

4. Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen;

5. Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam;

6. Department of Orthopedic Surgery, University Medical Center Utrecht; and

7. Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center Leiden, Haaglanden Medical Center and Haga Teaching Hospital, The Hague, The Netherlands

Abstract

OBJECTIVE Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI. METHODS A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain. CONCLUSIONS This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

General Medicine

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