RESUMEN
Study design: Prospective observational pilot study. Objectives: To compare quantitative electromyographic (EMG), imaging and strength data at two time points in individuals with cervical spinal cord injury (SCI). Setting: SCI center, Veterans Affairs Health Care System, Palo Alto, California, USA. Methods: Subjects without suspected peripheral nerve injury were recruited within 3 months of injury. Needle EMG examination was performed in myotomes above, at, and below the SCI level around 11- and 12-months post injury. EMG data were decomposed using custom software into constituent motor unit trains and each distinct motor unit was analyzed for firing rate and amplitude. Strength measurements were made with dynamometry and according to the International Standard of Neurologic Classification of SCI (ISNCSCI). Cervical magnetic resonance images (MRI) were evaluated by two neuroradiologists for gray and white matter damage around the SCI. Here, we compare the EMG, strength, and imaging findings of the one of the four participants who completed both 3- and 12-month EMG evaluations. Results: There was an increase in force generation in all muscles tested at 1 year. Localized findings of very fast firing motor units helped localize spinal cord damage and revealed gray matter damage in spinal segments where MRI was normal. Meanwhile, improvement in strength over time corresponded with different electrophysiologic patterns. Conclusions: Electromyographic decomposition at two time points provides valuable information about localization of spinal cord damage, integrity of motor neuron pools and may provide a unique understanding of neural recovery mechanisms.
Asunto(s)
Electrodiagnóstico/métodos , Electromiografía/métodos , Fuerza Muscular/fisiología , Recuperación de la Función/fisiología , Traumatismos de la Médula Espinal/diagnóstico por imagen , Vértebras Cervicales/lesiones , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Traumatismos de la Médula Espinal/fisiopatologíaRESUMEN
STUDY DESIGN: Retrospective chart review. OBJECTIVES: The objective of this study is to evaluate the efficacy of nonsteroidal anti-inflammatory drug (NSAID) prophylaxis for heterotopic ossification (HO) in the acute phase after spinal cord injury (SCI). SETTING: Acute rehabilitation hospital in California, USA. METHODS: This retrospective chart review (October 2013-March 2017) included individuals with motor complete SCI followed by the SCI service within 60 days of injury. Group demographics and HO diagnosis were compared in those who received and those who did not receive NSAID prophylaxis. A backward stepwise multiple regression was employed to assess the predictive association between injury characteristics and HO prophylaxis on HO diagnosis. RESULTS: A total of 108 AIS A and B cases were included, and 27 received ≥ 15 days of therapy (overall range 6-44 days). Logistic regression analysis revealed those who received ≥ 15 days of NSAID prophylaxis had an odds ratio of 0.1 of being diagnosed with HO compared with those who did not (95% CI, 0.02 to 0.52). Significant predictors of HO diagnosis were tracheostomy (OR 2.8, 95% CI, 1.05 to 7.5), urinary tract infection (OR 4.3, 95% CI, 1.5 to 12.2), and pressure injury (OR 3.3, 95% CI, 1.1 to 9.5). Adverse effects of NSAID use were minimal. CONCLUSIONS: NSAID prophylaxis appears to help prevent HO development during the acute phase after SCI. Prospective study with prolonged follow up is necessary to confirm the long-term efficacy of HO prevention and to further evaluate safety following spinal fusion. SPONSORSHIP: None.