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[PMID]:28628542
[Au] Autor:Parker AL; Pugh T; Hirsch MA
[Ad] Endereço:From the Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Carolinas Medical Center, Charlotte, North Carolina.
[Ti] Título:A Rare Intramedullary Spinal Cord Metastasis from a Retroperitoneal Leiomyosarcoma Presenting as a Non-Traumatic Spinal Cord Injury.
[So] Source:Am J Phys Med Rehabil;96(7):e134-e137, 2017 Jul.
[Is] ISSN:1537-7385
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Leiomyosarcoma (LMS) is a rare but well-recognized malignant soft tissue sarcoma of smooth muscle origin. Metastases commonly occur in the lungs, liver, kidney, brain, and bone. Cases of metastatic osseous lesions or other extradural space-occupying masses secondary to LMS leading to neurologic compromise are relatively commonplace in the literature. Conversely, cases of intramedullary spinal cord metastasis (ISCM), an unusual entity as a sequela of any cancer, are exceedingly rare as a consequence of LMS. Only 2 cases of an ISCM from LMS are currently documented in the literature, and to the best of our knowledge, no case is described in the rehabilitation literature. This case report presents a patient with a history of longstanding metastatic LMS presenting with incomplete paraplegia, neurogenic bowel and bladder, and neuropathic pain. The patient was found to have an ISCM of the thoracic spinal cord. She made functional gains with concurrent inpatient rehabilitation and radiation but was unable to perform her own intermittent catheterization program, bowel program, or transfers and was unable to discharge home independently. Intramedullary spinal cord metastasis is a rare and potentially devastating consequence of LMS or any primary cancer, but can be amenable to common interventions in the acute inpatient rehabilitation setting.
[Mh] Termos MeSH primário: Leiomiossarcoma/secundário
Neoplasias Retroperitoneais/patologia
Neoplasias da Medula Espinal/secundário
[Mh] Termos MeSH secundário: Idoso
Diagnóstico Diferencial
Feminino
Seres Humanos
Leiomiossarcoma/complicações
Leiomiossarcoma/diagnóstico
Neuralgia/diagnóstico
Neuralgia/etiologia
Intestino Neurogênico/diagnóstico
Intestino Neurogênico/etiologia
Paraplegia/diagnóstico
Paraplegia/etiologia
Neoplasias Retroperitoneais/complicações
Neoplasias Retroperitoneais/diagnóstico
Traumatismos da Medula Espinal/diagnóstico
Neoplasias da Medula Espinal/complicações
Neoplasias da Medula Espinal/diagnóstico
Bexiga Urinaria Neurogênica/diagnóstico
Bexiga Urinaria Neurogênica/etiologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170823
[Lr] Data última revisão:
170823
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE
[do] DOI:10.1097/PHM.0000000000000651


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[PMID]:28150263
[Au] Autor:Wu TJ; Lin CC; Wang HH
[Ad] Endereço:Department of Nursing, Chung Shan Medical University Hospital, and Adjunct Instructor, School of Nursing, Chung Shan Medical University, and Doctoral Student, School of Nursing, Kaohsiung Medical University, Taiwan, ROC.
[Ti] Título:[The Effectiveness of Abdominal Massage on Neurogenic Bowel Dysfunction in Patients With Spinal Cord Injury: A Systematic Review].
[So] Source:Hu Li Za Zhi;64(1):90-97, 2017 Feb.
[Is] ISSN:0047-262X
[Cp] País de publicação:China (Republic : 1949- )
[La] Idioma:chi
[Ab] Resumo:BACKGROUND: Neurogenic bowel dysfunction is a common comorbidity in spinal cord injury patients that may result in fecal incontinence. Abdominal massage is one intestinal training method that is used to improve bowel movement and defecation. PURPOSE: To review the effectiveness of abdominal massage on neurogenic bowel dysfunction in patients with spinal cord injury. METHODS: A systematic review of Chinese and English-language articles was performed in six databases using the following key words: spinal cord injury, abdominal massage, neurogenic bowel dysfunction, and bowel training. Relevant studies published prior to June 2016 that met the inclusion and exclusion criteria were selected. The Downs and Black scale was used to appraise the quality of each of the included studies. Eight studies were included in the final analysis. RESULTS: Four of these studies indicated that abdominal massage significantly improved bowel functions and the regularity and frequency of bowel movements. Although two of the studies indicated that abdominal massage significantly reduced the use of glycerin and laxatives, the remaining six did not. The eight studies earned respective quality scores ranging between 13 and 25. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The current literature lacks consensus on the efficacy of abdominal massage in terms of improving bowel dysfunction in patients with spinal cord injuries. Future studies should use more stringent experimental designs such as randomized controlled studies to explore the correlations among massage time and frequency and bowel function improvements in order to provide guidelines for clinical care applications.
[Mh] Termos MeSH primário: Massagem
Intestino Neurogênico/terapia
Traumatismos da Medula Espinal/complicações
[Mh] Termos MeSH secundário: Seres Humanos
Traumatismos da Medula Espinal/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:170203
[St] Status:MEDLINE


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[PMID]:27473299
[Au] Autor:Hwang M; Zebracki K; Vogel LC
[Ad] Endereço:Shriners Hospitals for Children, Chicago, IL. Electronic address: mhwang@shrinenet.org.
[Ti] Título:Long-Term Outcomes and Longitudinal Changes of Neurogenic Bowel Management in Adults With Pediatric-Onset Spinal Cord Injury.
[So] Source:Arch Phys Med Rehabil;98(2):241-248, 2017 Feb.
[Is] ISSN:1532-821X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To describe long-term outcomes of neurogenic bowel dysfunction (NBD), determine changes over time in the type of bowel program, and determine changes in psychosocial outcomes associated with NBD-related factors in adults with pediatric-onset spinal cord injury (SCI). DESIGN: Longitudinal cohort survey. Follow-up occurred annually for a total of 466 interviews, with most participants (75%) contributing to at least 3 consecutive interviews. SETTING: Community. PARTICIPANTS: Adults (N=131) who had sustained an SCI before the age of 19 years (men, 64.1%; tetraplegia, 58.8%; mean age ± SD, 33.4±6.1y; mean time since injury ± SD, 19.5±7.0y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Type and evacuation time of bowel management programs; standardized measures assessing life satisfaction, health perception, depressive symptoms, and participation. Generalized estimating equations were formulated to determine odds of change in outcomes over time. RESULTS: At first interview, rectal suppository/enema use was most common (51%). Over time, the likelihood of using manual evacuation (odds ratio [OR]=1.077; 95% confidence interval [CI], 1.023-1.134; P=.005), oral laxatives (OR=1.052; 95% CI, 1.001-1.107; P=.047), and colostomy (OR=1.071; 95% CI, 1.001-1.147; P=.047) increased, whereas the odds of rectal suppository use decreased (OR=.933; 95% CI, .896-.973; P=.001). Bowel evacuation times were likely to decrease over time in participants using manual evacuation (OR=.499; 95% CI, .256-.974; P=.042) and digital rectal stimulation (OR=.490; 95% CI, .274-.881; P=.017), but increase for rectal suppository/enema use (OR=1.871; 95% CI, 1.264-2.771; P=.002). When the level of injury was controlled for, participants using manual evacuation and digital rectal stimulation were more likely to have increases in community participation scores (P<.05). CONCLUSIONS: Changes in type of bowel program over time may be associated with the time required to complete bowel evacuation in this relatively young adult SCI population.
[Mh] Termos MeSH primário: Catárticos/uso terapêutico
Intestino Neurogênico/psicologia
Intestino Neurogênico/terapia
Traumatismos da Medula Espinal/complicações
[Mh] Termos MeSH secundário: Dor Abdominal/terapia
Adulto
Depressão/psicologia
Incontinência Fecal/terapia
Feminino
Nível de Saúde
Seres Humanos
Estudos Longitudinais
Masculino
Meia-Idade
Intestino Neurogênico/etiologia
Satisfação Pessoal
Participação Social
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cathartics)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170717
[Lr] Data última revisão:
170717
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:160731
[St] Status:MEDLINE


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[PMID]:27815246
[Au] Autor:McClurg D; Norton C
[Ad] Endereço:Nursing Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow G4 0BA, UK Doreen.mcclurg@gcu.ac.uk.
[Ti] Título:What is the best way to manage neurogenic bowel dysfunction?
[So] Source:BMJ;354:i3931, 2016 Jul 27.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Constipação Intestinal/terapia
Gerenciamento Clínico
Incontinência Fecal/terapia
Intestino Neurogênico/terapia
[Mh] Termos MeSH secundário: Constipação Intestinal/etiologia
Incontinência Fecal/etiologia
Seres Humanos
Intestino Neurogênico/complicações
Guias de Prática Clínica como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161106
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.i3931


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[PMID]:27557052
[Au] Autor:Emmanuel A; Kumar G; Christensen P; Mealing S; Størling ZM; Andersen F; Kirshblum S
[Ad] Endereço:GI Physiology Unit, University College London Hospital, London, United Kingdom.
[Ti] Título:Long-Term Cost-Effectiveness of Transanal Irrigation in Patients with Neurogenic Bowel Dysfunction.
[So] Source:PLoS One;11(8):e0159394, 2016.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: People suffering from neurogenic bowel dysfunction (NBD) and an ineffective bowel regimen often suffer from fecal incontinence (FI) and related symptoms, which have a huge impact on their quality of life. In these situations, transanal irrigation (TAI) has been shown to reduce these symptoms and improve quality of life. AIM: To investigate the long-term cost-effectiveness of initiating TAI in patients with NBD who have failed standard bowel care (SBC). METHODS: A deterministic Markov decision model was developed to project the lifetime health economic outcomes, including quality-adjusted life years (QALYs), episodes of FI, urinary tract infections (UTIs), and stoma surgery when initiating TAI relative to continuing SBC. A data set consisting of 227 patients with NBD due to spinal cord injury (SCI), multiple sclerosis, spina bifida and cauda equina syndrome was used in the analysis. In the model a 30-year old individual with SCI was used as a base-case. A probabilistic sensitivity analysis was applied to evaluate the robustness of the model. RESULTS: The model predicts that a 30-year old SCI patient with a life expectancy of 37 years initiating TAI will experience a 36% reduction in FI episodes, a 29% reduction in UTIs, a 35% reduction in likelihood of stoma surgery and a 0.4 improvement in QALYs, compared with patients continuing SBC. A lifetime cost-saving of £21,768 per patient was estimated for TAI versus continuing SBC alone. CONCLUSION: TAI is a cost-saving treatment strategy reducing risk of stoma surgery, UTIs, episodes of FI and improving QALYs for NBD patients who have failed SBC.
[Mh] Termos MeSH primário: Canal Anal
Análise Custo-Benefício
Intestino Neurogênico/terapia
Irrigação Terapêutica
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Canal Anal/fisiopatologia
Incontinência Fecal
Feminino
Seres Humanos
Masculino
Cadeias de Markov
Meia-Idade
Intestino Neurogênico/fisiopatologia
Qualidade de Vida
Anos de Vida Ajustados por Qualidade de Vida
Irrigação Terapêutica/economia
Irrigação Terapêutica/métodos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170726
[Lr] Data última revisão:
170726
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160825
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0159394


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[PMID]:27491188
[Au] Autor:Paixão MJ
[Ti] Título:Evidence base for managing neurogenic bowel dysfunction.
[So] Source:Nurs Times;112(24):19, 2016 Jun 15-21.
[Is] ISSN:0954-7762
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Medicina Baseada em Evidências
Intestino Neurogênico/terapia
[Mh] Termos MeSH secundário: Seres Humanos
Intestino Neurogênico/fisiopatologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1609
[Cu] Atualização por classe:160805
[Lr] Data última revisão:
160805
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:160806
[St] Status:MEDLINE


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[PMID]:27450748
[Au] Autor:Prévinaire JG; Soler JM; Bordji H; Fiolet MC; Navaux MA; Mortier PE
[Ad] Endereço:Centre Calvé, fondation Hopale, 62600 Berck-sur-Mer, France. Electronic address: previnjg@hopale.com.
[Ti] Título:[Assessment of severity of neurogenic bowel dysfunction in chronic patients with a simple 1-item questionnaire (PGI-S)].
[Ti] Título:Sévérité des troubles colorectaux associés aux maladies neurologiques et évaluation pratique par questionnaire à un item (PGI-S)..
[So] Source:Prog Urol;26(10):573-81, 2016 Sep.
[Is] ISSN:1166-7087
[Cp] País de publicação:France
[La] Idioma:fre
[Ab] Resumo:INTRODUCTION: Bowel symptoms (constipation and incontinence) are frequent in patients with a neurologic disease, but rarely assessed in rehabilitation centres. AIM: To study the prevalence of neurogenic bowel dysfunction (NBD) in those patients, and to assess its severity with the Patient Global Impression of Severity (PGI-S). MATERIAL: Prospective study by questionnaires, with the Neurogenic Bowel Dysfunction Score (0-47) and the PGI-S, a 1-item questionnaire (absent, mild, moderate, severe) for the severity of the bowel symptoms, and the Bristol Stool Chart for stool consistency. All patients presenting a chronic (>2months) neurological disease were included. RESULTS: Inclusion of 169 patients, 97 with spinal cord injury, 42 with multiple sclerosis and 30 with hemiplegia. In each population, prevalence of constipation was 67 %, 45 % and 17 %, of pelvic floor dyssynergia 82 %, 45 % and 27 %, and leakages (gas or stools) de 74 %, 48 % and 43 %, respectively. Moderate to severe bowel symptoms were seen in 61 % of spinal cord injury, 43 % of multiple sclerosis and 23 % of hemiplegic patients, with NBD scores of 11.9±6.5, 5.7±4.9 and 3.7±4.2, respectively (P<0.01). There was a significant relation between PGI-S and NBD score (P<0.01). Significant lower NBD scores were associated with normal stool consistency (Bristol type 3 or 4) (P<0.01). In case of severe bowel symptoms, the use of transanal irrigation was hampered by patients' motivation and acceptation, and their autonomy. CONCLUSION: PGI-S and Bristol Stool Chart are reliable tools to assess the presence of bowel symptoms in clinical practice.
[Mh] Termos MeSH primário: Intestino Neurogênico/diagnóstico
Autorrelato
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Doença Crônica
Feminino
Seres Humanos
Masculino
Meia-Idade
Intestino Neurogênico/epidemiologia
Prevalência
Estudos Prospectivos
Índice de Gravidade de Doença
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170707
[Lr] Data última revisão:
170707
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160725
[St] Status:MEDLINE


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[PMID]:27449575
[Au] Autor:Mallek A; Elleuch MH; Ghroubi S
[Ad] Endereço:Service de médecine physique, rééducation et réadaptation fonctionnelle, CHU Habib Bourguiba, route L'Ain Km 1.5, 3000 Sfax, Tunisia; Unité de recherche de l'évaluation des pathologies de l'appareil locomoteur UR12ES18, 3000 Sfax, Tunisia.
[Ti] Título:Neurogenic bowel dysfunction (NBD) translation and linguistic validation to classical Arabic.
[So] Source:Prog Urol;26(10):553-7, 2016 Sep.
[Is] ISSN:1166-7087
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To translate and linguistically validate in classical Arabic; the French version of the neurogenic bowel dysfunction (NBD). PATIENTS AND METHODS: Arabic translation of the NBD score was obtained by the "forward translation/backword translation" method. Patients with multiple sclerosis (MS) and spinal cord injury were included. Evaluation of intestinal and anorectal disorders was conducted by the self-administered questionnaire NBD, which was filled twice two weeks apart. An item-by-item analysis was made. The feasibility, acceptability, internal consistency using Cronbach's alpha, and test-retest repeatability by non-parametric Spearman correlation were studied. RESULTS: Twenty-three patients with colorectal disorders secondary to neurological disease were included, the average age was 40.79±9.16years and the sex-ratio was 1.85. The questionnaire was feasible and acceptable, no items were excluded. The spearman correlation was of 0.842. Internal consistency was judged good through the Cronbach's alpha was of 0.896. CONCLUSION: The Arabic version of NBD was reproducible and construct validity was satisfactory. The study of its responsiveness to change with a larger number of patients will be the subject of further work. LEVEL OF EVIDENCE: 4.
[Mh] Termos MeSH primário: Intestino Neurogênico
Inquéritos e Questionários
Traduções
[Mh] Termos MeSH secundário: Egito
Linguística
Marrocos
Psicometria
Tunísia
[Pt] Tipo de publicação:JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170707
[Lr] Data última revisão:
170707
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160725
[St] Status:MEDLINE


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[PMID]:27377302
[Au] Autor:Guo J; Zhu Y; Yang Y; Wang X; Chen B; Zhang W; Xie B; Zhu Z; Yue Y; Cheng J
[Ad] Endereço:Second School of Clinical Medical, Nanjing University of Chinese Medicine, Nanjing, China.
[Ti] Título:Electroacupuncture at Zusanli (ST36) ameliorates colonic neuronal nitric oxide synthase upregulation in rats with neurogenic bowel dysfunction following spinal cord injury.
[So] Source:Spinal Cord;54(12):1139-1144, 2016 Dec.
[Is] ISSN:1476-5624
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Study designExperimental study.ObjectiveTo determine the effects of electroacupuncture (EA) at Zusanli (ST36) on colonic motility and neuronal nitric oxide synthase (nNOS) expression in rats with neurogenic bowel dysfunction (NBD) after spinal cord injury (SCI).SettingSecond School of Clinical Medical, Nanjing University of Chinese Medicine, Jiangsu, China.MethodsWe divided 30 adult Sprague-Dawley rats into a sham group (10 rats), a model group (SCI alone, 10 rats) and a EA group (SCI+EA at ST36, 10 rats). Defecation time was recorded as the time from activated carbon administration (on day 15) to evacuation of the first black stool. Immunohistochemical, real-time PCR and western blot analyses were performed to assess changes in nNOS-immunoreactive cells, and nNOS messenger RNA (mRNA) and protein, respectively, after 14 experimental days.ResultsDefecation time was lower in the EA group than in the model group (P<0.01). On immunohistochemical analysis, nNOS was localized in the myenteric plexus of the colon. The number of nNOS-immunoreactive cells and the intensity of nNOS staining were greater in the model group than in the sham group and lesser in the EA group than in the model group. Consistent with the immunohistochemical findings, nNOS mRNA and protein expression was higher in the model group than in the sham group and lower in the EA group than in the model group (P<0.05 for both).ConclusionIncreased colonic nNOS expression can induce/aggravate NBD in SCI rats. EA at ST36 ameliorated NBD, possibly by downregulating colonic nNOS expression.
[Mh] Termos MeSH primário: Colo/enzimologia
Eletroacupuntura/métodos
Intestino Neurogênico/etiologia
Intestino Neurogênico/terapia
Óxido Nítrico Sintase Tipo I/metabolismo
Traumatismos da Medula Espinal/complicações
[Mh] Termos MeSH secundário: Pontos de Acupuntura
Animais
Western Blotting
Colo/patologia
Defecação/fisiologia
Modelos Animais de Doenças
Feminino
Imuno-Histoquímica
Masculino
Plexo Mientérico/enzimologia
Plexo Mientérico/patologia
Intestino Neurogênico/enzimologia
Intestino Neurogênico/patologia
RNA Mensageiro/metabolismo
Distribuição Aleatória
Ratos Sprague-Dawley
Reação em Cadeia da Polimerase em Tempo Real
Índice de Gravidade de Doença
Traumatismos da Medula Espinal/enzimologia
Traumatismos da Medula Espinal/patologia
Traumatismos da Medula Espinal/reabilitação
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (RNA, Messenger); EC 1.14.13.39 (Nitric Oxide Synthase Type I)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160706
[St] Status:MEDLINE
[do] DOI:10.1038/sc.2016.76


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[PMID]:27343731
[Au] Autor:Formby PM; Wagner SC; Kang DG; Van Blarcum GS; Lehman RA
[Ad] Endereço:Department of Orthopaedics, Walter Reed National Military Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889, USA.
[Ti] Título:Operative management of complex lumbosacral dissociations in combat injuries.
[So] Source:Spine J;16(10):1200-1207, 2016 Oct.
[Is] ISSN:1878-1632
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND CONTEXT: As war injury patterns have changed throughout Operations Iraqi and Enduring Freedom (OIF and OEF), a relative increase in the incidence of complex lumbosacral dissociation (LSD) injuries has been noted. Lumbosacral dissociation injuries are an anatomical separation of the spinal column from the pelvis, and represent a manifestation of severe, high-energy trauma. PURPOSE: This study aimed to assess the clinical outcomes of combat-related LSD injuries at a mean of 7 years following operative treatment. STUDY DESIGN: This is a retrospective review. PATIENT SAMPLE: We identified 20 patients with operatively managed LSDs. OUTCOME MEASURES: Time from injury to arrival in the United States, operative details, fixation methods, postoperative complications, time to retirement from military service, disability, and ambulatory status at latest follow-up. METHODS: We performed a retrospective review of outcomes of all patients with operatively managed combat-related LSD from January 1, 2003 to December 31, 2011. RESULTS: Twenty patients met inclusion criteria and were treated as follows: posterior spinal fusion (12, 60%), sacroiliac screw fixation (7, 35%), and combined anterior-posterior fusion for associated L3 burst fracture (1, 5%). The mean age was 28.2±6.4 years old. The most common mechanism of injury was mounted improvised explosive device (IED, 55%). On average, 2.2 spinal regions were injured per patient. Neurologic dysfunction was present in 15 patients. Three patients underwent operative stabilization of their injuries before evacuation to the United States. Four patients had a postoperative wound infection and two patients underwent reoperation. Mean follow-up was 85.9 months (range: 39.7-140.8 months). At most recent follow-up, seventeen patients were no longer on active duty military service. Eight patients had persistent bowel dysfunction and nine patients had persistent bladder dysfunction. Fifteen patients reported chronic low back pain. Seventeen were ambulating and five had documentation of running following surgery. CONCLUSIONS: This is the largest series of operatively managed LSD in patients currently reported. Our series suggests that combat-related LSD injuries frequently result in persistent, long-term neurologic dysfunction, disability, and chronic pain. Operative management carries a high postoperative risk of infection. However, a select group of patients are highly functional at latest follow-up.
[Mh] Termos MeSH primário: Traumatismos por Explosões/cirurgia
Região Lombossacral/cirurgia
Complicações Pós-Operatórias
Fraturas da Coluna Vertebral/cirurgia
Fusão Vertebral/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Campanha Afegã de 2001-
Feminino
Seres Humanos
Guerra do Iraque 2003-2011
Dor Lombar/etiologia
Região Lombossacral/lesões
Masculino
Intestino Neurogênico/etiologia
Reoperação/estatística & dados numéricos
Estudos Retrospectivos
Fraturas da Coluna Vertebral/etiologia
Bexiga Urinaria Neurogênica/etiologia
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160626
[St] Status:MEDLINE



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