Mckinley William O, Tewksbury Michael A, Mujteba Nayyer M
Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University/Medical College of Virginia Hospital, Richmond 23298, USA.
J Spinal Cord Med. 2002 Spring;25(1):28-32. doi: 10.1080/10790268.2002.11753598.
Nontraumatic spinal cord injury (NT/SCI), which can occur secondary to spinal stenosis, has been shown to represent a significant proportion of individuals admitted for SCI rehabilitation. The objective of this study was to compare demographics and outcomes of patients with spinal stenosis-induced SCI (SS/SCI) with those with traumatic spinal cord injury (T/SCI) following inpatient rehabilitation.
This 7-year prospective review compared 81 patients with SS/SCI and 102 patients with T/SCI admitted to an SCI rehabilitation unit with similar levels and completeness of injury. Main outcome measures included rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, rehabilitation charges, and discharge rates to home.
Results indicate that, when compared with the T/SCI, patients with SS/SCI had a significantly (P < .05) higher mean age (64.1 years vs 44.4 years), were more often female (39% vs 20%), and tended to present with paraplegia vs tetraplegia (69% vs 46%) and with motor incomplete SCI vs incomplete SCI (100% vs 49%). When comparing etiologies of SCI within tetraplegic and paraplegic groups, results showed that individuals with tetraplegic SS/SCI had a significantly (P < .05) shorter rehabilitation LOS (25.7 vs 35.9 days), and lower FIM change (24.5 vs 32.5) and FIM efficiency (1.0 vs 1.3); however, no statistical differences were noted for discharge FIM scores and discharge to home rates. Individuals with paraplegic SS/SCI also had significantly lower FIM change (20.2 vs 28.7); however no significant differences were noted for rehabilitation LOS, charges, FIM efficiency, or discharge-to-home rates.
The findings indicate that patients with SS/SCI present with less severe clinical impairments (motor incomplete and paraplegia) in comparison with patients with T/SCI. Clinically similar SS/SCI groups were noted to achieve rates of functional gain and community discharge comparable with T/SCI patients. Although patients with T/SCI achieved greater overall functional improvement, patients with SS/SCI had shorter rehabilitation LOS and lower rehabilitation charges. These findings have important implications for the interdisciplinary rehabilitation process in the overall management and outcome of individuals with NT/SCI.
非创伤性脊髓损伤（NT/SCI）可继发于椎管狭窄，在因脊髓损伤（SCI）康复入院的患者中占相当比例。本研究的目的是比较椎管狭窄所致脊髓损伤（SS/SCI）患者与创伤性脊髓损伤（T/SCI）患者在住院康复后的人口统计学特征和预后。
这项为期7年的前瞻性研究比较了81例SS/SCI患者和102例T/SCI患者，这些患者入住脊髓损伤康复单元，损伤水平和损伤完整性相似。主要结局指标包括康复医院住院时间（LOS）、功能独立性测量（FIM）评分、FIM变化、FIM效率、康复费用以及回家出院率。
结果表明，与T/SCI患者相比，SS/SCI患者的平均年龄显著更高（64.1岁对44.4岁，P <.05），女性比例更高（39%对20%），且更常表现为截瘫而非四肢瘫（69%对46%）以及运动不完全性SCI而非不完全性SCI（100%对49%）。在比较四肢瘫和截瘫组内SCI的病因时，结果显示四肢瘫SS/SCI患者的康复住院时间显著更短（25.7天对35.9天），FIM变化更低（24.5对32.5）以及FIM效率更低（1.0对1.3）；然而，出院时的FIM评分和回家出院率没有统计学差异。截瘫SS/SCI患者的FIM变化也显著更低（20.2对28.7）；然而，在康复住院时间、费用、FIM效率或回家出院率方面没有显著差异。
研究结果表明，与T/SCI患者相比，SS/SCI患者的临床损伤较轻（运动不完全性和截瘫）。在功能改善率和社区出院率方面，临床情况相似的SS/SCI组与T/SCI患者相当。虽然T/SCI患者总体功能改善更大，但SS/SCI患者的康复住院时间更短，康复费用更低。这些发现对NT/SCI患者的整体管理和预后中的多学科康复过程具有重要意义。
