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

View More View Less
  • 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
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

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.

ABBREVIATIONS

AIS = ASIA Impairment Scale; ASIA = American Spinal Injury Association; CIR = cumulative incidence rate; SCI = spinal cord injury; SHC = secondary health condition; SMR = standardized mortality ratio; tSCI = traumatic SCI.

Spine - 1 year subscription bundle (Individuals Only)

USD  $376.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Bloemen-Vrencken JH, Post MW, Hendriks JM, De Reus EC, De Witte LP. Health problems of persons with spinal cord injury living in the Netherlands. Disabil Rehabil. 2005;27(22):13811389.

    • Search Google Scholar
    • Export Citation
  • 2

    Harvey C, Wilson SE, Greene CG, Berkowitz M, Stripling TE. New estimates of the direct costs of traumatic spinal cord injuries: results of a nationwide survey. Paraplegia. 1992;30(12):834850.

    • Search Google Scholar
    • Export Citation
  • 3

    Chamberlain JD, Buzzell A, Gmünder HP, Hug K, Jordan X, Moser A, et al. Comparison of all-cause and cause-specific mortality of persons with traumatic spinal cord injuries to the general Swiss population: results from a national cohort study. Neuroepidemiology. 2019;52(3-4):205213.

    • Search Google Scholar
    • Export Citation
  • 4

    Miller LE, Anderson LH. Association of ambulatory ability on complications and medical costs in patients with traumatic spinal cord injury: a decision-analytic model. Cureus. 2019;11(8):e5337.

    • Search Google Scholar
    • Export Citation
  • 5

    Jensen MP, Molton IR, Groah SL, Campbell ML, Charlifue S, Chiodo A, et al. Secondary health conditions in individuals aging with SCI: terminology, concepts and analytic approaches. Spinal Cord. 2012;50(5):373378.

    • Search Google Scholar
    • Export Citation
  • 6

    Strauss DJ, Devivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil. 2006;87(8):10791085.

    • Search Google Scholar
    • Export Citation
  • 7

    DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil. 1999;80(11):14111419.

    • Search Google Scholar
    • Export Citation
  • 8

    Adriaansen JJ, Ruijs LE, van Koppenhagen CF, van Asbeck FW, Snoek GJ, van Kuppevelt D, et al. Secondary health conditions and quality of life in persons living with spinal cord injury for at least ten years. J Rehabil Med. 2016;48(10):853860.

    • Search Google Scholar
    • Export Citation
  • 9

    Post MW, de Witte LP, van Asbeck FW, van Dijk AJ, Schrijvers AJ. Predictors of health status and life satisfaction in spinal cord injury. Arch Phys Med Rehabil. 1998;79(4):395401.

    • Search Google Scholar
    • Export Citation
  • 10

    McKinley WO, Tewksbury MA, Godbout CJ. Comparison of medical complications following nontraumatic and traumatic spinal cord injury. J Spinal Cord Med. 2002;25(2):8893.

    • Search Google Scholar
    • Export Citation
  • 11

    Migliorini CE, New PW, Tonge BJ. Quality of life in adults with spinal cord injury living in the community. Spinal Cord. 2011;49(3):365370.

    • Search Google Scholar
    • Export Citation
  • 12

    Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB, et al. International standards for neurological and functional classification of spinal cord injury. Spinal Cord. 1997;35(5):266274.

    • Search Google Scholar
    • Export Citation
  • 13

    Fawcett JW, Curt A, Steeves JD, Coleman WP, Tuszynski MH, Lammertse D, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007;45(3):190205.

    • Search Google Scholar
    • Export Citation
  • 14

    Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, Post MW, Bussmann JB. Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation. J Rehabil Med. 2007;39(5):393398.

    • Search Google Scholar
    • Export Citation
  • 15

    Adriaansen JJ, Post MW, de Groot S, van Asbeck FW, Stolwijk-Swüste JM, Tepper M, Lindeman E. Secondary health conditions in persons with spinal cord injury: a longitudinal study from one to five years post-discharge. J Rehabil Med. 2013;45(10):10161022.

    • Search Google Scholar
    • Export Citation
  • 16

    Groah SL, Weitzenkamp D, Sett P, Soni B, Savic G. The relationship between neurological level of injury and symptomatic cardiovascular disease risk in the aging spinal injured. Spinal Cord. 2001;39(6):310317.

    • Search Google Scholar
    • Export Citation
  • 17

    Lee CS, Lu YH, Lee ST, Lin CC, Ding HJ. Evaluating the prevalence of silent coronary artery disease in asymptomatic patients with spinal cord injury. Int Heart J. 2006;47(3):325330.

    • Search Google Scholar
    • Export Citation
  • 18

    Adriaansen JJE, Douma-Haan Y, van Asbeck FWA, van Koppenhagen CF, de Groot S, Smit CA, et al. Prevalence of hypertension and associated risk factors in people with long-term spinal cord injury living in the Netherlands. Disabil Rehabil. 2017;39(9):919927.

    • Search Google Scholar
    • Export Citation
  • 19

    Hitzig SL, Tonack M, Campbell KA, McGillivray CF, Boschen KA, Richards K, Craven BC. Secondary health complications in an aging Canadian spinal cord injury sample. Am J Phys Med Rehabil. 2008;87(7):545555.

    • Search Google Scholar
    • Export Citation
  • 20

    Jones T, Ugalde V, Franks P, Zhou H, White RH. Venous thromboembolism after spinal cord injury: incidence, time course, and associated risk factors in 16,240 adults and children. Arch Phys Med Rehabil. 2005;86(12):22402247.

    • Search Google Scholar
    • Export Citation
  • 21

    McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil. 1999;80(11):14021410.

    • Search Google Scholar
    • Export Citation
  • 22

    Noreau L, Proulx P, Gagnon L, Drolet M, Laramée MT. Secondary impairments after spinal cord injury: a population-based study. Am J Phys Med Rehabil. 2000;79(6):526535.

    • Search Google Scholar
    • Export Citation
  • 23

    Aarabi B, Harrop JS, Tator CH, Alexander M, Dettori JR, Grossman RG, et al. Predictors of pulmonary complications in blunt traumatic spinal cord injury. J Neurosurg Spine. 2012;17(1)(suppl):3845.

    • Search Google Scholar
    • Export Citation
  • 24

    Han TR, Kim JH, Kwon BS. Chronic gastrointestinal problems and bowel dysfunction in patients with spinal cord injury. Spinal Cord. 1998;36(7):485490.

    • Search Google Scholar
    • Export Citation
  • 25

    Tate DG, Forchheimer M, Rodriguez G, Chiodo A, Cameron AP, Meade M, Krassioukov A. Risk factors associated with neurogenic bowel complications and dysfunction in spinal cord injury. Arch Phys Med Rehabil. 2016;97(10):16791686.

    • Search Google Scholar
    • Export Citation
  • 26

    Adriaansen JJ, van Asbeck FW, van Kuppevelt D, Snoek GJ, Post MW. Outcomes of neurogenic bowel management in individuals living with a spinal cord injury for at least 10 years. Arch Phys Med Rehabil. 2015;96(5):905912.

    • Search Google Scholar
    • Export Citation
  • 27

    Liu CW, Huang CC, Chen CH, Yang YH, Chen TW, Huang MH. Prediction of severe neurogenic bowel dysfunction in persons with spinal cord injury. Spinal Cord. 2010;48(7):554559.

    • Search Google Scholar
    • Export Citation
  • 28

    Finnerup NB, Faaborg P, Krogh K, Jensen TS. Abdominal pain in long-term spinal cord injury. Spinal Cord. 2008;46(3):198203.

  • 29

    Moonka R, Stiens SA, Resnick WJ, McDonald JM, Eubank WB, Dominitz JA, Stelzner MG. The prevalence and natural history of gallstones in spinal cord injured patients. J Am Coll Surg. 1999;189(3):274281.

    • Search Google Scholar
    • Export Citation
  • 30

    Stillman MD, Hoffman JM, Barber JK, Williams SR, Burns SP. Urinary tract infections and bladder management over the first year after discharge from inpatient rehabilitation. Spinal Cord Ser Cases.2018;4:9292.

    • Search Google Scholar
    • Export Citation
  • 31

    Herruzo Cabrera R, Leturia Arrazola A, Vizcaino Alcaide MJ, Fernández Arjona M, Rey Calero J. Analytic epidemiology of clinical urinary tract infection in spinal cord injury. Eur J Epidemiol. 1994;10(1):2327.

    • Search Google Scholar
    • Export Citation
  • 32

    Wahman K, Nilsson Wikmar L, Chlaidze G, Joseph C. Secondary medical complications after traumatic spinal cord injury in Stockholm, Sweden: towards developing prevention strategies. J Rehabil Med. 2019;51(7):513517.

    • Search Google Scholar
    • Export Citation
  • 33

    Chen Y, DeVivo MJ, Lloyd LK. Bladder stone incidence in persons with spinal cord injury: determinants and trends, 1973-1996. Urology. 2001;58(5):665670.

    • Search Google Scholar
    • Export Citation
  • 34

    Ku JH, Jung TY, Lee JK, Park WH, Shim HB. Risk factors for urinary stone formation in men with spinal cord injury: a 17-year follow-up study. BJU Int. 2006;97(4):790793.

    • Search Google Scholar
    • Export Citation
  • 35

    Favazza T, Midha M, Martin J, Grob BM. Factors influencing bladder stone formation in patients with spinal cord injury. J Spinal Cord Med. 2004;27(3):252254.

    • Search Google Scholar
    • Export Citation
  • 36

    Chen Y, DeVivo MJ, Roseman JM. Current trend and risk factors for kidney stones in persons with spinal cord injury: a longitudinal study. Spinal Cord. 2000;38(6):346353.

    • Search Google Scholar
    • Export Citation
  • 37

    Nahm LS, Chen Y, DeVivo MJ, Lloyd LK. Bladder cancer mortality after spinal cord injury over 4 decades. J Urol. 2015;193(6):19231928.

    • Search Google Scholar
    • Export Citation
  • 38

    Groah SL, Weitzenkamp DA, Lammertse DP, Whiteneck GG, Lezotte DC, Hamman RF. Excess risk of bladder cancer in spinal cord injury: evidence for an association between indwelling catheter use and bladder cancer. Arch Phys Med Rehabil. 2002;83(3):346351.

    • Search Google Scholar
    • Export Citation
  • 39

    Klotz R, Joseph PA, Ravaud JF, Wiart L, Barat M. The Tetrafigap Survey on the long-term outcome of tetraplegic spinal cord injured persons: part III. Medical complications and associated factors. Spinal Cord. 2002;40(9):457467.

    • Search Google Scholar
    • Export Citation
  • 40

    Cardenas DD, Bryce TN, Shem K, Richards JS, Elhefni H. Gender and minority differences in the pain experience of people with spinal cord injury. Arch Phys Med Rehabil. 2004;85(11):17741781.

    • Search Google Scholar
    • Export Citation
  • 41

    Modirian E, Pirouzi P, Soroush M, Karbalaei-Esmaeili S, Shojaei H, Zamani H. Chronic pain after spinal cord injury: results of a long-term study. Pain Med. 2010;11(7):10371043.

    • Search Google Scholar
    • Export Citation
  • 42

    Iorio-Morin C, Noonan VK, White B, Noreau L, Leblond J, Dumont FS, et al. Quality of Life and Health Utility Scores among Canadians living with traumatic spinal cord injury—a national cross-sectional study. Spine (Phila Pa 1976). 2018;43(14):9991006.

    • Search Google Scholar
    • Export Citation
  • 43

    Demirel G, Yllmaz H, Gençosmanoğlu B, Kesiktaş N. Pain following spinal cord injury. Spinal Cord. 1998;36(1):2528.

  • 44

    Nakipoglu-Yuzer GF, Atçı N, Ozgirgin N. Neuropathic pain in spinal cord injury. Pain Physician. 2013;16(3):259264.

  • 45

    Holtz KA, Lipson R, Noonan VK, Kwon BK, Mills PB. Prevalence and effect of problematic spasticity after traumatic spinal cord injury. Arch Phys Med Rehabil. 2017;98(6):11321138.

    • Search Google Scholar
    • Export Citation
  • 46

    Gifre L, Vidal J, Carrasco J, Portell E, Puig J, Monegal A, et al. Incidence of skeletal fractures after traumatic spinal cord injury: a 10-year follow-up study. Clin Rehabil. 2014;28(4):361369.

    • Search Google Scholar
    • Export Citation
  • 47

    Citak M, Suero EM, Backhaus M, Aach M, Godry H, Meindl R, Schildhauer TA. Risk factors for heterotopic ossification in patients with spinal cord injury: a case-control study of 264 patients. Spine (Phila Pa 1976).2012;37(23):19531957.

    • Search Google Scholar
    • Export Citation
  • 48

    Krauss H, Maier D, Bühren V, Högel F. Development of heterotopic ossifications, blood markers and outcome after radiation therapy in spinal cord injured patients. Spinal Cord. 2015;53(5):345348.

    • Search Google Scholar
    • Export Citation
  • 49

    Wittenberg RH, Peschke U, Bötel U. Heterotopic ossification after spinal cord injury. Epidemiology and risk factors. J Bone Joint Surg Br. 1992;74(2):215218.

    • Search Google Scholar
    • Export Citation
  • 50

    Coelho CVC, Beraldo PSS. Risk factors of heterotopic ossification in traumatic spinal cord injury. Arq Neuropsiquiatr. 2009;67(2B):382387.

    • Search Google Scholar
    • Export Citation
  • 51

    Chen Y, Devivo MJ, Jackson AB. Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects. Arch Phys Med Rehabil. 2005;86(6):12081213.

    • Search Google Scholar
    • Export Citation
  • 52

    Krishnan S, Karg PE, Boninger ML, Brienza DM. Association between presence of pneumonia and pressure ulcer formation following traumatic spinal cord injury. J Spinal Cord Med. 2017;40(4):415422.

    • Search Google Scholar
    • Export Citation
  • 53

    Correa GI, Fuentes M, Gonzalez X, Cumsille F, Piñeros JL, Finkelstein J. Predictive factors for pressure ulcers in the ambulatory stage of spinal cord injury patients. Spinal Cord. 2006;44(12):734739.

    • Search Google Scholar
    • Export Citation
  • 54

    Guihan M, Garber SL, Bombardier CH, Goldstein B, Holmes SA, Cao L. Predictors of pressure ulcer recurrence in veterans with spinal cord injury. J Spinal Cord Med. 2008;31(5):551559.

    • Search Google Scholar
    • Export Citation
  • 55

    Paker N, Buğdaycı D, Gökşenoğlu G, Akbaş D, Korkut T. Recurrence rate after pressure ulcer reconstruction in patients with spinal cord injury in patients under control by a plastic surgery and physical medicine and rehabilitation team. Turk J Phys Med Rehabil. 2018;64(4):322327.

    • Search Google Scholar
    • Export Citation
  • 56

    Lai YJ, Lin CL, Chang YJ, Lin MC, Lee ST, Sung FC, et al. Spinal cord injury increases the risk of type 2 diabetes: a population-based cohort study. Spine J. 2014;14(9):19571964.

    • Search Google Scholar
    • Export Citation
  • 57

    Winslow C, Rozovsky J. Effect of spinal cord injury on the respiratory system. Am J Phys Med Rehabil. 2003;82(10):803814.

  • 58

    Wu X, Li Z, Cao J, Jiao J, Wang Y, Liu G, et al. The association between major complications of immobility during hospitalization and quality of life among bedridden patients: a 3 month prospective multi-center study. PLoS One. 2018;13(10):e0205729.

    • Search Google Scholar
    • Export Citation
  • 59

    Lindgren M, Unosson M, Fredrikson M, Ek AC. Immobility—a major risk factor for development of pressure ulcers among adult hospitalized patients: a prospective study. Scand J Caring Sci. 2004;18(1):5764.

    • Search Google Scholar
    • Export Citation
  • 60

    Hwang TI, Hill K, Schneider V, Pak CY. Effect of prolonged bedrest on the propensity for renal stone formation. J Clin Endocrinol Metab. 1988;66(1):109112.

    • Search Google Scholar
    • Export Citation
  • 61

    Ku JH, Choi WJ, Lee KY, Jung TY, Lee JK, Park WH, Shim HB. Complications of the upper urinary tract in patients with spinal cord injury: a long-term follow-up study. Urol Res. 2005;33(6):435439.

    • Search Google Scholar
    • Export Citation
  • 62

    Gui-Zhong L, Li-Bo M. Bladder cancer in individuals with spinal cord injuries: a meta-analysis. Spinal Cord. 2017;55(4):341345.

  • 63

    West DA, Cummings JM, Longo WE, Virgo KS, Johnson FE, Parra RO. Role of chronic catheterization in the development of bladder cancer in patients with spinal cord injury. Urology. 1999;53(2):292297.

    • Search Google Scholar
    • Export Citation
  • 64

    Siddall PJ, Loeser JD. Pain following spinal cord injury. Spinal Cord. 2001;39(2):6373.

  • 65

    Mariano AJ. Chronic pain and spinal cord injury. Clin J Pain. 1992;8(2):8792.

  • 66

    Dijkers M, Bryce T, Zanca J. Prevalence of chronic pain after traumatic spinal cord injury: a systematic review. J Rehabil Res Dev. 2009;46(1):1329.

    • Search Google Scholar
    • Export Citation
  • 67

    Burke D, Lennon O, Fullen BM. Quality of life after spinal cord injury: the impact of pain. Eur J Pain. 2018;22(9):16621672.

  • 68

    Curt A, Nitsche B, Rodic B, Schurch B, Dietz V. Assessment of autonomic dysreflexia in patients with spinal cord injury. J Neurol Neurosurg Psychiatry. 1997;62(5):473477.

    • Search Google Scholar
    • Export Citation
  • 69

    Thijssen DH, Maiorana AJ, O’Driscoll G, Cable NT, Hopman MT, Green DJ. Impact of inactivity and exercise on the vasculature in humans. Eur J Appl Physiol. 2010;108(5):845875.

    • Search Google Scholar
    • Export Citation
  • 70

    Frankel HL, Michaelis LS, Golding DR, Beral V. The blood pressure in paraplegia. I. Paraplegia. 1972;10(3):193200.

  • 71

    Wu JC, Chen YC, Liu L, Chen TJ, Huang WC, Cheng H, Tung-Ping S. Increased risk of stroke after spinal cord injury: a nationwide 4-year follow-up cohort study. Neurology. 2012;78(14):10511057.

    • Search Google Scholar
    • Export Citation
  • 72

    Spungen AM, Adkins RH, Stewart CA, Wang J, Pierson RN Jr, Waters RL, Bauman WA. Factors influencing body composition in persons with spinal cord injury: a cross-sectional study. J Appl Physiol (1985).2003;95(6):23982407.

    • Search Google Scholar
    • Export Citation
  • 73

    Whiteneck GG, Charlifue SW, Frankel HL, Fraser MH, Gardner BP, Gerhart KA, et al. Mortality, morbidity, and psychosocial outcomes of persons spinal cord injured more than 20 years ago. Paraplegia. 1992;30(9):617630.

    • Search Google Scholar
    • Export Citation
  • 74

    Krause JS, Cao Y, DeVivo MJ, DiPiro ND. Risk and protective factors for cause-specific mortality after spinal cord injury. Arch Phys Med Rehabil. 2016;97(10):16691678.

    • Search Google Scholar
    • Export Citation
  • 75

    Cao Y, Krause JS. The association between secondary health conditions and indirect costs after spinal cord injury. Spinal Cord. 2021;59(3):306310.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 310 310 310
Full Text Views 51 51 51
PDF Downloads 69 69 69
EPUB Downloads 0 0 0