Research code: IR.IUMS.FMD.REC.1401.587
Ethics code: IR.IUMS.FMD.REC.1401.587
Clinical trials code: IR.IUMS.FMD.REC.1401.587
, drtaheri38@yahoo.com
Abstract: (595 Views)
Background:
Spinal cord injury is a serious injury that leads to permanent or transient severe spinal cord dysfunction including sensory, motor, and sphincter deficits. In terms of etiology, it is divided into traumatic or non-traumatic causes. Traumatic spinal cord injury, most commonly caused by motor vehicle accidents, falls, sports accidents, and violence, has severe long-term effects on patient outcomes and can lead to permanent disability and dependency. In recent decades, due to medical advances, more patients with spinal cord injuries survive and live longer. Therefore, in addition to the physical and neurological prognosis, research focuses on the general well-being and quality of life of these patients. In addition, satisfaction with quality of life is the main goal of primary treatment and rehabilitation. This study was conducted to investigate the long-term quality of life of patients with traumatic cervical spinal cord injury in Haftome-Tir Hospital, Tehran.
Materials and methods:
This study was carried out cross-sectionally and all patients with traumatic cervical spinal cord injury who underwent surgery from September 2018 to September 2021 were followed up. Required demographic, clinical, and surgical information including age, gender, trauma mechanism, level of involvement, clinical examination status, type of surgery, duration of hospitalization, and other required variables were collected and registered from patient records and picture archiving and communication system (PACS). Short-term outcome including hospital mortality was collected through patient records. Then, the long-term outcome of the patients, which included health-related QoL assessment was obtained using the Short Form Health Survey- 12 items (SF-12) tool in two areas of physical health (Physical Component Summary (PCS)) and mental health (Mental Component Summary (MCS)) through a telephone call and outpatient visits of patients in the clinic. SF-12 is a reliable instrument and one of the most commonly used tools to assess the quality of life of patients with spinal cord injury and other debilitating diseases. Although the SF-36 is the gold standard for this topic, due to its length and complex clinical use, the SF-12 has replaced it in some studies and is becoming more popular.
The inclusion criteria for the study included all patients who underwent surgery with traumatic cervical spinal cord injury. Also, the criteria for exclusion from the study included: the presence of an underlying neurological disease involving the spinal cord, a history of underlying neurological disease involving the spinal cord, hemorrhagic shock and unstable patients due to traumatic injury of intra-abdominal and thoracic organs, the need for emergency spine surgery, non-traumatic spinal cord injury, unrelated death during the study and follow-up, history of spine surgery for other reasons before the trauma, and lack of consent to participate in the study.
Data analysis:
Data analysis was done by SPSS statistical software version 25. For qualitative variables, frequency and percentage of frequency, and for quantitative variables, mean and standard deviation were calculated. Independent t-tests, ANOVA (analysis of variance), post hoc tests, chi-square, and one-parameter non-tests were also used for analysis. A significance level of 0.05 was considered.
Ethical considerations:
This research has been approved by the Ethics Committee of the Iran University of Medical Sciences with the ethical code of IR.IUMS.FMD.REC.1401.587. The principles of the Helsinki Convention were considered. All patient information is confidential and the results have been mentioned anonymously.
Results:
After taking into account the exclusion cases, 75 patients with traumatic cervical spinal cord injury were analyzed during the study period. The average age of the patients was 44.95±15.58 years with a minimum age of 17 and a maximum of 79 years. Sixty patients (80%) were male and fifteen patients (20%) were female. Motor Vehicle Accidents (44 patients-58.7%) and then falling from a height (16 patients-21.3%) were the most common causes of injury in the studied patients (Chart 1).
44 patients (58.7%) had complete spinal cord injury, 30 patients (40%) had incomplete spinal cord injury, and 1 patient was diagnosed with Spinal Cord Injury Without Radiographic Abnormality (SCIWORA).
Among the patients with incomplete spinal cord injury, 26 patients (86.7%) had central cord syndrome and 4 patients (13.3%) had Brown-Sequard syndrome.
The most common cause of spinal cord injury was fracture and dislocation of the cervical spine (43 patients-57.3%). The most common type of fracture was Burst type, which was observed in 24 patients (57.1%).
The most common involved level was C5, which was observed in 14 patients (33.3%). In patients with cervical canal stenosis who suffered spinal cord injury following trauma, the number of cervical vertebrae involved was 3 levels in 3 patients (15.8%) and 4 levels in 8 patients (42.1%). In patients with cervical discopathy who suffered spinal cord injury following trauma, the most common level involved was C3/4 in 5 patients (55.6%).
In 38.8% of patients (26 patients), the anterior surgical approach, in 34 patients (50.7%), the posterior surgical approach, and in 7 cases (10.5%) combined anterior and posterior surgical approach was performed.
Table 1 shows the clinical and radiological information of the patients.
The average interval between the occurrence of spinal cord injury and surgery was 3.78±2.93 days. The average length of hospitalization in the patients was 22.83±21.76 days. 55 patients (73.3%) were discharged from the hospital and 20 patients (26.7%) died during hospitalization. The follow-up period of the patients was between 18 and 60 months and the average was 43.83±14.43 months (Table No. 2).
Also, 9 patients (12%) died after being discharged from the hospital during the rehabilitation period.
The final result of the patients (Table No. 2 and 3):
The average quality of life score of patients for physical quality of life (SF-12 PCS) was 34.27±9.73 and for mental quality of life (SF-12 MCS) was 46.65±10.27. Moreover, 66.7% of patients had SF-12PCS below 50, which indicated a lower quality of life than normal in society. Also, 42.5% of patients had a score of SF-12MCS below 42, which indicated clinical depression.
The outcome of SF12PCS had a significant statistical association with the following: it was better in Brown-Square syndrome (46.35) than in the central cord syndrome (31.14) (P=0.004) and was also better in stenosis with or less than three levels (49.55) than more than three levels stenosis (33.72) (P=0.04).
The outcome of SF12MCS had a significant statistical association with the following variable: it was better in Brown-Squad syndrome (57.18) than in the central cord syndrome (44.19) (P=0.02).
It should be noted that the age of patients and the time of surgery after the injury did not have a significant statistical association on the final outcome (SF-12PCS and SF-12MCS) (P>0.05).
Conclusion:
Although assessment of neurological and physical recovery in patients with spinal cord injury is important, it should not replace assessment of QoL. This study and other studies that evaluate the QoL of SCI patients seem to be an introduction to further research to evaluate the QoL and the factors involved in it.
Keywords: Traumatic Spinal Cord Injury, Cervical, Quality of Life, SF-12, SF-12 PCS, SF-12 MCS.
Spinal cord injury is a serious injury that leads to permanent or transient severe spinal cord dysfunction including sensory, motor, and sphincter deficits. In terms of etiology, it is divided into traumatic or non-traumatic causes. Traumatic spinal cord injury, most commonly caused by motor vehicle accidents, falls, sports accidents, and violence, has severe long-term effects on patient outcomes and can lead to permanent disability and dependency. In recent decades, due to medical advances, more patients with spinal cord injuries survive and live longer. Therefore, in addition to the physical and neurological prognosis, research focuses on the general well-being and quality of life of these patients. In addition, satisfaction with quality of life is the main goal of primary treatment and rehabilitation. This study was conducted to investigate the long-term quality of life of patients with traumatic cervical spinal cord injury in Haftome-Tir Hospital, Tehran.
Materials and methods:
This study was carried out cross-sectionally and all patients with traumatic cervical spinal cord injury who underwent surgery from September 2018 to September 2021 were followed up. Required demographic, clinical, and surgical information including age, gender, trauma mechanism, level of involvement, clinical examination status, type of surgery, duration of hospitalization, and other required variables were collected and registered from patient records and picture archiving and communication system (PACS). Short-term outcome including hospital mortality was collected through patient records. Then, the long-term outcome of the patients, which included health-related QoL assessment was obtained using the Short Form Health Survey- 12 items (SF-12) tool in two areas of physical health (Physical Component Summary (PCS)) and mental health (Mental Component Summary (MCS)) through a telephone call and outpatient visits of patients in the clinic. SF-12 is a reliable instrument and one of the most commonly used tools to assess the quality of life of patients with spinal cord injury and other debilitating diseases. Although the SF-36 is the gold standard for this topic, due to its length and complex clinical use, the SF-12 has replaced it in some studies and is becoming more popular.
The inclusion criteria for the study included all patients who underwent surgery with traumatic cervical spinal cord injury. Also, the criteria for exclusion from the study included: the presence of an underlying neurological disease involving the spinal cord, a history of underlying neurological disease involving the spinal cord, hemorrhagic shock and unstable patients due to traumatic injury of intra-abdominal and thoracic organs, the need for emergency spine surgery, non-traumatic spinal cord injury, unrelated death during the study and follow-up, history of spine surgery for other reasons before the trauma, and lack of consent to participate in the study.
Data analysis:
Data analysis was done by SPSS statistical software version 25. For qualitative variables, frequency and percentage of frequency, and for quantitative variables, mean and standard deviation were calculated. Independent t-tests, ANOVA (analysis of variance), post hoc tests, chi-square, and one-parameter non-tests were also used for analysis. A significance level of 0.05 was considered.
Ethical considerations:
This research has been approved by the Ethics Committee of the Iran University of Medical Sciences with the ethical code of IR.IUMS.FMD.REC.1401.587. The principles of the Helsinki Convention were considered. All patient information is confidential and the results have been mentioned anonymously.
Results:
After taking into account the exclusion cases, 75 patients with traumatic cervical spinal cord injury were analyzed during the study period. The average age of the patients was 44.95±15.58 years with a minimum age of 17 and a maximum of 79 years. Sixty patients (80%) were male and fifteen patients (20%) were female. Motor Vehicle Accidents (44 patients-58.7%) and then falling from a height (16 patients-21.3%) were the most common causes of injury in the studied patients (Chart 1).
44 patients (58.7%) had complete spinal cord injury, 30 patients (40%) had incomplete spinal cord injury, and 1 patient was diagnosed with Spinal Cord Injury Without Radiographic Abnormality (SCIWORA).
Among the patients with incomplete spinal cord injury, 26 patients (86.7%) had central cord syndrome and 4 patients (13.3%) had Brown-Sequard syndrome.
The most common cause of spinal cord injury was fracture and dislocation of the cervical spine (43 patients-57.3%). The most common type of fracture was Burst type, which was observed in 24 patients (57.1%).
The most common involved level was C5, which was observed in 14 patients (33.3%). In patients with cervical canal stenosis who suffered spinal cord injury following trauma, the number of cervical vertebrae involved was 3 levels in 3 patients (15.8%) and 4 levels in 8 patients (42.1%). In patients with cervical discopathy who suffered spinal cord injury following trauma, the most common level involved was C3/4 in 5 patients (55.6%).
In 38.8% of patients (26 patients), the anterior surgical approach, in 34 patients (50.7%), the posterior surgical approach, and in 7 cases (10.5%) combined anterior and posterior surgical approach was performed.
Table 1 shows the clinical and radiological information of the patients.
The average interval between the occurrence of spinal cord injury and surgery was 3.78±2.93 days. The average length of hospitalization in the patients was 22.83±21.76 days. 55 patients (73.3%) were discharged from the hospital and 20 patients (26.7%) died during hospitalization. The follow-up period of the patients was between 18 and 60 months and the average was 43.83±14.43 months (Table No. 2).
Also, 9 patients (12%) died after being discharged from the hospital during the rehabilitation period.
The final result of the patients (Table No. 2 and 3):
The average quality of life score of patients for physical quality of life (SF-12 PCS) was 34.27±9.73 and for mental quality of life (SF-12 MCS) was 46.65±10.27. Moreover, 66.7% of patients had SF-12PCS below 50, which indicated a lower quality of life than normal in society. Also, 42.5% of patients had a score of SF-12MCS below 42, which indicated clinical depression.
The outcome of SF12PCS had a significant statistical association with the following: it was better in Brown-Square syndrome (46.35) than in the central cord syndrome (31.14) (P=0.004) and was also better in stenosis with or less than three levels (49.55) than more than three levels stenosis (33.72) (P=0.04).
The outcome of SF12MCS had a significant statistical association with the following variable: it was better in Brown-Squad syndrome (57.18) than in the central cord syndrome (44.19) (P=0.02).
It should be noted that the age of patients and the time of surgery after the injury did not have a significant statistical association on the final outcome (SF-12PCS and SF-12MCS) (P>0.05).
Conclusion:
Although assessment of neurological and physical recovery in patients with spinal cord injury is important, it should not replace assessment of QoL. This study and other studies that evaluate the QoL of SCI patients seem to be an introduction to further research to evaluate the QoL and the factors involved in it.
Keywords: Traumatic Spinal Cord Injury, Cervical, Quality of Life, SF-12, SF-12 PCS, SF-12 MCS.
Type of Study: Research |
Subject:
Neurosurgery
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