Santhosh Kumar, M (2008) A Prospective study of the value of Neurological and Radiological Examinations in Predicting Bladder Function in persons with Thoraco-Lumbar Fractures and Spinal Injury. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION : Spinal Cord Injury (SCI) is a devastating medical condition which results in decreased sensation below the level of injury, decreased motor power and decreased bladder and bowel control. “An ailment not to be treated” is what is written in the Edwin Smith Surgical Papyrus,1 written in Egypt between 2500 and 3000 B.C regarding Spinal Cord Injury. Thanks to Dr. Mary Varghese who did pioneering work in India by establishing a department for Spinal cord injured patients and efforts of several other leaders in this speciality across the world, we are now able to treat persons with spinal cord injuries and improve their quality of life. Spinal Cord Injury (SCI) has long-term effects in many aspects of an individual’s life. Acute SCI patients commonly have two major questions for which they seek answers, one is if they can walk and the other is if they can have normal bowel and bladder sensation and control. Anxiety about one’s urinary continence is often one of the major preoccupations of a person with spinal cord injury. The degree of bladder dysfunction may be related to the injury itself, the level of the spinal cord affected by the injury, and the severity of neurological impairment. Investigation techniques used to help address the issue of predicting bladder outcome in persons with acute SCI include clinical examination, X-rays of the spine, CT scan, MRI and electrophysiological examinations. AIMS AND OBJECTIVES : The aim of the study was 1. To examine the value of Neurological and Radiological examinations in predicting bladder function in persons with Thoraco-Lumbar fractures and Spinal Injury. 2. To determine if ASIA incomplete spinal lesions on clinical examination will have a better prognosis for bladder function in the form of volitional voiding. 3. To determine the role of bulbocavernous reflex in predicting the type of bladder. 4. To determine if persons with a vertebral fracture at T12 or above will have a hyperreflexic bladder and those with of L-1 and below will have an areflexic bladder. 5. To determine if those with a mild narrowing of the vertebral canal have a better prognosis for volitional voiding. MATERIALS AND METHODS : Inclusion criteria Twenty consecutive patients with thoracolumbar fractures and spinal injury, admitted in the Department of Physical Medicine Rehabilitation, Christian Medical College, and Vellore within three weeks of injury, were recruited into the study. Exclusion criteria: 1. Patients with non-traumatic paraplegia were excluded. 2. Patients with pre-existing thoraco-lumbar scoliosis were also excluded as evaluating the x-rays for canal size would be difficult. METHODS: After data collection it was subjected to statistical analysis using SPSS Software Vs. 11.0. Data were expressed as number (%) and mean +/- standard deviation for categorical and continuous variables. Chi-square/Fisher’s exact tests were used for group comparisons. Independent t- test (for normal data) and Mann-Whitney test (for non-normal data) were performed to compare the mean scores. RESULTS: • There was a significant correlation found between ASIA impairment scale obtained during the first neurological examination and volitional voiding. • There was a significant correlation found between ASIA motor scores more than 50, ASIA sensory scores more than 90, joint position sense of the great toe preserved obtained during the first neurological examination and volitional voiding. • The use of Canal body ratio at the level of vertebral fracture on plain radiographs was not useful in prediction of volitional voiding. Therefore plain radiography was not found to be a good predictor of bladder function in persons with thoracolumbar fractures and with spinal cord injury. CONCLUSION : In this study a possible association between initial neurological evaluation and radiological findings and bladder function at discharge in SCI patients with thoracolumbar fractures was tested. Neurological examination included sensory evaluation, joint position sense in the great toe, motor examination, and voluntary contraction of the external anal sphincter and bulbocavernous reflex. Radiological examination was done using plain X- rays and the canal body ratio and sagittal transverse ratio were calculated. 20 patients with thoracolumbar fractures who fulfilled the inclusion criteria were admitted in the study and the following conclusions arrived at: 1. A significant correlation was found between ASIA impairment scale obtained during the first neurological examination and volitional voiding (Fisher’s exact test, P<0.05). 2. A significant correlation was found between ASIA motor scores more than 50 obtained during the first neurological examination and volitional voiding (Fisher’s exact test, P<0.05). 3. A significant correlation was found between ASIA sensory scores more than 90 obtained during the first neurological examination and volitional voiding (Fisher’s exact test, P<0.05). 4. A significant correlation was found between joint position sense of the great toe preserved during the first neurological examination and volitional voiding (Fisher’s exact test, P<0.05). 5. The presence of Bulbocavernous reflex did not predict the type of bladder dysfunction on Urodynamic evaluation (P> 0.05). However an absence of Bulbocavernous reflex predicted an areflexic bladder. 6. The level of fracture did not correspond to the type of bladder. 7. The use of Canal body ratio at the level of vertebral fracture on plain radiographs was not useful in prediction of volitional voiding. (P> 0.05) 8. Therefore plain radiography was not found to be a good predictor of bladder function in persons with thoracolumbar fractures and with spinal cord injury. 9. Therefore the parameters: initial ASIA Impairment Scale from B to D, ASIA motor score > 50, ASIA sensory score > 90 and preservation of joint position sense of the great toe may be used to predict volitional voiding in persons with thoracolumbar fractures and spinal cord injury.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Neurological ; Radiological Examinations ; Bladder Function ; Thoraco-Lumbar Fractures ; Spinal Injury ; A Prospective study . |
| Subjects: | MEDICAL > Physical Medicine and Rehabilitation |
| Depositing User: | Subramani R |
| Date Deposited: | 16 Aug 2017 00:51 |
| Last Modified: | 16 Aug 2017 09:31 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1858 |
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