F-4-04-05
CAUSES AND MEDICAL OUTCOME OF SPINAL CORD INJURIES IN ROSAI HOSPITALS IN JAPAN
Akira Magara (Tsubame Rosai Hospital, Tsubame, Japan), M. Sumida (Kansai Rosai Hospital), A. Tokuhiro (Kibi-Kogen Rosai Medical Rehab. Center) R. Uchida (Kantou Rosai Hospital)
Purpose & Method: A nationwide questionnaire had been done by mailing for 27 Japan Rosai (labor injury) hospitals and 2 Rosai rehabilitation centers in 1992, 1993. From 1003 spinal cord injuries, 531 males & 113 females were extracted at random.
Result: Mean age was 46y/o±19y/o. Histogram of levels of paresis made very clear shape and had 3 peaks. The biggest peak was C5 and other peaks were T5 and T12. 237 cases had complete paralysis (mean age 40y/o), 279 cases had incomplete paresis (mean age 51y/o), complete group was younger than incomplete group. 183 cases were labor injuries, while 462 cases were not labor injuries.
Conclusion: Young boys are likely to have thoracic complete paralysis from big traffic accident force, which are not labor injury. Middle aged must take care of falling down from above in labor site, which tend to have lumbar injuries. Elderly must take care of daily falling down in flat level and have cervical incomplete injury, not in labor site. Less bed sores in early beginning of rehabilitation. 75% of all bed sores were in sacral portion. It was remarkable that more heterotopic ossifications occurred in younger cases than elderly cases. And it was remarkable too that thrombophrebitis occurred almost only in young cervical injuries.
F-4-04-06
SPINAL CORD INJURY REHABILITATION - THE SINGAPORE EXPERIENCE
H. L. Yen, K. Chua, W. Chan (Tan Tock Seng Hospital, Singapore)
Spinal cord injury is an uncommon but potentially devastating condition. All cases of traumatic spinal injuries admitted to our unit between January 1990 and December 1994 were reviewed retrospectively to determine the demographic characteristics, causes and patterns of injuries and outcome after rehabilitation.
There was a total of 189 patients with ages between 14 and 82 years. The majority (74.7%) were below the age of 50. There was a male preponderance (83.1%) and a significant proportion of foreigners (20.6%). The most common causes of injuries were falls (47.1%) and road traffic accidents (36%). Damage to the cervical spine predominated (56.4%), followed by the thoracolumbar junction (21.3%).
At the end of rehabilitation, the number of patients who were Frankel D/E improved significantly from 49 to 107 (p<0.001). Seventy-one patients were able to ambulate independently without aid. Total independence in activities of daily living were achieved in 22.7%; an additional 45.5% were either independent with appliances or required occasional minimum assistance. The majority (88.4%) were discharged to their own homes. Of those who returned for follow-up, 95% were gainfully employed at the time of injury but only 14% were able to return to work within 1 year. In conclusion, although improvements were made in functional status after rehabilitation, the reemployment rate at 1 year remained low.
