OBJECTIVE: To investigate the clinical effect and safety of different numbers of botulinum toxin type A (BTX-A) bladder injections in the treatment of neurogenic detrusor overactivity (NDO). DESIGN: A single-blind randomized control trial. SETTING: A single spinal cord injury (SCI) rehabilitation center in China. PARTICIPANTS: A total of 44 patients with spinal cord injury and neurogenic detrusor overactivity who underwent intradetrusor injection of 200 U BTX-A were enrolled. The cohort included 34 men and 10 women. INTERVENTIONS: They were randomly divided into two groups of 30 vs. 20 sites of injection with 200 U BTX-A. OUTCOME MEASURES: Urodynamic parameters such as maximum detrusor pressure at first DO (PdetmaxDO), volume at the first involuntary detrusor contraction, were measured at baseline and week 12 after injection. Mean urine volume per catheterization(V-CIC), scores of the Incontinence Specific Quality of Life Instrument (I-QoL) were also recorded before and after treatment. RESULTS: < 0.001). There were eight and seven patients with complete dryness after treatment. CONCLUSIONS: When the total dose of 200 U was maintained, reducing the number of injection sites from 30 to 20 had a similar therapeutic effect in NDO without compromising safety. Clinically, this approach may be advantageous in terms of reducing the operating time and improving patient comfort.
Objective: To demonstrate the prevalence and barriers to independent bowel care in individuals with paraplegia Study design: A cross-sectional study Setting: Fourteen spinal cord injury (SCI) rehabilitation facilities Subjects: Individuals with paraplegia, i.e. those living with lower extremity weakness but normal upper extremity function, living in the community Methods: Data from the Thai arm of the International Spinal Cord Injury community survey questionnaires were extracted. Twenty factors potentially associated with bowel care dependence statuses were identified by an expert panel, including three demographic parameters, three SCI characteristics, six secondary health conditions, five activity limitations, one personal factor, and two environmental factors. A skeletal directed acyclic graph was used to guide a multivariable logistic regression analysis with an exploratory modelling strategy. Results: Of 453 paraplegic respondents, 45% reported dependent bowel care. Multivariable logistic regression analysis demonstrated that three factors, including dependent transfer from bed to wheelchair, inability to walk for a moderate distance, and lack of medications, medical aids, and supplies, were significantly associated with dependent bowel care, with odds ratios of 2.483, 2.021, and 1.675, respectively. Conclusion: The percentage of dependent bowel care in individuals with paraplegia is unexpectedly high. Dependent transfer from bed to wheelchair, inability to walk for a moderate distance, and an environmental barrier of lack of medications, medical aids and supplies are barriers to independent bowel care. Rehabilitation professionals should focus on restoring performance in transfers and walking, as well as on providing support with relevant medical consumables, to enhance bowel care independence in individuals with paraplegia.
Context/Objective: Postoperative mortality following traumatic subaxial cervical spinal cord injury (cSCI) remains substantial, yet the combined influence of neurologic completeness and age on survival is poorly characterized in operatively treated patients. This study evaluated age-stratified mortality after surgical management of complete versus incomplete traumatic subaxial cSCI. Design: Retrospective cohort study using risk ratio analysis, Kaplan-Meier survival analysis, and multivariable Cox proportional hazards. Setting: Global federated electronic health record database (TriNetX). Participants: Adults who underwent surgery for traumatic subaxial cSCI, identified using ICD-10 and CPT codes, with injury classified as complete or incomplete (n = 5,477). Interventions: Operative management of traumatic subaxial cSCI. Outcome Measures: All-cause mortality at 3, 6 months, and 1 year postoperatively. Independent predictors of mortality were identified via Cox regression. Results: Complete cSCI was associated with significantly higher mortality at 3 months (10.73% vs. 7.7%; RR 1.39), 6 months (12.5% vs. 9.2%; RR 1.36), and 1 year (14.7% vs. 11.2%; RR 1.31) (all P < 0.001). Mortality differences were most pronounced in patients aged 61-80 years, with approximately twofold higher risk in complete injuries. Increasing age, male sex, diabetes, heart failure, and chronic kidney disease independently predicted mortality. Conclusion: Complete traumatic cSCI carries significantly higher postoperative mortality than incomplete injury, particularly among patients aged 61-80 years. These findings underscore the combined prognostic impact of neurologic severity and age, and may guide perioperative counseling and risk stratification, but should not be interpreted as demonstrating formal age-dependent effect modification.
