Rehabilitation outcomes following infections causing spinal cord myelopathy

Abstract

Study design:Retrospective, open-cohort, consecutive case series.Objective:To describe the demographic characteristics, clinical features and outcomes in patients undergoing initial in-patient rehabilitation after an infectious cause of spinal cord myelopathy.Setting:Spinal Rehabilitation Unit, Melbourne, Victoria, Australia. Admissions between 1 January 1995 and 31 December 2010.Methods:The following data were recorded: aetiology of spinal cord infection, risk factors, rehabilitation length of stay ( LOS), level of injury ( paraplegia vs tetraplegia), complications related to spinal cord damage and discharge destination. The American Spinal Injury Association ( ASIA) Impairment Scale ( AIS) and functional independence measure ( FIM) were assessed at admission and at discharge.Results:Fifty-one patients were admitted ( men=32, 62.7%) with a median age of 65 years ( interquartile range ( IQR) 52-72, range 22-89). On admission, 37 ( 73%) had paraplegic level of injury and most patients ( n=46, 90%) had an incomplete grade of spinal damage. Infections were most commonly bacterial ( n=47, 92%); the other causes were viral ( n=3, 6%) and tuberculosis ( n=1, 2%). The median LOS was 106 days ( IQR 65-135). The most common complications were pain ( n=47, 92%), urinary tract infection ( n=27, 53%), spasticity ( n=25, 49%) and pressure ulcer during acute hospital admission ( n=19, 37%). By the time of discharge from rehabilitation, patients typically showed a significant change in their AIS grade of spinal damage ( P<0.001). They also showed significant improvement ( P<0.001) in their FIM motor score ( at admission: median=27, IQR 20-34; at discharge: median=66, IQR 41-75).Conclusion:Most patients returned home with a good level of functioning with respect to mobility, bladder and bowel status, and their disability improved significantly. © 2014 International Spinal Cord Society.