- Email: [email protected]
Esophageal perforation in traumatic tetraplegia: Case report
Spinal injury / Annals of Physical and Rehabilitation Medicine 60S (2017) e9–e15 ∗
Corresponding author. E-mail address: [email protected] (T. Weissland)
Objective/Introduction Spinal cord-injured athletes are of an inability to vasodilate and sweat below the injury, increasing the risk for marked core body temperature rises (Nicotra et al., 2006). The tetraplegics athletes have an important thermoregulatory impairment and are great risk of heat illness at a high intensity exercise or in hot environment (Price and Campbell, 2003). The magnitude of this impairment is proportional to the level of the lesion and requires adaptations adapted to each individual response (Griggs et al., 2015). Thus, the objective of this study was to assess body temperature induced by wheelchair rugby sessions and to compare the skin (Tsk◦ ) and the central (Tc◦ ) temperature measured during a one training day. Material/Patients and methods/Method Seven elite wheelchair rugby players (33 ± 7 years) with high-level lesions (tetraplegia) and all members in French team (7.1 ± 2 years training duration, 1.3 ± 0.8 points according to international classification) participated of this study. Central (Tc◦ ) and skin (Tsk◦ ) temperatures were continuous recorded during 24 h with an electronic pill (e® ® ® Celsius ) and Thermocron ibutton (DS1922L) devices placed on the shoulder. At the morning (Mo), before (Bef) and after (Aft) the training session and during the night (Ni), Tc◦ and Tsk◦ were noted. Results Tsk◦ was significant lower than Tc◦ (P < 0.01). Training session increase significantly Tc◦ and Tsk◦ (+3.5% for Tc◦ and 4.8% for Tsk◦ , respectively between Aft and Bef, P < 0.01). Ni Tc◦ (35.8 ± 0.2 ◦ C) was significant lower than all measures (P < 0.001) and the variation between extreme diurnal and night values (max–min) were 2.4 ± 0.6 ◦ C. No difference was founded for Tsk◦ between Mo, Bef and Ni and for Tc◦ between Mo and Bef. Discussion/Conclusion The Tsk◦ values are lower than those obtained with the pills, Tc◦ . Tc◦ increase of 1.3 ± 0.5 ◦ C after wheelchair rugby is lower than that obtained by Price and Campbell (2.1 ± 0.5 ◦ C) during 60 min at 60% VO2pic on wheelchair ergometer in hot environment chamber (31.5 ◦ C, 43RH). However, skin measures are sensitive to exercise-induced imbalance and could be used by the staff to manage the thermoregulation troubles. It could be interesting to provide individual solutions to limit the effects of the large variation in Tc◦ measured during 24 h. Keywords Tetraplegia; Thermoregulation; Wheelchair rugby Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.092 CO238 ®
Vitaros : Efficiency, tolerance and satisfaction in a population of spinal cord-injured (SCI) men and comparison to usual treatments
Fanny Dalmont ∗ , Loïc Le Chapelain , Hélène Guesdon , Anne-Gabrielle Francois , Jean Paysant Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France ∗ Corresponding author. E-mail address: [email protected] (F. Dalmont) Objective According to European guidelines, phosphodiesterase5 inhibitors (PDE5I) are recommended as first-line treatment in erectile dysfunction after spinal cord injury (SCI), and intracav® ernous injections (ICI) as second choice. Vitaros (alprostadil) is a new treatment with intra-urethral administration; several studies have already proved its efficacy in general population. The aim of this monocentric retrospective study was to evaluate ® Vitaros ’s efficacy in SCI men. Side effects and benefits were also studied, and the whole results were compared with those obtained with PDE5I and ICI.
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Material/Patients and methods Eighteen to 60-years-old SCI patients were included if they suffered from erectile dysfunction ® secondary to the injury for which Vitaros had been prescribed. ® Self-evaluations were used to assess each treatment (Vitaros , PDE5I and ICI) and the baseline (without treatment); it included the Erection Hardness Score (EHS) and IIEF5 (abbreviated score from the International Index of Erectile Function), time duration, side effects, global satisfaction score and the preferred treatment for further use. The Wilcoxon test was used for statistical analysis. Results Forty patients were included, among whom 29 had completed all of the self-evaluations. The average age was 42.3 ± 10.4 ® years-old; 8 were tetraplegics and 21 were paraplegics. Vitaros implied an improvement of 3.9 points for the IIEF5 score from the baseline (P = 0.0005). Seven of the 29 patients reported side effects ® ® with Vitaros , moderate and transitory. When Vitaros was compared to ICI, a significant difference to the benefit of ICI was found for the IIEF5 score (9.4 points, P = 0.0015), for the EHS score (2.21 points, P = 0.0010) and for time duration (90 min, P = 0.0020). When ® Vitaros was compared to PDE5I, a significant difference to the benefit of PDE5I was found for the IIEF5 score (3.03 points, P = 0.0288) and for the EHS score (1.04, P = 0.0040). Nine of the 29 patients had ® finally selected Vitaros for future use. ® Discussion/Conclusion As Vitaros may be an effective treatment of erectile dysfunction in SCI men, it seems to be less efficient than ICI and PDE5I; however, some patients choose it for future use. ® Keywords Vitaros ; Spinal cord injury; EHS; IIEF5 Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.093 P058
Esophageal perforation in traumatic tetraplegia: Case report Laurence Have 1 , Pierre Coloma 2 , Jean-Christian Pignat 3 , Laurence Tell 4,∗ 1 Service de MPR, hôpital Desgenettes, 69500 Bron, France 2 Service de neurochirurgie, hôpital Pierre-Wertheimer, hospices civils de Lyon, 69500 Bron, France 3 Service d’ORL, hôpital Pierre-Wertheimer, hospices civils de Lyon, 69500 Bron, France 4 Service de rééducation post-réanimation, hôpital Pierre-Wertheimer, hospices civils de Lyon, 69500 Bron, France ∗ Corresponding author. E-mail address: [email protected] (L. Tell) Objective Esophageal perforation after anterior spine surgery is a rare complication (< 1.5%), but life-threatening with a high mortality. Material/Patients and methods A 34-year-old man with complete C6 tetraplegia after traumatic C5 BURST fracture was treated by osteosynthesis from C4 to C6 associating an iliac graft. The main problem was a persistent clinical and biological inflammatory state, despite the treatment of different septic complications such as thromboembolism, respiratory (SDRA, tracheotomy), cutaneous. Results The video-fluoroscopic-swallowing-exam showed an uncertainly fistula next to the osteosynthesis lower extremity. The spine MRI showed an inflammatory bony remodeling, aeric signals into intervertebral space with the appearance of a necrotic bony graft appeared on spine scan. Nasofibroscopy did not find any perforation. Only the panendoscopie showed the fistula. Discussion/Conclusion Esophageal perforation after anterior spine surgery is rare but life-threatening. It could be explained by the BURST fracture, the surgical procedures with esophageal compression between the endotracheal tube and spacers, a perforation during surgical dissection and postoperatively, the intimate relation between the esophageal with the osteosynthesis.
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Spinal injury / Annals of Physical and Rehabilitation Medicine 60S (2017) e9–e15
Keywords Tetraplegia; Esophageus fistule Disclosure of interest The author has not supplied her declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.094 P059
Traumatic spinal cord injury: A single-center report of 108 cases
Mariem Gaddour ∗ , Wafa Haj Hmed , Ines Loubiri , Emna Toulgui , Mohamed Guedria , Sahbi Mtawaa , Sonia Jemni , Faycel Kahchnaoui , Nadia Lazreg CHU Sahloul, médecine physique et réhabilitation, Sousse, Tunisia ∗ Corresponding author. E-mail address: [email protected] (M. Gaddour) Objective As a devastating condition, traumatic spinal cord injury (TSCI) not only causes permanent serious dysfunction but also leads to disorders of several organ systems. It is generally known that TSCI exerts a severe burden on patients, their families and society because of the tremendous cost of health-care treatments, rehabilitation and lost productivity. The objective of this study was to describe the epidemiological profile of traumatic spinal cord injury (TSCI) in one rehabilitation department of a university hospital. Material/Patients and methods Hospital medical records of patients with TSCI admitted to hospital from 1 January 2006 to 31 December 2013 were reviewed. Collected variables included gender, age, marital status, occupation, co morbidities, etiology, level of injury, American Spinal Injury Association (ASIA) impairment scale at admission, functional independence measure (FIM), concomitant injuries and treatment choice. Results During the study period, 108 cases were identified. Maleto-female ratio was 0.4, with a mean age of 34 ± 13 years. Motor vehicle accidents (MVAs) (48.14%), followed by falls (25%) were the leading causes. The most common injury site was the cervical spinal cord, especially C4–C6, accounting for 31.5%. Most patients presented ASIA impairment scale type “A” and “B”. The mean of FIM score was 52.5. The mean of duration of stay of patients in rehabilitation department was 40 days. Surgery was the major treatment choice (84.8%). Discussion/Conclusion The number of TSCI patients increased annually in our center. The proportion of males was higher. The leading two causes were falls and MVAs. Manual workers and unemployed individuals were those at higher risk. Surgery was the major treatment choice. These data may be useful to implement those preventive strategies focused on the characteristics of different groups and pay more attention to high-risk populations. Keywords Spinal cord injury; Trauma; Rehabilitation Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.095 P060
Demographic and clinical characteristics of patients with spinal cord injury: A single hospital-based study
Mariem Gaddour ∗ , Wafa Haj Hmed , Ines Loubiri , Rihab Moncer , Emna Toulgui , Sonia Jemni , Fayc¸al Khachnaoui CHU Sahloul, médecine physique et réadaptation fonctionnelle, Sousse, Tunisia ∗ Corresponding author. E-mail address: [email protected] (M. Gaddour) Objective To evaluate demographic and clinical characteristics of patients diagnosed with spinal cord injury (SCI) admitted to a single-center.
Material/Patients and methods A retrospective study realized in a single-center study university hospital center Sahloul, Sousse, Tunisia. This study reviewed 177 patients with SCI. Data were extracted from medical records and retrospectively reviewed. Results A total of 177 patients with a diagnosis of SCI were included in the analysis. Of these, 108 (61.1%) had traumatic SCI (TSCI) and 69 (38.9%) had non-traumatic SCI (NTSCI). The principal causes of traumatic TSCI were motor vehicle accidents in 52 patients (48.1%), falls in 27 patients (25.0%). Degenerative diseasecausing myelopathy and hernia was the main cause of NTSCI in 50 patients (50.9%), followed by infection in 21.6 patients (14.9%). The age of patients with NTSCI was higher (49 vs. 34; P < 0.001) and SCI was less severe, AIS D 40.6% vs. 10.5% (P = 0.0001) compared with the TSCI group. Discussion/Conclusion The demographic profiles of patients with TSCI and NTSCI differ in terms of proportion of total SCIs, patient age, male: female ratio and incomplete vs. complete injury. The most common etiology of TSCI was motor vehicle accidents (48.1%), and neurological lesions were complete in 61.1% of patients. The most common etiology of NTSCI was degenerative causes (50.9%), and lesions were incomplete in 88.5% of patients. Keywords Spinal cord injury; Etiologies; Epidemiology Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.096 P061
Hyperbaric trauma of an intrathecal baclofen pump secondary to scuba diving: About one case
Philippe Gallien ∗ , Damien Rat , Sandrine Robineau , Jephte Houedakor , Emilie Leblong , Nicolas Benoit , Aurelie Durufle , Bastien Fraudet Pôle MPR Saint-Helier, MPR, Rennes, France ∗ Corresponding author. E-mail address: [email protected] (P. Gallien) Objective/Introduction Spasticity is a frequent consequence to a cerebral or spinal cord damage. Therapeutic strategies depend on the repercussions on patients’ daily activities and the fact that is a focal or spread spasticity. Intrathecal Baclofen pump (ITB Pump) implantation come with a frequent medical follow-up, and a specific patient’s education as some complications may occur. Material/Patients and methods/Method Case report. Results A 60-year-old male patient was implanted with ITB Pump 15 years after a traumatic spinal cord injury of level T11 ASIA-A and Frankel-A. He is independent in his daily life and rather active. During his follow-up, 2 back-to-back refill procedures were limited to 14 mL of drug out of a usual 20 mL reservoir. The patient had gone back to scuba diving 4 months before without medical awareness or specific precautions, sometimes even below 10 meters. This induced the bottom shield of the pump to collapse under the pressure and repeated hyperbaric exposures. X-Rays prove the permanent mechanical deformation of the device. The ITB pump continues to work normally. Discussion/Conclusion The risks of hyperbaric exposure on the ITB pumps are described by the device company. A pressure higher than 2.0 ATA (hyperbaric chambers or dive below 10 meters) may have effects on the drug delivery and/or on the device itself. It can vary from small withdrawal symptoms to fatal drug underdose. Despite the potential permanent deformation, the other side effects should disappear when returning to normal pressure. Doctors and patients must be aware and talk about physical activities as well as other daily life situations as more and more young patients are under ITB pump. Because some risks are specific to sports that are not so rare as we might think.
Corresponding author. E-mail address: [email protected] (T. Weissland)
Objective/Introduction Spinal cord-injured athletes are of an inability to vasodilate and sweat below the injury, increasing the risk for marked core body temperature rises (Nicotra et al., 2006). The tetraplegics athletes have an important thermoregulatory impairment and are great risk of heat illness at a high intensity exercise or in hot environment (Price and Campbell, 2003). The magnitude of this impairment is proportional to the level of the lesion and requires adaptations adapted to each individual response (Griggs et al., 2015). Thus, the objective of this study was to assess body temperature induced by wheelchair rugby sessions and to compare the skin (Tsk◦ ) and the central (Tc◦ ) temperature measured during a one training day. Material/Patients and methods/Method Seven elite wheelchair rugby players (33 ± 7 years) with high-level lesions (tetraplegia) and all members in French team (7.1 ± 2 years training duration, 1.3 ± 0.8 points according to international classification) participated of this study. Central (Tc◦ ) and skin (Tsk◦ ) temperatures were continuous recorded during 24 h with an electronic pill (e® ® ® Celsius ) and Thermocron ibutton (DS1922L) devices placed on the shoulder. At the morning (Mo), before (Bef) and after (Aft) the training session and during the night (Ni), Tc◦ and Tsk◦ were noted. Results Tsk◦ was significant lower than Tc◦ (P < 0.01). Training session increase significantly Tc◦ and Tsk◦ (+3.5% for Tc◦ and 4.8% for Tsk◦ , respectively between Aft and Bef, P < 0.01). Ni Tc◦ (35.8 ± 0.2 ◦ C) was significant lower than all measures (P < 0.001) and the variation between extreme diurnal and night values (max–min) were 2.4 ± 0.6 ◦ C. No difference was founded for Tsk◦ between Mo, Bef and Ni and for Tc◦ between Mo and Bef. Discussion/Conclusion The Tsk◦ values are lower than those obtained with the pills, Tc◦ . Tc◦ increase of 1.3 ± 0.5 ◦ C after wheelchair rugby is lower than that obtained by Price and Campbell (2.1 ± 0.5 ◦ C) during 60 min at 60% VO2pic on wheelchair ergometer in hot environment chamber (31.5 ◦ C, 43RH). However, skin measures are sensitive to exercise-induced imbalance and could be used by the staff to manage the thermoregulation troubles. It could be interesting to provide individual solutions to limit the effects of the large variation in Tc◦ measured during 24 h. Keywords Tetraplegia; Thermoregulation; Wheelchair rugby Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.092 CO238 ®
Vitaros : Efficiency, tolerance and satisfaction in a population of spinal cord-injured (SCI) men and comparison to usual treatments
Fanny Dalmont ∗ , Loïc Le Chapelain , Hélène Guesdon , Anne-Gabrielle Francois , Jean Paysant Institut régional de réadaptation, centre Louis-Pierquin, Nancy, France ∗ Corresponding author. E-mail address: [email protected] (F. Dalmont) Objective According to European guidelines, phosphodiesterase5 inhibitors (PDE5I) are recommended as first-line treatment in erectile dysfunction after spinal cord injury (SCI), and intracav® ernous injections (ICI) as second choice. Vitaros (alprostadil) is a new treatment with intra-urethral administration; several studies have already proved its efficacy in general population. The aim of this monocentric retrospective study was to evaluate ® Vitaros ’s efficacy in SCI men. Side effects and benefits were also studied, and the whole results were compared with those obtained with PDE5I and ICI.
e13
Material/Patients and methods Eighteen to 60-years-old SCI patients were included if they suffered from erectile dysfunction ® secondary to the injury for which Vitaros had been prescribed. ® Self-evaluations were used to assess each treatment (Vitaros , PDE5I and ICI) and the baseline (without treatment); it included the Erection Hardness Score (EHS) and IIEF5 (abbreviated score from the International Index of Erectile Function), time duration, side effects, global satisfaction score and the preferred treatment for further use. The Wilcoxon test was used for statistical analysis. Results Forty patients were included, among whom 29 had completed all of the self-evaluations. The average age was 42.3 ± 10.4 ® years-old; 8 were tetraplegics and 21 were paraplegics. Vitaros implied an improvement of 3.9 points for the IIEF5 score from the baseline (P = 0.0005). Seven of the 29 patients reported side effects ® ® with Vitaros , moderate and transitory. When Vitaros was compared to ICI, a significant difference to the benefit of ICI was found for the IIEF5 score (9.4 points, P = 0.0015), for the EHS score (2.21 points, P = 0.0010) and for time duration (90 min, P = 0.0020). When ® Vitaros was compared to PDE5I, a significant difference to the benefit of PDE5I was found for the IIEF5 score (3.03 points, P = 0.0288) and for the EHS score (1.04, P = 0.0040). Nine of the 29 patients had ® finally selected Vitaros for future use. ® Discussion/Conclusion As Vitaros may be an effective treatment of erectile dysfunction in SCI men, it seems to be less efficient than ICI and PDE5I; however, some patients choose it for future use. ® Keywords Vitaros ; Spinal cord injury; EHS; IIEF5 Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.093 P058
Esophageal perforation in traumatic tetraplegia: Case report Laurence Have 1 , Pierre Coloma 2 , Jean-Christian Pignat 3 , Laurence Tell 4,∗ 1 Service de MPR, hôpital Desgenettes, 69500 Bron, France 2 Service de neurochirurgie, hôpital Pierre-Wertheimer, hospices civils de Lyon, 69500 Bron, France 3 Service d’ORL, hôpital Pierre-Wertheimer, hospices civils de Lyon, 69500 Bron, France 4 Service de rééducation post-réanimation, hôpital Pierre-Wertheimer, hospices civils de Lyon, 69500 Bron, France ∗ Corresponding author. E-mail address: [email protected] (L. Tell) Objective Esophageal perforation after anterior spine surgery is a rare complication (< 1.5%), but life-threatening with a high mortality. Material/Patients and methods A 34-year-old man with complete C6 tetraplegia after traumatic C5 BURST fracture was treated by osteosynthesis from C4 to C6 associating an iliac graft. The main problem was a persistent clinical and biological inflammatory state, despite the treatment of different septic complications such as thromboembolism, respiratory (SDRA, tracheotomy), cutaneous. Results The video-fluoroscopic-swallowing-exam showed an uncertainly fistula next to the osteosynthesis lower extremity. The spine MRI showed an inflammatory bony remodeling, aeric signals into intervertebral space with the appearance of a necrotic bony graft appeared on spine scan. Nasofibroscopy did not find any perforation. Only the panendoscopie showed the fistula. Discussion/Conclusion Esophageal perforation after anterior spine surgery is rare but life-threatening. It could be explained by the BURST fracture, the surgical procedures with esophageal compression between the endotracheal tube and spacers, a perforation during surgical dissection and postoperatively, the intimate relation between the esophageal with the osteosynthesis.
e14
Spinal injury / Annals of Physical and Rehabilitation Medicine 60S (2017) e9–e15
Keywords Tetraplegia; Esophageus fistule Disclosure of interest The author has not supplied her declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.094 P059
Traumatic spinal cord injury: A single-center report of 108 cases
Mariem Gaddour ∗ , Wafa Haj Hmed , Ines Loubiri , Emna Toulgui , Mohamed Guedria , Sahbi Mtawaa , Sonia Jemni , Faycel Kahchnaoui , Nadia Lazreg CHU Sahloul, médecine physique et réhabilitation, Sousse, Tunisia ∗ Corresponding author. E-mail address: [email protected] (M. Gaddour) Objective As a devastating condition, traumatic spinal cord injury (TSCI) not only causes permanent serious dysfunction but also leads to disorders of several organ systems. It is generally known that TSCI exerts a severe burden on patients, their families and society because of the tremendous cost of health-care treatments, rehabilitation and lost productivity. The objective of this study was to describe the epidemiological profile of traumatic spinal cord injury (TSCI) in one rehabilitation department of a university hospital. Material/Patients and methods Hospital medical records of patients with TSCI admitted to hospital from 1 January 2006 to 31 December 2013 were reviewed. Collected variables included gender, age, marital status, occupation, co morbidities, etiology, level of injury, American Spinal Injury Association (ASIA) impairment scale at admission, functional independence measure (FIM), concomitant injuries and treatment choice. Results During the study period, 108 cases were identified. Maleto-female ratio was 0.4, with a mean age of 34 ± 13 years. Motor vehicle accidents (MVAs) (48.14%), followed by falls (25%) were the leading causes. The most common injury site was the cervical spinal cord, especially C4–C6, accounting for 31.5%. Most patients presented ASIA impairment scale type “A” and “B”. The mean of FIM score was 52.5. The mean of duration of stay of patients in rehabilitation department was 40 days. Surgery was the major treatment choice (84.8%). Discussion/Conclusion The number of TSCI patients increased annually in our center. The proportion of males was higher. The leading two causes were falls and MVAs. Manual workers and unemployed individuals were those at higher risk. Surgery was the major treatment choice. These data may be useful to implement those preventive strategies focused on the characteristics of different groups and pay more attention to high-risk populations. Keywords Spinal cord injury; Trauma; Rehabilitation Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.095 P060
Demographic and clinical characteristics of patients with spinal cord injury: A single hospital-based study
Mariem Gaddour ∗ , Wafa Haj Hmed , Ines Loubiri , Rihab Moncer , Emna Toulgui , Sonia Jemni , Fayc¸al Khachnaoui CHU Sahloul, médecine physique et réadaptation fonctionnelle, Sousse, Tunisia ∗ Corresponding author. E-mail address: [email protected] (M. Gaddour) Objective To evaluate demographic and clinical characteristics of patients diagnosed with spinal cord injury (SCI) admitted to a single-center.
Material/Patients and methods A retrospective study realized in a single-center study university hospital center Sahloul, Sousse, Tunisia. This study reviewed 177 patients with SCI. Data were extracted from medical records and retrospectively reviewed. Results A total of 177 patients with a diagnosis of SCI were included in the analysis. Of these, 108 (61.1%) had traumatic SCI (TSCI) and 69 (38.9%) had non-traumatic SCI (NTSCI). The principal causes of traumatic TSCI were motor vehicle accidents in 52 patients (48.1%), falls in 27 patients (25.0%). Degenerative diseasecausing myelopathy and hernia was the main cause of NTSCI in 50 patients (50.9%), followed by infection in 21.6 patients (14.9%). The age of patients with NTSCI was higher (49 vs. 34; P < 0.001) and SCI was less severe, AIS D 40.6% vs. 10.5% (P = 0.0001) compared with the TSCI group. Discussion/Conclusion The demographic profiles of patients with TSCI and NTSCI differ in terms of proportion of total SCIs, patient age, male: female ratio and incomplete vs. complete injury. The most common etiology of TSCI was motor vehicle accidents (48.1%), and neurological lesions were complete in 61.1% of patients. The most common etiology of NTSCI was degenerative causes (50.9%), and lesions were incomplete in 88.5% of patients. Keywords Spinal cord injury; Etiologies; Epidemiology Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2017.07.096 P061
Hyperbaric trauma of an intrathecal baclofen pump secondary to scuba diving: About one case
Philippe Gallien ∗ , Damien Rat , Sandrine Robineau , Jephte Houedakor , Emilie Leblong , Nicolas Benoit , Aurelie Durufle , Bastien Fraudet Pôle MPR Saint-Helier, MPR, Rennes, France ∗ Corresponding author. E-mail address: [email protected] (P. Gallien) Objective/Introduction Spasticity is a frequent consequence to a cerebral or spinal cord damage. Therapeutic strategies depend on the repercussions on patients’ daily activities and the fact that is a focal or spread spasticity. Intrathecal Baclofen pump (ITB Pump) implantation come with a frequent medical follow-up, and a specific patient’s education as some complications may occur. Material/Patients and methods/Method Case report. Results A 60-year-old male patient was implanted with ITB Pump 15 years after a traumatic spinal cord injury of level T11 ASIA-A and Frankel-A. He is independent in his daily life and rather active. During his follow-up, 2 back-to-back refill procedures were limited to 14 mL of drug out of a usual 20 mL reservoir. The patient had gone back to scuba diving 4 months before without medical awareness or specific precautions, sometimes even below 10 meters. This induced the bottom shield of the pump to collapse under the pressure and repeated hyperbaric exposures. X-Rays prove the permanent mechanical deformation of the device. The ITB pump continues to work normally. Discussion/Conclusion The risks of hyperbaric exposure on the ITB pumps are described by the device company. A pressure higher than 2.0 ATA (hyperbaric chambers or dive below 10 meters) may have effects on the drug delivery and/or on the device itself. It can vary from small withdrawal symptoms to fatal drug underdose. Despite the potential permanent deformation, the other side effects should disappear when returning to normal pressure. Doctors and patients must be aware and talk about physical activities as well as other daily life situations as more and more young patients are under ITB pump. Because some risks are specific to sports that are not so rare as we might think.