Spinal Cord Injury 5

What are common medical complications one year post-injury in a 20 year old C4 ASIA A?
• Pressure ulcers most common complication: risks include cigarettes, sleep meds
• Pneumonia (more common in tetraplegics) leading cause of death from SCI
• UTI: ppx antibiotics not supported
• Urolithiasis: risks are recurrent UTI, indwelling catheters, vesicoureteral reflux, prior stones, hypercalciuria --> can treat with shock wave lithotripsy
• Bladder cancer: risk including indwelling catheters, smoking, kidney stones
• OSA
• Loss of bone mineral density --> no strong evidence for use of bisphosphonates
• Fractures

What are the health maintenance recommendations for this 20 year old C4 ASIA A?
• Question about B/B, BP control, skin, pain, spasticity, sexual function, equipment needs, changes in strength or function
• Counsel on smoking cessation
• Annual renal US for upper urinary tract, video urodynamics for lower urinary tract
• For a woman, there may be increased spasticity, dyautonomia during menstruation --> hormone contraceptives may help; pregnancy at high risk for UTI, AD; no higher risk of cancers or osteoporosis

What are options for a male with C4 ASIA A regarding sexual function and fertility?
• 92% of men can get an erection, but only about half can have successful intercourse, and less than 5% can have unassisted ejaculation
• Vacuum suction and constrictor ring, penile implants (metal rod or inflatable implant)
• PDE-5 inhib (Viagra) used, side effects mimic AD (HA, facial flushing)
• Penile vibratory stimulation is first line treatment for anejaculation --> other treatments are electroejaculation, rectal probes
• Sperm count may be normal, but quality and motility can be poor --> intrauterine insemination, IVF

How is diffuse pain assessed in a 20 year old tetraplegic?
• Pain in 64-80% of SCI
• 15% report visceral pain
• 19-24% have neuropathic pain
• 42% have msk pain: most common in shoulders, followed by wrists, hands, and elbows --> treat with stretching and strengthening, local injections, NSAIDs, occasional opiates