John D Yeo

Causes of death after spinal cord injury

Study design: Mortality review was undertaken of patients who suffered traumatic spinal cord injury (SCI) between 1955 and 1994 inclusive.Objectives: The study objective was to provide evidence of reasons for the observed reduction in long-term life expectancy for the SCI population.Setting: Patients were those who had most, if not all, of their inpatient and outpatient care at Royal North Shore Hospital, Spinal Injuries Unit, Sydney, New South Wales, Australia.Methods: Data on causes of death for 195 patients fitting the inclusion criteria were analysed by actuarial methods using ICD9CM classifications.Results: The incidence of death in the spinal cord injured, from septicaemia, pneumonia and influenza, diseases of the urinary uystem and suicide, are significantly higher than in the general population. The findings confirm variations in potentially treatable causes of death depending on neurological impairment, attained age and duration since injury. Unlike septicaemia and pneumonia, which have shown a significant reduction since 1980, the death rate for suicide alone has risen.Conclusion: This analysis identified complications which affect mortality and morbidity in patients suffering from the effects of SCI.

Mortality following spinal cord injury

This study analyzed the mortality in 1453 spinal cord injured patients admitted early after injury to a specialised Spinal Injuries Unit within a University teaching hospital over a 40-year period. The cohort comprised 55.3% patients with cervical lesions and 44.7% patients with thoracic/lumbar lesions. Those patients who died within 18 months of the spinal injury (132) were excluded from the final analysis. Standardised Mortality Ratios, survival rates and life expectancy ratios were calculated for specific ranges of current attained age and duration since injury with reference to level and degree of spinal cord injury. The projected mean life expectancy of spinal cord injured people compared to that of the whole population was then estimated to approach 70% of normal for individuals with complete tetraplegia and 84% of normal for complete paraplegia (Frankel grade A). Patients with an incomplete lesion and motor functional capabilities (Frankel grade D) are projected to have a life expectancy of at least 92% of the normal population.

Cervical spinal cord injury in rugby union and rugby league: are incidence rates declining in NSW?

Objectives: To estimate trends in incidence rates of rugby code‐related severe cervical spinal cord injuries in New South Wales (NSW) from 1986 to 2003. To evaluate the Australian Spinal Cord Injury Register (ASCIR) for injury surveillance by comparison with two published studies.

Epidemiology of cervical spine abnormalities in asymptomatic adult professional Rugby Union players using static and dynamic MRI protocols – 2002 to 2006.

Objective In this study, the prevalence of abnormalities in the cervical spine of asymptomatic professional rugby players using both static and dynamic magnetic resonance imaging (MRI) in order to improve the detection of abnormalities and prevention of related injuries was investigated. Design Prospective observational study. Setting French professional rugby union clubs, between 2002 and 2006. Participants 206 elite male adult players. Intervention Static sagittal T2 and axial T2* fast spin echo (FSE), and dynamic sagittal single-shot FSE weighted MRI scans of the C2–C7 region were examined for the presence of abnormalities. Participants’ spines were in supine neutral position for the static protocol but were allowed complete flexibility in a sagittal plane for the dynamic protocol. Main outcome measurements The medulla-to-canal ratio (MCR) was measured at every vertebral disc level for both MRI methods. When observed, anatomical abnormalities were categorised. Results Anatomical abnormalities mainly consisted of degenerative discopathy and were most frequently observed in players aged>21 years, as well as in players whose MCR was abnormally high based on medical expertise. Most MCRs that were initially assessed as intermediate with static MRI were subsequently assessed as abnormal with dynamic MRI assessment. Conclusions Since dynamic MRI is more accurate than static techniques in examining the cervical spine, it contributes substantially to identifying the risk of spinal injuries in professional rugby players, and when used in association with clinical assessment, it can assist in preventing spinal injury.

Impairment of erection after external sphincter resection.

This paper presents the results of a study on the pathological changes associated with post traumatic central spinal cord necrosis.

Studies on the levels of 17 hydroxy-corticoids in 24-hour specimens of urine from five quadriplegic patients and two paraplegic patients admitted to the Royal North Shore Hospital, Sydney

Studies on the levels of 17 hydroxy-corticoids in 24-hour specimens of urine from five quadriplegic patients and two paraplegic patients admitted to the Royal North Shore Hospital, Sydney

Monoamine and Tissue Fluid Levels in Contused Spinal Cord of Sheep

Methods are described for the determination of sheep spinal cord tissue fluid content and norepinephrine, serotonin, and dopamine concentrations after experimental injury. The amount of tissue fluid varied in different regions of sheep spinal cord following injury. Norepinephrine and serotonin wet weight concentrations were corrected for this variation in tissue fluid. Corrected norepinephrine wet weight cord concentrations did not change up to 3 hr after injury. Levels of serotonin at 60 min after injury were similar to controls. Dopamine was not detected in sheep spinal cord. α‐Methyl tyrosine significantly reduced fluid in the spinal cord at 75 min after injury. Hinwood B. G. et al. Monoamine and tissue fluid levels in contused spinal cord of sheep. J. Neurochem.35, 786–791 (1980).

Pregnancy and Quadriplegia —the Problem of Autonomic Dysreflexia

The course of pregnancy and labour in a quadriplegic patient is described. The literature on autonomic dysreflexia associated with pregnancy is briefly reviewed and the use of a cystometrogram to predict the onset and severity of this complication of labour is discussed.

Prevention of spinal cord injuries in Australia.

An Awareness and Prevention Team of five lecturers has been employed for 5 years funded by the Spinal Research Foundation at the Royal North Shore Hospital of Sydney, New South Wales. An evaluation of the effectiveness of the lecture programme in increasing knowledge and preventing the incidence of spinal cord injury was carried out to demonstrate the justification for continuing the Programme. This evaluation was achieved using a questionnaire designed for sample responses by school students in target age range. The questionnaires were distributed to 27 schools in five categories in order to obtain a spread of responses and a workable control group of schools which had not been visited by the Team. Results of 3823 questionnaires were tabulated and analysed by computer. The schools which had been visited by the Lecture Team showed both higher levels of knowledge on the structure of the spinal cord and effects of injury and also a more balanced attitude and awareness towards people requiring wheelchairs for mobility.