04/10/2013 // Concord, CA, USA // LifeCare123 // Greg A. Vigna M.D., J.D. // (press release)

With the improvement in medical management and transport of the acutely injured patients both in the hospital and by emergency medical technicians in the field there has been an increase in patients that survive a spinal cord injury. There has also been an improvement in the medical and surgical treatments that have increased the life expectancy of spinal cord patients. There are identified medical complications in the spinal cord population that all primary care physicians who care for these patients must be aware of to effectively monitor and prevent complications.

Medical Perspective:

Historically kidney related problems were the leading cause of death. Now this accounts for less than 5% off all deaths in the spinal cord patients. This is attributed likely to improvement in antibiotic therapy as well as advances in urologic management from routine urodynamic testing. Spinal cord injured patients must be proactive to insist on routine testing which will detect changes in urologic function that occurs in the absence of symptoms. These changes may include the development of urinary reflux back up to the kidney which will predispose these patients to kidney stones, sepsis, and renal failure. Primary care physicians must be aware that long-term catheter management predisposes these patients to unique problems from increased bladder infections, shrinkage and stiffing of the bladder that will cause reflux, and a increase in bladder cancer which appears to be highly invasive. Patients should be educated on the increase risk of cancer and if hematuria develops furter diagnostic testing may be required.

With aging there is a general decrease in gastrointestinal motility. Spinal cord injuries effect gastrointestinal motility. Long-term spinal cord injured patient will need to adjust their bowel program overtime to account for this. The risk of gall stones is 7x greater in the spinal cord population with injuries above T10. These patients may have an absence of symptoms other than autonomic dysreflexia or merely and increase in spasticity. Primary care physicians and patients must be aware of this. Further, unexplained sepsis may require the physician to investigate the gall bladder as a source. Hemorrhoids and anal fissures are more common in spinal cord injured population and may require surgical repair. Spinal cord patients must receive routine colonoscopy to detect colon cancer and will likely require a more aggressive bowel prep to adequately clean the colon prior to the study.

Over half of paraplegics develop upper extremity compressive neuropathies that will decrease strength and sensation,and cause pain which will have significant functional consequences on these patients. Every spinal cord injured patient on routine follow up should be screened for these complications that can be managed both conservatively as well as surgically. Cyst in the spinal cord following spinal cord injury may develop which may have catastrophic consequences in terms of both decreased strength and sensation and require yearly MRIs to screen for this complication.

Overuse injuries such as rotator cuff tears are common as well as wrist and elbow injuries. Paraplegics who utilize a manual wheelchair will likely require an electric wheelchair seventeen years after an injury to allow for mobility. Narrowing of the spinal canal above and below a fusion of cervical spine is a recognize complication and should be followed with MRIs.

Aging will decrease skin strength and coupling this with overuse injuries and neurologic complications will predispose chronic spinal cord patients to pressure ulcerations that require surgery because of increase in difficulty with transfers and performing pressure reliefs. Patients with chronic pressure ulcerations who are not surgical candidates may require biopsies of the sore because of the risk of cancerous transformation of tissue within the ulcer.

Cardiovascular complications are the leading cause of death now in the spinal cord population. There is increased risk of diabetes and changes in cholesterol profiles that increase the risk of heart disease. Spinal cord patients above T6 may have decreased symptoms related to cardiovascular disease and may require cardiac stress test to screen for cardiovascular disease.

Life Care Planner Perspective:

All reasonable and necessary care related to the spinal cord injury must be included in the plan. A life care planner will not take financial issues into consideration. The plan is devised to prevent complications, and improve and maintain the medical, physical, and psychosocial aspects of the spinal cord injured life. These recommendations are beyond the scope of this article, but it is this author’s opinion that there is an unfortunate shift in the delivery of care which are directing spinal cord patients to family doctors for health care maintance because of economic pressures from both private payor sources and governmental influences. Family doctors are not trained and likely not familiar with the unique medical, physical, and psychologic consequences of spinal cord injury. A life care plan properly executed will prevent this by outlining the proper care and recommending proper followup with appropriate specialist that commonly deal with spinal cord related issues.

Lawyer’s Perspective:

It is this author’s opinion that a lawyer must understand all issues related to physical, medical, and psychosocial recovery and long-term management to best represent a spinal cord patient. The attorney must be able to relate and communicate the future medical needs and future cost to the jury to maximize money recovery for future damages.

Media Information:

Address: 1401 Willow Pass Road, Concord, CA 94520
Phone: 888.990.9410
Url: Lifecare Solutions Group