Pulmonary dysfunction in patients after cervical spinal cord injury: serial follow-up measurement within the first year post-injury.

OBJECTIVES

Respiratory complications are most common cause of morbidity/mortality in patients with cervical spinal cord injury (cSCI) due to respiratory muscle weakness and lower diaphragm position resulting in limited availability of inspiration, reduced thorax mobility and limited forced expiration. Differences in respiratory dysfunctions (RDs) in patients with motor complete versus incomplete cSCI were assessed.

DESIGN

Prospective longitudinal study, serial measurement.

SETTING

University hospital and ambulatory departments.

METHODS

Twenty two patients with acute cSCI were recruited. Neurological level of injury and severity according to ISNCSCI were used as criteria for recruitment. Patients were divided into two groups - motor complete and incomplete. Standardized pulmonary function tests (PFT) were used - spirometry and respiratory muscle strength (RMS) measurement. Motor score of key muscles assessments for upper (UEMS) and lower (LEMS) limbs were used. Tests were performed in 5 measurement sessions starting on (medians) 14.5 days (M1), then 6.7 weeks, 3.2 months, 6.3 months and 1.0 year (M5).

RESULTS

Significant differences in measurement sessions M2-M5 between groups in forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), expiratory reserve volume (ERV), maximal static inspiratory/expiratory pressures (MIP, MEP) and UEMS were proved. Consequently, prominent differences in courses of particular parameters were found. No intergroup changes in UEMS were found during study.

CONCLUSIONS

Obvious differences in parameters of spirometry, respiratory muscles and limb muscles strength between motor complete and incomplete group were found. Carefull monitoring of RDs by functional assessments (i.e., PFT and UEMS/LEMS tests) within one year after SCI seems to be clinically important.