Limb loss in individuals with chronic spinal cord injury. (4th May 2022)

• Record Type: Journal Article
• Authors: Svircev, Jelena; Tan, Debbie; Garrison, Ashley; Pennelly, Brent; Burns, Stephen P.
• Is Part Of: Journal of spinal cord medicine. Volume 45:Number 3(2022)
• Page Start: 420
• Page End: 425
• Publication Date: 2022-05-04
• Subjects: Spinal cord injuries -- Amputation -- Peripheral vascular disease; Spinal cord -- Wounds and injuries -- Periodicals; Spinal cord -- Diseases -- Periodicals; 616.8305
• DOI: 10.1080/10790268.2020.1800964
• Languages: English
• ISSNs: 1079-0268

Abstract

Abstract : Objective : The purpose of this study is to describe a population of individuals with chronic spinal cord injury (SCI), who underwent lower limb amputations, identify indications for amputations, medical co-morbidities and summarize resulting complications and functional changes. Design : Retrospective observational cohort study. Setting: SCI Service, Department of Veterans Affairs (VA) Health Care System. Participants : Veterans with SCI of greater than one-year duration who underwent amputation at a VA Medical Center over a 15-year period, using patient registry and electronic health records. Diagnosis and procedure codes were utilized to identify amputations. Interventions : Not applicable. Outcome measures : Amputation level, complications, functional status, change in prescribed mobility equipment and mortality. Results : 52 individuals with SCI received amputation surgery with a mean age of 62.9 years at time of amputation. Thirty-seven (71.2%) had paraplegia, and 34 (65.3%) had motor-complete SCI. Pressure injuries and osteomyelitis were most common indications for amputation. Amputations were primarily (83%) at the transtibial level or more proximal, with the most common amputation level at transfemoral/through-knee (29;55.8%). Postoperative complications occurred in five individuals. Seven of nine individuals who were ambulatory pre-surgery remained ambulatory. Equipment modifications were required in 37 (71%) of individuals. Five-year survival following amputations was 52%, and presence of peripheral vascular disease was significantly associated with mortality (P = 0.006). Conclusions : Pressure injuries and osteomyelitis were most common etiologies for limb loss. Less than half experienced functional change after amputation; more than half required new or modified mobility equipment. An increase in mortality may reflect overall health deterioration over time.