Rehabilitation outcomes following infections causing spinal cord myelopathy

Retrospective, open-cohort, consecutive case series.

To describe the demographic characteristics, clinical features and outcomes in patients undergoing initial in-patient rehabilitation after an infectious cause of spinal cord myelopathy.

Spinal Rehabilitation Unit, Melbourne, Victoria, Australia. Admissions between 1 January 1995 and 31 December 2010.

The following data were recorded: aetiology of spinal cord infection, risk factors, rehabilitation length of stay (LOS), level of injury (paraplegia vs tetraplegia), complications related to spinal cord damage and discharge destination. The American Spinal Injury Association (ASIA) Impairment Scale (AIS) and functional independence measure (FIM) were assessed at admission and at discharge.

Fifty-one patients were admitted (men=32, 62.7%) with a median age of 65 years (interquartile range (IQR) 52-72, range 22-89). On admission, 37 (73%) had paraplegic level of injury and most patients (n=46, 90%) had an incomplete grade of spinal damage. Infections were most commonly bacterial (n=47, 92%); the other causes were viral (n=3, 6%) and tuberculosis (n=1, 2%). The median LOS was 106 days (IQR 65-135). The most common complications were pain (n=47, 92%), urinary tract infection (n=27, 53%), spasticity (n=25, 49%) and pressure ulcer during acute hospital admission (n=19, 37%). By the time of discharge from rehabilitation, patients typically showed a significant change in their AIS grade of spinal damage (P<0.001). They also showed significant improvement (P<0.001) in their FIM motor score (at admission: median=27, IQR 20-34; at discharge: median=66, IQR 41-75).

Most patients returned home with a good level of functioning with respect to mobility, bladder and bowel status, and their disability improved significantly.