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Pedicle screw fixation is a commonly performed operation following fractures of dorsal and lumbar spines. As neurosurgeons, our primary aim is decompression of neural structures and stabilization of the vertebral column. However, careful preoperative planning is imperative to restore the alignment of the spine in sagittal and coronal planes as otherwise implant failure and progressive deformity may result. Eleven years ago, I had operated on a 12-year-old child with an L5 fracture and cauda equina syndrome where no attempt was made to either do a corpectomy and reconstruct the body or reduce it by placing screws in the fractured segment or include additional levels in the construct. Over time he had only minimal improvement in neurological status. Unfortunately, there was sequential implant failure that led to eventual removal. The serial roentgenography in this case is described. [ABSTRACT FROM AUTHOR]

Common quantitative assessments of neck injury criteria do not predict anatomical neck injuries and lack direct relations to design parameters of whiplash-protection systems. This study aims to provide insights into potential soft tissue-level injury sites based on the interactions developed in-between different anatomical structures in case of a rear-end collision. A detailed finite element human model has exhibited an excellent biofidelity when validated against volunteer impacts. Three head restraint arrangements were simulated, predicting both the kinematic response and the anatomical pain source at each arrangement. Head restraint’s contribution has reduced neck shear and head kinematics by at least 70 percent, minimized pressure gradients acting on ganglia and nerve roots less than half. Posterior column ligaments were the most load-bearing components, followed by the lower intervertebral discs and upper capsular ligaments. Sprain of the interspinous ligamentum flavum at early stages has caused instability in the craniovertebral structure causing its discs and facet joints to be elevated compressive loads. Excessive hyperextension motion, which occurred in the absence of the head restraint, has promoted a stable avulsion teardrop fracture of the fourth vertebral body’s anteroinferior aspect and rupture the anterior longitudinal ligament. The observed neck injuries can be mathematically related to head–torso relative kinematics. These relations will lead to the development of a comprehensive neck injury criterion that can predict the injury level. This, in turn, will impose a significant impact on the design processes of vehicle anti-whiplash safety equipment.

In spite of the relative common occurrence of spinal injuries, spinal epidural hematomas (SEHs) are rare lesions. Depending on the onset, site, size, and presence of neurological deficits, they can be treated conservatively or surgically. In the presented article, we report an uncommon case of posttraumatic dorsolumbar SEH and discuss the characteristic magnetic resonance imaging (MRI) imaging findings of epidural fat in the cases of traumatic spinal hematomas. [ABSTRACT FROM AUTHOR]

Study DesignRetrospective study.PurposeTo assess treatment outcomes of snowboarding-related spinal and spinal cord injuries.Overview of LiteratureSnowboarding-related spinal or spinal cord injury have a great impact on social and sporting activities.MethodsA retrospective review of 19 cases of surgically treated snowboard-related injury was done. Analyzed parameters included site of injury, type of fracture, peri- and postoperative complications, pre- and postoperative neurological status, activities of daily living, and participation in sports activities at the final follow-up.ResultsThe major site of injury was the thoracolumbar junction caused by fracture-dislocation (13/19 cases). The remaining 6 cases had cervical spine injuries. Over 60% of the patients had Frankel A and B paralysis. All patients were surgically treated by posterior fusion with instrumentation. Five underwent additional anterior fusion. Surgical outcome was restoration of ambulatory capacity in 12 patients (63.2%). Ultimately, 15 patients (78.9%) could return to work. Patients with complete paralysis upon admission showed reduced ambulatory capacity compared to those with incomplete paralysis. None of the patients again participated in any sports activities, including snowboarding.ConclusionsSnowboarding-related spinal or spinal cord injury has a great impact on social as well as sports activities. It is necessary to enhance promotion of injury prevention emphasizing the snowboarders' responsibility code.

Background: The aim was to study functional recovery in experimental animals (rabbits) with transected spinal cords treated with a combination of photo-cross-linked chitosan in a homogeneous mixture with polyethylene glycol (PEG-chitosan)., Methods: 20 rabbits ( n = 10 experimental and n = 10 controls) were submitted to complete spinal cord transection at T9. The experimental group received an intraoperative injection of PEG-chitosan. Neurological recovery was assessed using the modified Basso, Beattie, and Bresnahan scale., Results: In the experimental group, partial recovery of movements, sensory function, and sphincter control were all observed by postoperative day 30. Paraplegia and anesthesia persisted in the control group; 4 controls died versus none in the test group., Conclusion: PEG-chitosan is a candidate for neurological restoration after spinal paralysis., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Surgical Neurology International.)

Study Design: A retrospective epidemiological study.Objective: To reveal the long-term survival and causes of death after traumatic spinal fracture (TSF) and to determine the possible factors predicting death.Summary Of Background Data: Increased mortality following osteoporotic spinal fracture has been represented in several studies. Earlier studies concerning mortality after TSF have focused on specific types of fractures, or else only the mortality of the acute phases has been documented. In-hospital mortality has varied between 0.1% and 4.1%.Methods: The study sample of 947 patients including all patients with TSF admitted to Oulu University Hospital, Finland, between January 1, 2007 and December 31, 2011. TSFs were identified using International Classification of Diseases 10th revision or Nordic Classification of Surgical Procedures codes and all patient records were manually reviewed. Times and causes of death, obtained from Statistics Finland's Archive of Death Certificates, were available until the end 2016 and 2015, respectively.Results: At the end of the follow-up 227 (24.0%) had died. Mortality was 6.8% after the first year and 19.1% after 5 years. Mortality was increased in all age groups compared with the general population, 1-year standardized mortality ratios ranging from 3.1 in over 65-year-olds to 19.8 in under 30-year-olds. In age groups of 50 to 64 years and over 65 years, the most important risk factors for death were males with hazard ratios of 3.0 and 1.6, respectively, and low fall as trauma mechanism with hazard ratios of 9.4 and 10.2, respectively.Conclusion: Traumatic spinal fractures are associated with increased mortality compared with the general population, high mortality focusing especially on older people and men. The increase seems to be comparable to the increase following hip fracture. Patients who sustain spinal fracture due to falling need special attention in care, due to the observation that low fall as trauma mechanism increased the risk of death significantly.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) is always a medical emergency as it could lead to chronic painful conditions, permanent paralysis or even death. Objectives: Assessing the knowledge, attitude and practice (KAP) regarding the first aid of spinal injury in Kingdom of Saudi Arabia (KSA). Methods: A prospective randomized controlled study based on a questionnaire sheet that was conducted at Saudi Arabia, from March to July 2018.The study included 390 medical students randomly chosen from different faculties of medicine around KSA. Results: The level of knowledge was sufficient among 84.9% of medical students. The attitude of the medical students was good among most of the participants regarding calling help and starting CRP immediately, taking care while moving the patients and applying direct pressure on the side of bleeding. The level of practice among most of medical students was good toward patients with spinal injury even conscious or not. Conclusion: The KAP level was sufficient among medical students about first aid of spinal injury. The proper knowledge, positive attitude and practice skills towards first aid can make a significant difference in Saudi Arabia. [ABSTRACT FROM AUTHOR]

Abstract This study aims to determine spinal injury patterns and identify crash factors commonly associated with serious spinal injury as a result of motorcycle crashes. Data was retrospectively collected from motorcyclists sustaining spinal injuries from road crashes treated at Kuala Lumpur Hospital, Malaysia, over the 5-year period from 2005 to 2009. Each patient's injuries were analyzed by reviewing his or her medical records for radiographic imaging and computed tomography scans. A total of 151 patients were included in this study, of which, males accounted for over 87%. The first lower lumbar (L1) was the most commonly injured vertebral level, followed by the adjacent thoracic vertebra (T12). Fracture to the vertebral body without dislocation was found to be the most frequently observed spinal injury pattern. Injury severities for a majority of patients (65%) were measured at Maximum Abbreviated Injury Scale (MAIS) of 2. Serious spinal injury was associated with thorax or upper-extremity injury. Prevalence of lumbar spinal injury in the study reflects a predominantly low-speed crash among the motorcyclist in the region. Motorcyclists are at greater odd to sustain severe spinal injury when directly striking an object compare to striking the ground during the crash event. Highlights • The first lumbar vertebra (L1) was the most commonly injured vertebral levels • Association of thorax or upper-extremity injuries with serious spinal injury • The high occurrence of neurologic injury accompanied thoracic spine • Motorcyclists are at greater odd to sustain severe spinal injury upon directly striking an object compared to the ground [ABSTRACT FROM AUTHOR]

Aim: The aim is to analyse a group of 273 patients of the Spinal Unit of University Hospital Brno during 2013- 2016 period with regard to analyse pressure ulcers appearance. Patients and methods: A total of 273 patients were completely clinically evaluated including American Spinal injury Association score (ASIA). A subgroup of patients with pressure ulcers (PUs) was earmarked and evaluated their localization and degree of PUs and solution. Results: A group of 273 patients consisted of 230 (84.5%) men and 43 (15.5%) women. Average age was 46.7 years for men and 46.5 years for women. ASIA Impairment Scale (AIS) A was found in 114 (41.8%) patients, AIS B in 28 (10.3%), AIS C in 58 (21.2%) and AIS din 73 (26.7%) patients. The neurologic level of injury in cervical area was verified in 130 (47.6%) patients, thoracic 120 (44%) and lumbar 23 (8.4%) patients. In the baseline group of 273 patients 26 (9.5%) patients with 33 PUs were found. 21 (7,7%) patients AIS A and 5 (1.8%) patients AIS B were in a subgroup with PUs. Most of patients 17 (6.2%) had neurologic level of injury in thoracic spine, 8 (2.9%) in cervical spine. The most PUs 13 (39.3%) were under ischial tuber and in sacrum 7 (21.2%). The most frequent 23 (69.5%) were PUs of II. degree, the most serious PUs IV. degree were 6 (18.3%) andiII. degree was present in 4 (12.2%) PUs. A total of 11 (33.3%) PUs were then solved surgically. Conclusion: The highest risk for PUs in our group of 273 patients had seriously disabled patients AIS A, paraplegics with intensive activity in wheelchair. The most frequent was PU under ischial tuber. [ABSTRACT FROM AUTHOR]

Some neurological diseases such as parkinson, stroke, and spinal injury are as a result of cellular loss in the otherwise normal nervous system. Replacing damaged cells with healthy ones has opened a new hope window to treat or prevent the further disease progression. Different studies have shown that stem cells can differentiate and replace the lost neurons and glial cells in the central nervous system. However, the right cell type selection, treatment procedure, the best cell delivery method, and the treatment followup are among the major challenges faced this therapeutic vision. In this review, we have got through significant basic and clinical studies for neurological disease cell therapy to provide a basis for future applications of this therapeutic approach in clinics. Indeed, continuous and noticeable progress in cell therapy through the basic and clinical investigations will offer new hopes to people suffer from these diseases across the globe. [ABSTRACT FROM AUTHOR]

The National Emergency X-Radiography Utilization Study (NEXUS) criteria were derived from a heterogeneous group of adult blunt trauma patients, with the outcome measure assessed most commonly using plain X-ray radiographs. Recent observations have suggested inadequacy of these criteria for excluding injury in population subgroups such as the elderly. The aim of this systematic review was to determine the sensitivity of the NEXUS criteria in excluding cervical spine injury among older patients aged ≥65 years. A systematic review of the literature published prior to 1 January 2017 that reported on the performance of the NEXUS criteria among older patients was conducted. The databases OVID Embase and OVID Medline were searched. The sensitivity of the NEXUS criteria was recalculated for each study among older patients. There were seven studies included in this review. All studies were considered to be at risk of bias and rated down for quality of evidence. Emergency physicians were assessors in all included studies. Sensitivity of the NEXUS criteria among older patients ranged from 66% to 100%. Variable sensitivity was demonstrated when the NEXUS criteria were applied to older blunt trauma patients. This questions the applicability of the NEXUS criteria in this subgroup. [ABSTRACT FROM AUTHOR]

Aim of Study To see whether surgical intervention in gunshot injuries to the spine leads to recovery in neurologic status. Methods It is a retrospective study conducted at the Jai Prakash Narayan Apex Trauma Centre (JPNATC), All India Institutes of Medical Sciences (AIIMS), New Delhi, where case records of 20 patients with gunshot injury to the spine, admitted between January 2013 to March 2018, were analyzed. Result Out of 20 patients, 17 underwent surgical intervention. Entry wound was most common on the back, with the thoracic vertebrae being the most common segment involved. Nine patients had complete spinal cord injury (SCI) at the time of presentation and seven of them underwent surgery. However, only one of these patients showed neurologic improvement at follow-up. Seven patients with canal compromise underwent surgery, and only two of them showed improvement in neurologic status at follow-up. Early surgery was done in 8 out of 16 patients. All 16 patients underwent decompressive procedure, and 3 underwent additional stabilization procedure. Bullet was removed in nine cases. Intraoperative blood loss was minimal in 9 cases, and dural breach was noticed in 14 cases. At follow-up, 56.25% patients showed improvement in neurologic status. Conclusion Surgical intervention, timing of surgery, amount of intraoperative blood loss, and dural breach had no significant impact on the overall surgical outcome. Neurologic status at the time of presentation is the single most important factor that determines the ultimate outcome. Indication and type of surgical intervention is still an ambiguous topic. Owing to lack of conclusive evidence, we believe that there is role for surgery when it is done with an intention to restore the neurologic function. [ABSTRACT FROM AUTHOR]

Introduction: In combined posterior-anterior stabilization of thoracolumbar burst fractures, the expandable vertebral body replacement device (VBRD) is typically placed bisegmentally for anterior column reconstruction (ACR). The aim of this study, however, was to assess feasibility, outcome and potential pitfalls of monosegmental ACR using a VBRD. In addition, clinical and radiological outcome of monosegmental ACR was related to that of bisegmental ACR using the same thoracoscopic technique.Methods: Thirty-seven consecutive neurologically intact patients with burst fractures of the thoracolumbar junction (T11-L2) treated by combined posterior-anterior stabilization were included. Monosegmental ACR was performed in 18 and bisegmental ACR in 19 patients. Fracture type and extent of vertebral body comminution were determined on preoperative CT scans. Monosegmental and bisegmental kyphosis angles were analyzed preoperatively, postoperatively and at final radiological follow-up. Clinical outcome was assessed after a minimum of 2 years (74 ± 45 months; range 24-154; follow-up rate 89.2%) using VAS Spine Score, RMDQ, ODI and WHOQOL-BREF.Results: Monosegmental ACR resulted in a mean monosegmental and bisegmental surgical correction of - 15.6 ± 7.7° and - 14.7 ± 8.1°, respectively. Postoperative monosegmental and bisegmental loss of correction averaged 2.7 ± 2.7° and 5.2 ± 3.7°, respectively. Two surgical pitfalls of monosegmental ACR were identified: VBRD positioning (1) onto the weak cancellous bone (too far cranially to the inferior endplate of the fractured vertebra) and (2) onto a significantly compromised inferior endplate with at least two (even subtle) fracture lines. Ignoring these pitfalls resulted in VBRD subsidence in five cases. When relating the clinical and radiological outcome of monosegmental ACR to that of bisegmental ACR, no significant differences were found, except for frequency of VBRD subsidence (5 vs. 0, P = 0.02) and bisegmental loss of correction (5.2 ± 3.7° vs. 2.6 ± 2.5°, P = 0.022). After exclusion of cases with VBRD subsidence, the latter did not reach significance anymore (4.9 ± 4.0° vs. 2.6 ± 2.5°, P = 0.084).Conclusions: This study indicates that monosegmental ACR using a VBRD is feasible in thoracolumbar burst fractures if the inferior endplate is intact (incomplete burst fractures) or features only a single simple split fracture line (burst-split fractures). If the two identified pitfalls are avoided, monosegmental ACR may be a viable alternative to bisegmental ACR in selected thoracolumbar burst fractures to spare a motion segment and to reduce the distance for bony fusion. [ABSTRACT FROM AUTHOR]

Patients with a spinal cord injury above the 6th thoracic vertebrae may be prone to autonomic dysreflexia (AD) in response to bladder stimulus associated with a urodynamics investigation. It is essential that these patients are managed carefully in the urodynamics clinic in order to prevent life-threatening hypertension and bradycardia. Part of this management is the measurement and manual recording of pulse rate (PR) and non-invasive blood pressure (NIBP), alongside the standard urodynamics data set. The purpose of recording these additional data is to identify the characteristic drop in PR and rise in NIBP that indicates the onset of AD. This technical note describes the development of a novel, in-house constructed interface that allows PR and NIBP to be recorded alongside the standard urodynamics data set, using a commonly available vital signs monitor and urodynamics workstation. [ABSTRACT FROM AUTHOR]

Background Context: Traumatic spinal injuries are often associated with both long-term disability, higher frequency of hospital readmissions, and high medical costs for individuals of all ages. Age differences in terms of injury profile and health outcomes among those who sustain a spinal cord injury have been identified. However, factors that may influence health outcomes among those with a spinal injury have not been extensively examined at a population level.Purpose: The present study aims to describe the characteristics of traumatic spinal injury, identify factors predictive of mortality, and estimate the cost of hospital treatment for younger and older people.Study Design/setting: This is a population-based retrospective epidemiological study using linked hospitalization and mortality records during January 1, 2010 to June 30, 2014 in New South Wales, Australia.Patient Sample: The present study included 13,429 hospitalizations.Outcome Measures: Mortality within 30 and 90 days of hospitalization, hospital length of stay (LOS), and hospitalization costs were determined.Methods: Hospitalizations with a principal diagnosis of spinal cord injury or spinal fractures were used to identify traumatic spinal injuries. Age-standardized incidence rates were calculated and negative binomial regression was used to examine statistical significant changes over time. Cox proportional hazard regression was used to examine the effect of risk factors on survival at 90 days.Results: There were 13,429 hospitalizations, with 52.4% of individuals aged ≥65 years. The hospitalization rates for individuals aged ≤64 and ≥65 years were both estimated to significantly increase per year by 3.3% (95% confidence interval [CI] 0.97-5.79, p<.006) and 3.3% (95% CI 1.02-5.71, p=.005), respectively. For individuals aged ≥65 years, there were a higher proportion of women injured, comorbid conditions, injuries after a fall in the home or aged care facility, a longer hospital LOS, unplanned hospital admissions, and deaths than individual aged ≤64 years. The average cost per index hospitalization was AUD$23,808 for individuals aged ≤64 years and AUD$31,187 for individuals aged ≥65 years with a total estimated cost of AUD$371 million. Mortality risk at 90 days was increased for individuals who had one or more comorbidities, a higher injury severity score, and if their injury occurred in the home or an aged care facility.Conclusions: Spinal injury represents a substantial cost and results in debilitating injuries, particularly for older individuals. Spinal injury prevention efforts for older people should focus on the implementation of fall injury prevention, whereas for younger individuals, prevention measures should target road safety. [ABSTRACT FROM AUTHOR]

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Background The intensity of the damage to the nerve fibers is not measured through the severity of the spinal cord injury. Objective To understand the pattern of neurologic features in traumatic spinal cord injuries. Methods This was a case series of the total care of patients with consecutive acute spinal cord injury at different levels during the years 2015 to 2017, from extrication and transportation following the accident to death, or the completion of primary definitive rehabilitation. This work examined demographic and clinical characteristics of 220 consecutive cases of acute spinal injuries with or without neurologic symptoms subjected to conservative and surgical interventions. Age, sex, addiction patterns of smoking and alcohol, presenting symptoms, neurologic status, and postoperative outcomes are compared with the preoperative findings. Results The registry included 220 patients with spinal injury; majority in 41 to 50 years age group (28.6%) and males (77.7%). Nearly one-half had cervical (46.3%) injuries; 84.3% male; comparable proportion of dorsal and lumbar injuries had male dominance. One-fifth of the patients were smokers and alcoholics, all males. Mean hospital stay was 36.7 ± 140.5 days. Majority presented with neck pain (48.9%), radicular pain (56.4%), limb weakness (73.3%), and tingling sensation (47.7%); 14.4% reported tightness in limbs and 18.8% bladder involvement. In postoperative period, symptoms persisted in varied proportions. Significantly of postoperative neck pain was observed more among males (88.5%), yet symptoms that reduced postoperatively were neck pain, limb weakness, and tingling sensation. However, bladder involvement increased significantly. Conclusion The results showed that greater attention should be paid to older and male population that has more spinal cord injuries while comparable to those of the other studies in neurodeficits and clinical features. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to evaluate the accuracy of pedicle screw placement, its advantages, and limitations in posterior instrumentation of thoracolumbar and lumbar burst fractures assisted only by lateral fluoroscopic imaging.Materials and Methods: Pre- and postoperative computerized tomographic (CT) scans of 117 patients with thoracolumbar and lumbar burst fractures, who underwent posterior instrumentation with pedicle screw fixation, were prospectively analyzed. Accuracy of screw placement, reconstruction of the vertebral height, and correction of the kyphotic angle were studied. Position of the pedicle screws were determined, and cortical breach was graded on the postoperative axial CT scans. Percentage of vertebral height reconstruction and kyphotic angle correction were calculated from the postoperative midsagittal CT scans.Results: Four hundred and sixty-eight pedicle screws in 234 motion segments were included in this study. 427 screws were centrally placed with an accuracy rate of 91.24%. Out of the 41 (8.76%) screws that breached the pedicle wall, 32 (6.84%) screws had violated the medial wall, while 9 (1.92%) screws breached the lateral wall. There were no "air-ball" screws. No screw penetrated the anterior wall. Postoperatively, none of the patients deteriorated neurologically, and no screw required revision. Postoperatively, there was significant restoration of vertebral height and correction of kyphosis (P < 0.05).Conclusion: Pedicle fixation performed on a Relton-Hall frame is relatively simple and, when performed carefully using only lateral fluoroscopic imaging, has a lower potential for complications due to cortical breach. [ABSTRACT FROM AUTHOR]

Study Design: A retrospective epidemiological study.Objective: To reveal incidence and epidemiological features of traumatic spinal injuries (TSI) in Northern Finland.Summary Of Background Data: In Finland the annual incidence of traumatic spine fractures requiring inpatient care has been found to be 27/100,000, while international incidences have varied across the range of 16-64/100,000. More specific epidemiological data from Finland is not available. Internationally, the most common mechanisms of injury are road traffic as well as low and high falls. Associated injuries occur in 30% to 55% of cases.Methods: The study sample included patients with traumatic spinal injury admitted to Oulu University Hospital (OYS) with injury between the January 1, 2007 and December 31, 2011. Patient information was collected from the hospital care register, including all inpatient and outpatient visits and surgical procedures. Traumatic spinal column and spinal cord injuries were identified using International Classification of Diseases 10th revision or Nordic Classification of Surgical Procedures codes and all patient records were manually reviewed.Results: Nine hundred seventy-one patients met the criteria for TSI. The mean annual incidence of hospitalized traumatic spinal injuries was 26/100,000 in the whole of Northern Finland and 35/100,000 in the OYS main responsibility area. The most frequent etiology of TSI was low falls, which accounted for 35.8% of the injuries, followed by road traffic and high falls. Lumbar spine was the most common site of the fracture. Spinal surgery was performed in 376 (38.7%) cases. Three hundred eight patients (31.7%) suffered from associated injuries, 101 (10.4%) had a spinal cord injury, and 71 (7.3%) a brain injury.Conclusion: Low falls in elderly and road traffic injuries in younger age groups were the most common etiology of traumatic spinal injuries in Northern Finland and should be given more attention in primary prevention.Level Of Evidence: 3. [ABSTRACT FROM AUTHOR]

• Prevalence of non-immobilized spinal fractures decreased under selective protocol. • Due to no differences in adverse patient outcomes, a larger study is discouraged. • >85% of immobilized trauma patients do not have a spinal fracture. A new selective preventive spinal immobilization (PSI) protocol was introduced in the Netherlands. This may have led to an increase in non-immobilized spinal fractures (NISFs) and consequently adverse patient outcomes. A pilot study was conducted to describe the adverse patient outcomes in NISF of the PSI protocol change and assess the feasibility of a larger effect study. Retrospective comparative cohort pilot study including records of trauma patients with a presumed spinal injury who were presented at the emergency department of a level 2 trauma center by the emergency medical service (EMS). The pre-period 2013–2014 (strict PSI protocol), was compared to the post-period 2017–2018 (selective PSI protocol). Primary outcomes were the percentage of records with a NISF who had an adverse patient outcome such as neurological injuries and mortality before and after the protocol change. Secondary outcomes were the sample size calculation for a larger study and the feasibility of data collection. 1,147 records were included; 442 pre-period, and 705 post-period. The NISF-prevalence was 10% (95% CI 7–16, n = 19) and 8% (95% CI 6–11, n = 33), respectively. In both periods, no neurological injuries or mortality due to NISF were found, by which calculating a sample size is impossible. Data collection showed to be feasible. No neurological injuries or mortality due to NISF were found in a strict and a selective PSI protocol. Therefore, a larger study is discouraged. Future studies should focus on which patients really profit from PSI and which patients do not. [ABSTRACT FROM AUTHOR]

Tele-exercise, defined as an intervention that offers physical training provided remotely, represents an alternative for remote care during social isolation and the absence of in-person interventions, considering the difficulties of regular exercise engagement in tetraplegia. The current study aimed to examine whether tele-exercise training in individuals with tetraplegia meets the recommendations proposed by the spinal cord injury (SCI)-specific guidelines, and the adherence.Twenty SCI tetraplegia performed tele-exercise training. The weekly training load of the tele-exercise training during the 27 weeks was compared to the estimated training load of SCI-specific guidelines: TW vigorous guideline: vigorous intensity of guideline proposed for Tweedy et al.; MG vigorous guideline: vigorous intensity of guideline proposed for Martin Ginis et al.; MG moderate guideline: moderate intensity of guideline proposed for Martin Ginis et al. Adherence was obtained weekly during 27 weeks.The tele-exercise training load was 22.0% higher than the MG moderate guideline and 21.6% and 47.7% lower than the MG vigorous and TW vigorous guidelines, respectively. The tele-exercise training loads for men and women were, respectively, 2.3% and 35.0% higher than the MG moderate guideline; 34.0% and 13.2% lower than the MG vigorous guideline; and 56.1% and 42.1% lower than the TW vigorous guideline. Adherence was 45.1%.The tele-exercise training in men and women with tetraplegia for 7 months met the moderate intensity of recommendation proposed by one SCI exercise guideline. The adherence was 45.1%, with higher values for men compared to women. This finding shows that tele-exercise training may be an alternative exercise training intervention for tetraplegia and prompts reflexion on the inclusion of tele-exercise training in SCI exercise guidelines. [ABSTRACT FROM AUTHOR]