Limb loss in individuals with chronic spinal cord injury

The Journal of Spinal Cord Medicine, 2022 · DOI: 10.1080/10790268.2020.1800964 · Published: January 1, 2020

Spinal Cord Injury Orthopedics Rehabilitation

Simple Explanation

This study looks at Veterans with long-term spinal cord injuries who had to have a lower limb amputated. The main reasons for amputation were pressure sores and bone infections. Most people needed changes to their mobility equipment after the surgery, and survival rates were about 52% after five years.

Study Duration

15 years

Participants

52 Veterans with SCI

Evidence Level

Retrospective observational cohort study

Key Findings

1
Pressure injuries and osteomyelitis were the most common reasons for needing an amputation in people with chronic SCI.
2
Most amputations were performed at or above the knee.
3
Having peripheral vascular disease (PVD) significantly lowered the chances of survival after amputation.

Research Summary

This study describes clinical characteristics and outcomes of Veterans with chronic SCI who received lower limb amputation surgery. Pressure injuries and osteomyelitis were most common etiologies for limb loss. An increase in mortality may reflect overall health deterioration over time.

Practical Implications

Prevention is Key

Focus on preventing pressure injuries and osteomyelitis through regular skin checks, pressure relief, and proper seating.

Address PVD Risk Factors

Implement programs for smoking cessation, dietary management, and overall wellness to manage risk factors for peripheral vascular disease.

Comprehensive Rehabilitation

Provide thorough reassessment of equipment and functional abilities post-surgery to maximize functional abilities and minimize complications.

Study Limitations

1
The true incidence rate of amputation surgery in this individual cohort cannot be calculated.
2
The review of postoperative complications was limited to major postoperative complications and excludes minor ones such as urinary tract infections.
3
The study population was limited to a cohort of Veterans with SCI who received amputation surgery at a single VA Medical Center, were all male, and were older and had longer duration of injury than in prior population-based research on this topic.

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