Multimodality treatment concepts for contemporary treatment and management of patients with paraplegia are being developed and applied on a worldwide basis. The aim of these concepts is to maximize the success of treatment. The treatment algorithms are subject to the medical regulations in the individual countries. The comparison of multimodality concepts is rendered difficult by the existing regional differences in treatment. The evaluation of therapies in controlled randomized studies is limited by the low incidence of paraplegia and the large number of potential treatments. Therefore, it would be meaningful to assess the individual treatments in a systematic observational study.
The therapy concepts being investigated in the COaT-SCI register are the following:
- Earliest possible surgical treatment of traumatic spinal cord injury by means of decompression of the spinal canal to avoid secondary cellular damage, and stabilization of the spinal fracture (recommendation of the S1 Guideline of the German Society of Neurology, updated 2012).
- Rapid treatment of tumor-related spinal cord compression in case of symptoms of a paraplegic syndrome, as far as possible by surgical decompression of the spinal canal to avoid secondary cellular damage and achieve stabilization of the spine in case of a risk of fracture (in accordance with the S1 Guideline of the German Society of Neurology, updated 2012).
- In case of inflammatory paraplegia, removal of the source of inflammation in the spinal canal and rapid, targeted antibiotic treatment followed by specific antibiosis for at least 3 months (in accordance with the S1 Guideline of the German Society of Neurology, updated 2012).
- Early administration of non-steroidal anti-inflammatory drugs (NSAID) for the prevention of heterotopic ossifications and the alleviation of pain (Beckmann JT et al. 2014, Am J Sports Med. 42:1359-1364).
- Early administration of low-molecular heparins in weight-adapted doses for the prevention of venous thromboembolism (in accordance with the S1 Guideline of the German Society of Neurology, updated 2012).
- Multimodality treatment concept for grade III and IV decubitus ulcers (pressure ulcers) in accordance with the EPUP criteria.
Current epidemiological issues are the following:
- Overview of the incidence and risk factors of treatment-associated infections, including multiresistant pathogens, in the acute treatment of paraplegic patients.
- Identification of factors associated with spasticity (involuntary increase in muscle tone) after acute paraplegic injury.
- The course of treatment at a paraplegia center in a maximum-care institution for severely injured patients in a metropolitan region.