Elective bilateral above the knee amputation in T4-complete spinal cord injury: a case report

Spinal Cord (2008) 46, 585587

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CASE REPORT Elective bilateral above the knee amputation in T4-complete spinal cord injury: a case report

MS JaffeDepartment of Physical Medicine and Rehabilitation, Kaiser Permanente, San Diego, CA, USA

Study design: This case study outlines an individual with a T4 complete level injury with Ashworth scale grade 4 spasticity of the lower extremities.

Objective: To discuss a treatment option for this individual with spinal cord injury (SCI) who had a variety of functional impairments, disabilities, and medical complications based on his level of injury. Setting: The department of physical medicine and rehabilitation at Kaiser Permanente in San Diego, California.

Methods: The patients lower extremity spasticity contributed to pressure ulcers of his hips and feet as well as comfort and functional issues with his instrumental activities of daily living (ADLs). After failing medical therapies to control spasticity, and much discussion, bilateral above the knee amputations were performed.

Results: The patient had resolution of his SCI medical complications and a marked improvement in his quality of life.

Conclusion: This case study discusses a treatment option for a SCI-complete patient whose lower extremities had become detrimental to his function and general well being.

Spinal Cord (2008) 46, 585587; doi:10.1038/sc.2008.58; published online 3 June 2008

Keywords: spinal cord injuries; amputation; elective surgical procedure

Spinal cord injury (SCI) affects approximately 250 000 individuals in the United States.1 These individuals have a variety of functional impairments and disabilities based on their level of injury, the medical complications associated with their SCI and the specifics of each individual case. Such functional disabilities and SCI-associated medical conditions may have a profound effect on an SCI individuals perception of his/her quality of life (QOL). Some studies have shown that individuals with SCI when compared with a nondisabled community sample have a lower QOL.2,3

Spasticity is a common medical complication of SCI. The incidence is approximately 70%, with roughly one-half of the patients requiring pharmacologic intervention. Spasticity may often lead to various complications including contractures, pain, impaired function and decreased QOL.4 In one study, 40% of SCI individuals with spasticity reported that their spasticity was problematic either by restricting activities of daily living (ADLs) or...