脊椎ジャーナル

Transfemoral Amputation Following Chronic Spinal Cord Injury: A Prosthetic Solution for Improved Balance, Seating, Dynamic Function and Body Image

Abstract

Albert C. Recio, Cara E. Felter, Allen Nicole C. Alana, Deborah A. Crane, Steven A. Stiens

Background: Advances in the care and rehabilitation of patients with spinal cord injuries (SCI) have resulted in extended survival. As SCI patients age, chronic lower extremity ischemic complications are resulting in amputations. The literature relating to lower extremity amputation and prosthesis in SCI patients is sparse. Limb amputation may cause weight distribution imbalances, leading to back pain and increased risk of pressure ulcer formation. Lower extremity amputation challenges skin management, sitting balance, functional range and body image.

Case Description and Methods: We report a systematic retrospective review of a disability adaptation equipment entrepreneur with T4 AIS B paraplegia patient who underwent right transfemoral amputation because of poor wound healing in the setting of severe peripheral vascular disease. The prosthetic prescription included a total-contact socket with a knee-flexed formed prosthesis, mirroring the opposite limb. The socket design allowed decompression of the right ischium and secured the patient in the wheel chair for seated reach and leverage in work. The patient consistently used the prosthesis over 10 years and recognized a variety of benefits including improved seating stability, functional reach, transfers, cosmesis, dressing options and body image, and documented increase in community activity.

Conclusion: Lower extremity prosthesis fitting for patients with SCI and amputation can improve posture, seating, transfers, static and dynamic balance, participation in functional activities, and community reintegration.

Clinical Significance: Active patients with paraplegia and new transfemoral amputation should be offered a trial of a prothesis to enhance mobility. Many of the medical and functional consequences of amputation after SCI can be prevented with careful prosthesis selection, prescription, and training patients in the use of lower extremity prosthesis.