Disclosures: Rachel K. Teranishi, MD: Nothing to disclose

Case Description: The patient presented for annual evaluation and complained of challenges related to his right leg. This included painful spasticity, difficulty achieving sitting balance with his history of left transfemoral amputation, falls due to loss of balance, and reduced quality of life. On examination he had a non-healing ischial wound and right patellar fracture from self-inflicted trauma. The patient requested elective amputation of his remaining limb. After extensive multidisciplinary evaluation with spinal cord injury medicine, orthopedic surgery, psychiatry, and psychology, the decision was made to pursue elective transfemoral amputation.

Setting: Tertiary care hospital

Patient: A 54-year-old male with T7 ASIA impairment scale A spinal cord injury.

Assessment/Results: The Spinal Cord Injury Quality of Life (SCI-QOL) questionnaire is a bank of questions comprised of 22 subdomains across four broad domains of physical-mental health, emotional health, social participation, and physical functioning. A customized questionnaire of 29 questions was compiled for the patient. He completed the questionnaire at baseline, one week after amputation, and one year after amputation. At one week post-operatively compared to baseline, 21/29 measures improved, 7/29 remained stable, and 1/29 worsened. At one year post-operatively compared to baseline, 16/29 measures improved, 7/29 remained stable, and 6/29 worsened. However, at one year compared to one week post-operatively, 0/29 measures improved, 8/29 remained stable, and 21/29 worsened.

Discussion: Elective lower extremity amputation may be an option for spinal cord injury patients suffering from spasticity and it may result in improved quality of life. However, further studies are warranted, and a careful multidisciplinary approach is necessary.

Conclusion: While there was overall improvement in most quality of life measures at one week and one year post-operatively compared to baseline, the most dramatic improvements were seen at one week and the improvements at one year were modest.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/measuring-quality-of-life-after-elective-transfemoral-amputation-for-pain-and-spasticity-in-an-individual-with-paraplegia-from-chronic-spinal-cord-injury-a-case-report/