Elderly and spinal cord injury: a cohort study, neurological, functional recovery and outcomes

Abstract

To compare the neurological evolution, functional improvement, and outcomes after acute hospitalization for elderly patients with newly non-traumatic (NTSCI) and traumatic (TSCI) spinal cord injury. Retrospective single-center study conducted with a cohort of patients older than 70 years old with NTSCI and TSCI, admitted between January 2004 and December 2014.in a Rehabilitation center in Nantes France. One hundred and ten patients were included (43 TSCI and 67 NTSCI). Most of the NTSCI had incomplete paraplegia (p<0.001) whereas TSCI had incomplete tetraplegia (p=0.002). Falls were the main cause of traumatic injury. NTSCI and paraplegia had a favourable neurological improvement (p=0.14 and 0.02) whereas TSCI and tetraplegia remained stable (p=0.13 and p=0.007). Therefore functional status remained stable for almost half the patients. Sixty percent of the patient get an assistance or were independent in Katz ADL Index assessment, mostly were NTSCI and paraplegic (p=0.17 and 0.40). About 44% of the patients had normal micturition at discharge, they all had incomplete lesion. Fifteen patients used intermittent catheterization, most of them were TSCI (p=0.02). Private residence was the first place of residence after discharge (47%), 17% goes in nursing home residence. NTSCI were more likely to go home at discharge (p=0.07), to have less comorbidities (p=0.08), length of stay shorter (p=0.053) and a mean age at death higher (p=0.01). Twenty-six percent of the patient deceased, mostly by respiratory problem. The etiology of the lesion and level of neurological impairment influence the neurological evolution, functional improvement and the outcomes of elderly patient with newly SCI. Rehabilitation of elderly SCI must be adapted to enhance neurological and functional recovery.