F69. Longitudinal follow-up of traumatic cauda equina/conus medullaris injuries – Neurological, neurophysiological and funsctional outcomes

Abstract

Introduction Traumatic cauda equina/conus medullaris injuries lead to complex neurological syndromes that can compromise motor, sensory and autonomic functions of the lower limbs and pelvic organs. Some patients attain partial recovery of lower limb function and can accomplish independent ambulation. Standardized measures based on the neurological and functional evaluations are used to predict ambulation in spinal cord injuries. As distal spinal cord elements and cauda equina are composed mostly of peripheral nervous system structures, nerve conduction studies and electromyography (EMG), which are useful to quantify axonal loss, could help predict motor and functional outcomes. Methods 55 patients with trauma to the distal spinal cord due to thoracolumbar injuries, were submitted to a thoroughly evaluation in two distinct occasions - before the rehabilitation program (2–3 months after the injury) and after a long follow-up of at least 2 years. A longitudinal evaluation of neurological (ASIA/American Spinal Injury Association - Lower Extremity Motor Score-LEMS), functional (SCIM – Spinal Cord Independence Measure) and neurophysiological (EMG scores- EMGs) function was performed. The primary outcome was independent ambulation at the second year after the injury (SCIM item 12). A repeated-measures design with analysis of covariance (ANCOVA) was used to demonstrate the difference of pertinent parameters in the groups (complete X incomplete lesions) considering the baseline values, due to multiple confounders. Multiple regression and binary logistic regression analysis were used to determine the relevant importance of predictors. This work received local ethics board approval. Results From 55 patients (46 men, 18–53 years), 24 (43.6%) presented with an incomplete injury. Firearm injuries (63.6%) were the most frequent etiology, followed by motor vehicle accidents (20%) and falls (16.4%). There were no differences in demographic data between the groups (complete X incomplete injuries). All patients independently improved from motor function scores measured by LEMS and EMGs (p Conclusion The prognosis for neurological and functional recovery in traumatic cauda equina/conus medullaris injuries seems to be related to injury extension and to the initial improvement in motor function. The improvement in LEMS and EMGs, that were significantly correlated, suggests that the recovery of motor function might be related mostly to potential regrowth and regeneration of spinal roots.