Lesion characteristics are associated with bowel, bladder, and overall independence following cervical spinal cord injury

Abstract

Context/Objective There is a growing global interest in quantifying spinal cord lesions and spared neural tissue using magnetic resonance imaging (MRI) in individuals with spinal cord injury (SCI). The primary objective of this study was to assess the relationships between spinal cord lesion characteristics assessed on MRI and bowel, bladder, and overall independence following SCI. Design Retrospective, exploratory study. Participants 93 individuals with cervical SCI who were enrolled in a local United States Model Systems SCI database from 2010 to 2017. Methods Clinical and MRI data were obtained for potential participants, and MRIs of eligible participants were analyzed. Explanatory variables, captured on MRIs, included intramedullary lesion length (IMLL), midsagittal ventral tissue bridge width (VTBW), midsagittal dorsal tissue bridge width (DTBW), and axial damage ratio (ADR). Outcome Measures Bowel and bladder management scale of the Functional Independence Measure (FIM) and FIM total motor score. Results When accounting for all four variables, only ADR was significantly associated with bowel independence (OR = 0.970, 95% CI: 0.942–0.997, P = 0.030), and both ADR and IMLL were strongly associated with bladder independence (OR = 0.967, 95% CI: 0.936–0.999, P = 0.046 and OR = 0.948, 95% CI: 0.919–0.978, P = 0.0007, respectively). 32% of the variation in overall independence scores were explained by all four predictive variables, but only ADR was significantly associated with overall independence after accounting for all other predictive variables (β = −0.469, 95% CI: −0.719, −0.218, P = 0.0004). Conclusions Our results suggest that the MRI-measured extent of spinal cord lesion may be predictive of bowel, bladder, and overall independence following cervical SCI.