Neurological recovery after traumatic spinal cord injury: what is meaningful? A patients' and physicians' perspective.

Paula Valerie Ter Wengel,Paula Valerie Ter Wengel,Paula Valerie Ter Wengel,Marcel W M Post,Marcel W M Post,Marcel W M Post,Marcel W M Post,Janneke Stolwijk-Swuste,Enrico Martin,Allard Jan Frederik Hosman,William Peter Vandertop,Fetullah Cumhur Öner,Allard Jan Frederik Hosman,Said Sadiqi

doi:10.1038/s41393-020-0436-4

Abstract

Cross-sectional survey. Most studies on neurological recovery after traumatic spinal cord injury (tSCI) assess treatment effects using the American Spinal Injury Association Impairment Scale (AIS grade) or motor points recovery. To what extent neurological recovery is considered clinically meaningful is unknown. This study investigated the perceived clinical benefit of various degrees of neurological recovery one year after C5 AIS-A tSCI. The Netherlands. By means of a web-based survey SCI patients and physicians evaluated the benefit of various scenarios of neurological recovery on a scale from 0 to 100% (0% no benefit to 100% major benefit). Recovery to AIS-C and D, was split into C/C+ and D/D+, which was defined by the lower and upper limit of recovery for each grade. A total of 79 patients and 77 physicians participated in the survey. Each AIS grade improvement from AIS-A was considered significant benefit (all p < 0.05), ranging from 47.8% (SD 26.1) for AIS-B to 86.8% (SD 24.3) for AIS-D+. Motor level lowering was also considered significant benefit (p < 0.05), ranging from 66.1% (SD 22.3) for C6 to 81.7% (SD 26.0) for C8. Meaningful recovery can be achieved without improving in AIS grade, since the recovery of functional motor levels appears to be as important as improving in AIS grade by both patients and physicians. Moreover, minor neurological improvements within AIS-C and D are also considered clinically meaningful. Future studies should incorporate more detailed neurological outcomes to prevent potential underestimation of neurological recovery by only using the AIS grade.

Highlights

This effect is often evaluated with an improvement in American Spinal Injury Association Impairment Scale (AIS grade) or motor score points, which are frequently used as primary outcome measures
Since the definition of clinically meaningful recovery after complete cervical traumatic spinal cord injury (tSCI) is unclear, we investigated the experienced value of various degrees of neurological recovery by SCI patients and physicians who are involved in treatment of tSCI patients
They were asked to indicate how large the benefit of a lower motor level would be compared with the baseline, e.g., C6 compared with C5, C7 compared with C5, or C8 compared with C5

Summary

Introduction

Many studies have investigated the effect of early surgical decompression on neurological recovery in patients with tSCI [5,6,7]. This effect is often evaluated with an improvement in American Spinal Injury Association Impairment Scale (AIS grade) or motor score points, which are frequently used as primary outcome measures. Whilst some studies define at least one AIS grade improvement as a success [5, 8], others consider at least two AIS grades improvement as a success [6, 7] It is unknown whether this improvement in AIS grade or motor score points translates into clinically meaningful recovery from the patients’ and physicians’ perspective [9]

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