Acute Spinal Cord Injury Research Articles

Molecular pathology of acute spinal cord injury in middle-aged mice

The median age at which spinal cord injuries occur has steadily increased from 29 to 43 over the last several decades. Although more pre-clinical studies in aged rodents are being done to address this shift in demographics, comprehensive transcriptomic studies investigating SCI pathobiology in middle-aged mice are lacking. To address this gap in knowledge, we compared behavioral, histopathological, and transcriptional outcomes in young (2–4 months old) and middle-aged (10–12 months old) mice. In contrast to most previous studies, open field tests showed no differences in locomotor recovery between the young and middle-aged mice over a one-month period. The injury site also demonstrated similar histopathology in terms of lesion size, and numbers of macrophages and fibroblasts. Acutely after injury, proliferation of macrophages, fibroblasts, and astrocytes were also similar between the two age groups. In addition, spatial transcriptomics showed similar, transcriptionally defined regions around the injury site at 3 days post-injury. However, single cell RNA-sequencing of the cells at the injury site and surrounding spared tissue showed differences in select cell subpopulations. Taken together, our results indicate that although young and middle-aged mice display similar locomotor recovery and histopathology after SCI, changes in cell subpopulations may underlie a decline in repair mechanisms that manifest after middle age.

Pilot study of combined transvertebral magnetic and transcutaneous stimulation for the rehabilitation of combat acute spinal cord injuries

Aim of the study: To improve the effectiveness of neurorehabilitation in patients with severe combat spinal cord injury by combining spinal cord repetitive transvertebral magnetic stimulation (rTvMS) and non-invasive transcutaneous electrical stimulation (TcES) of peripheral nerves. Clinical rationale for study: For the best recovery from severe combat spinal cord injury, neurorehabilitation must start in the acute phase. Only technologies targeting sensorimotor conduction and functional improvement can confirm the potential of the time factor. Non-invasive neuromodulation has been shown to work for combat spinal cord injury of varying severity. Material and methods: We have analysed 154 cases of severe combat spinal cord injury, followed continuously for at least 12 months from the start of neurorehabilitation. A unified «end-to-end» protocol combined rTvMS of the spinal cord with simultaneous TcES of peripheral nerves in different modes was developed for non-invasive spinal cord neuromodulation. Results: The combination of these parameters produced the most positive results in post-traumatic sensory-motor disorders: (i). rTvMS, level ThX-LI: 2000 pulses per set, 100 pulse packages, 5–10 Hz, intensity “+ 30––40%” of the threshold of the evoked motor potential; TcES n. tibialis or n. peroneus: 5–10 Hz, pulse intensity corresponded to the threshold of the motor response, functional electrical stimulation (FES) mode. (ii). rTvMS, level CII-ThII: 2000 pulses per set, 50 pulse packages, 5–7 Hz, intensity + 20–30% of the threshold of the evoked motor potential; TcES n. medianus or n. ulnaris; n. tibialis or n. peroneus: 5–10 Hz, pulse intensity corresponded to the threshold of the motor response, FES mode. Approximately 28% of patients in group A (FRANKEL/ASIA) moved to a higher level of function after 3 courses of neurorehabilitation intervention (90 working days). Conclusions and clinical implications: Electro-magnetic stimulation of the spinal cord excitatory cell conduction system according to the principle of “end-to-end: as in Hebb’s theory,” combined with physical movement, led to an increase in spinal cord conduction in the acute phase of combat spinal cord injury. This was manifested by neurological and functional improvement.

Design and protocol for the decompression-plus trial: a phase 1 clinical study of dorsal myelotomy and expansive duroplasty with or without autologous nerve grafting in acute traumatic spinal cord injury

Design and protocol for the decompression-plus trial: a phase 1 clinical study of dorsal myelotomy and expansive duroplasty with or without autologous nerve grafting in acute traumatic spinal cord injury

High-Flux Chip for Sensitive Profiling of Small Extracellular Vesicle Proteins by Cas9/Switch-sgRNA Complex-Mediated Proximity Cleavage Assay.

Small extracellular vesicles (sEVs) play pivotal roles in modulating the pathological processes of various diseases and have emerged as promising biomarkers for disease diagnosis, including acute spinal cord injury and cancers. This is attributed to their ability to transport multiple proteins that reflect the molecular signatures of their parent cells. The evaluation of surface proteins presents a robust strategy for identifying a comprehensive set of biomarkers. In this study, we developed a high-throughput device capable of characterizing surface proteins on intact sEVs. Our approach employs CD63 antibodies immobilized on a 96-well plate and a CD9 aptamer integrated into switch-sgRNA, facilitating the efficient capture of intact sEVs and enabling subsequent surface protein profiling. The system utilizes a proximity cleavage assay mediated by the Cas9-nickase/switch-sgRNA complex and an identity probe, combined with DNA polymerase-assisted chain extension and displacement, to achieve highly specific and precise identification of target proteins. The DNA polymerase-mediated chain extension and displacement mechanism within the wells generates multiple G-rich sequences, which facilitate Thioflavin T (ThT)-based label-free signal amplification. This innovative design allows the high-throughput chip to profile the surface protein EpCAM on intact sEVs with exceptional sensitivity, achieving a remarkably low detection limit of 3.5 particles/μL. Moreover, the chip has been successfully applied to identify surface markers including EpCAM, PTK7, PDGF, and PSMA on sEVs derived from various biological samples, demonstrating its significant potential for high-throughput biomarker discovery and analysis.

The neuroprotective role of riluzole in spinal cord injury: a systematic review and meta-analysis.

We systematically reviewed the evidence for the efficacy of riluzole on functional recovery and lesion size following spinal cord injury (SCI). The search was conducted on Medline, Embase, Scopus, and Web of Science by November 2024 for studies evaluating the utility of riluzole administration following SCI in rodents and humans. Neurological and histopathological outcomes were extracted for subjects treated and not treated with Riluzole. Pooled effect estimates were calculated using the random-effects model. Heterogeneity was assessed using the I2 and Chi2 tests. Fifteen preclinical studies were included. Meta-analysis demonstrated that riluzole significantly improves locomotion recovery (standardized mean difference (SMD) = 0.70; 95% confidence interval (CI): 0.46, 0.95; p < 0.0001; I2 = 0.00%) and subsides the lesion size (SMD = -1.74; 95% CI: -2.47 to -1.01; p < 0.0001; I2 = 55.84%). The improvement in locomotion was not significantly different between mild to moderate and severe injuries (meta-regression coefficient = -0.22; 95% CI: -0.74, 0.30; p = 0.403). Notably, riluzole significantly improves motor function and reduces lesion size in animals with acute traumatic SCI. The improvement only occurs with multi-dose administration of riluzole (SMD = 0.76; 95% CI: 0.49, 1.03; p < 0.0001), and no significant effect was observed with single-dose therapies (SMD = 0.49; 95% CI: -0.05, 1.02; p = 0.074). Most human studies also report motor function improvements, further suggesting riluzole's potential as a therapeutic agent in SCI. These findings support further research and trials to confirm its efficacy in clinical settings.

Correlation between MRI and DTI parameters in acute thoracic spinal cord injury and clinical outcomes: A prospective observational study.

Correlation between MRI and DTI parameters in acute thoracic spinal cord injury and clinical outcomes: A prospective observational study.

Tetramethylpyrazine exerts a neuroprotective effect in acute spinal cord injury by mitigating oxidative stress through PKD1: Multi-omics analysis and experimental validation.

Tetramethylpyrazine exerts a neuroprotective effect in acute spinal cord injury by mitigating oxidative stress through PKD1: Multi-omics analysis and experimental validation.

Characterizing post-operative ICU admission after cervical spondylotic myelopathy surgery.

Characterizing post-operative ICU admission after cervical spondylotic myelopathy surgery.

The Synergistic Effect of Acute Traumatic Brain Injury and Spinal Cord Injury on the Development of Chronic Pain: A Populational Cohort Study on Neurotrauma Patients in Canada

Background: The impact of concomitant traumatic brain injury (TBI) and spinal cord injury (SCI) on the development of problematic chronic pain has never been studied. We hypothesized that concomitant TBI increases the rates of problematic chronic pain outcomes in SCI individuals. Objectives: To examine the association between concomitant TBI-SCI (as opposed to isolated TBI or SCI) and the development of problematic chronic pain outcomes, including referral to a specialized pain clinic or long-term usage of opioids or other chronic pain medications. Methods: A retrospective observational cohort study on 18,861 neurotrauma patients from prospective governmental populational databases from the province of Quebec, Canada (population ~8 million) was conducted. The main independent variable was the nature of neurotrauma sustained at the time of the accident: TBI only versus SCI only versus concomitant TBI-SCI. Problematic chronic pain was defined as (1) receiving a formal diagnosis of chronic pain, (2) using significant amounts of opioids, or (3) receiving a referral to a chronic pain clinic. Results: Out of the all the included patients, 16,472 (87%) had TBI only, 1528 had TSCI only (8.1%), and 861 (4.6%) had concomitant TBI-SCI diagnosis. At the group level, patients with concomitant TBI-SCI presented markedly higher use of opioid/chronic pain medication than patients with SCI or TBI only (15.3% vs. 8.5% vs. 0.5%; P &amp;lt; .001). At the multivariate level, the nature of neurotrauma sustained remained significantly associated with all 3 outcomes that were used to define problematic chronic pain. Finally, a synergistic effect between SCI and TBI was confirmed for the development of chronic use of opioids and other pain medications (odds ratio [OR] 1.92; P &amp;lt; .001). Conclusion: This study supports a synergistic effect of TBI and SCI for the development of chronic use of opioids and other pain medications. Clinicians should be aware of potential underlying TBI in SCI patients in order to address potential chronic pain issues after neurotrauma.

Choosing the right treatment for degenerative cervical myelopathy.

Choosing the right treatment for degenerative cervical myelopathy.

3D MRI Tract-Specific Spinal Cord Lesion Pattern Improves Prediction of Distinct Neurological Recovery.

To distinguish lateralized motor- and sensory-tract damage after acute spinal cord injury (SCI) and explore its predictive power for motor and sensory recovery. Thirty-five SCI patients (two female) from a multi-center data set (placebo-arm of the Nogo-A-Inhibition in SCI trial) underwent routine T2-weighted sagittal MRI scans at the lesion site at baseline (19.9 days, 95% confidence interval [CI]: 17.9-21.8), 1-month (54.2 days, 95% CI: 52.1-56.2), and 6-month (192.4 days, 95% CI: 181.3-203.6) post-injury. Concurrently with the MRI scans, clinical examinations were performed. Lesions were manually segmented across all slices, and 3D-tract damage was assessed by determining the overlap between segmented lesions and identified motor and sensory tracts in the axial plane. The relationship between lesion assessments and baseline-adjusted clinical outcomes at 6 months was explored. Over the 6-month, patients recovered by 4.95 motor points/month (95% CI: 3.89-5.89, p < 0.001) on the International Standards for the Neurological Classification of SCI scale, 2.28 light-touch points/month (95% CI: 1.43-3.12, p < 0.001), and 2.06 pinprick points/month (95% CI: 1.21-2.91, p < 0.001). Lesion volume decreased from 381.82mm 3 (95% CI: 295.78-467.87) by -14.04 mm3/month (95% CI: -25.39 to -1.56, p = 0.023). MRI visible changes in motor tract damage over the 6-month were marginal (0.02%/month, 95% CI: -0.81 to -1.02, p = 0.971). Changes in the sensory tracts were more pronounced, decreasing by -0.69%/month (95% CI: -1.29 to -0.09, p = 0.05). Left-and-right motor-tract damage at baseline significantly predicted left-and-right motor score recovery (R2 = 0.75, p = 0.015), while baseline left-and-right sensory-tract damage significantly predicted improvements in left-and-right pin-prick scores (R2 = 0.79, p = 0.024). Revealing the extent of damage to spinal motor-and sensory-pathways early after SCI is a valuable predictor of related neurological recovery. Tracking 3D dynamics of major spinal pathways has the potential to enhance diagnostic accuracy and patient stratification for future clinical trials.

Severe scoliotic deformities: results of surgical treatment and complications in a multicentric series of children and young adults.

Severe scoliotic deformities: results of surgical treatment and complications in a multicentric series of children and young adults.

Predictive Factors Affecting the Need for Mechanical Ventilation in Acute Traumatic Cervical Spinal Cord Injury.

Acute traumatic cervical spinal cord injuries (TCSCI) are associated with significant mortality and morbidity, particularly when complicated by neurogenic respiratory failure. While upper cervical-level injuries are established risk factors for mechanical ventilation, patients with acute injuries below the fifth cervical level without significant chest trauma may also require ventilatory support. However, reliable early predictors remain unclear. This study aims to identify the primary predictors of early mechanical ventilation needs in patients with acute TCSCI. We conducted a retrospective analysis of 148 cases of TCSCI treated between 2019 and 2022. Among these, 27 cases (18.24%) required ventilatory support. Multivariate analysis revealed that a compression grade of 2 or higher, exceeding 25% on Computed Tomography (CT) (adjusted odds ratio [aOR]: 10.18; 95% CI: 2.03-50.94; p < 0.001), and a cord contusion length spanning at least two levels on Magnetic Resonance Imaging (MRI) (aOR: 2.11; 95% CI: 1.06-4.22; p = 0.03) were significant independent predictors. CT-based spinal cord compression measurements showed a strong correlation with MRI findings (linear regression coefficient = 0.88, 95% CI: 0.80-0.96; Spearman's rho = 0.90; both p < 0.001). The regression line was closely aligned with the equality line, indicating CT can reliably approximate MRI. Noninferiority testing revealed no significant difference in predicting mechanical ventilation risk between modalities (p = 0.21). Survival analyses stratified by compression grades demonstrated similar predictive performance, with higher compression grades (2-4) associated with increased risk of ventilation over time. These findings suggest that the degree of cord compression and cord contusion length are reliable, noninvasive predictors of the need for mechanical ventilation in TCSCI, emphasizing the importance of early recognition, cost-effective health care management, and prognostic counseling. The Subaxial Injury Classification and Severity Scale demonstrated borderline significance (sensitivity 81.5%, specificity 87.6%). The study found that patients with >25% cervical spinal cord compression had significantly poorer outcomes compared to those with ≤25% compression, including longer hospital stays, lower survival rates, worse pre-treatment neurological status, and higher complication rates. Surgical treatment, particularly the posterior approach, was more common in the >25% compression group; however, post-treatment neurological improvement was observed only in cases of grade 2 degree compression, not grades 3 and 4 in CT and MRI. In contrast, the ≤25% compression group demonstrated better outcomes, with greater post-treatment improvement. [Figure: see text].

Bisphosphonate Use in Acute Spinal Cord Injury: A Focused Systematic Review on Zoledronic Acid

Bisphosphonate Use in Acute Spinal Cord Injury: A Focused Systematic Review on Zoledronic Acid

AO Spine Clinical Practice Recommendations for the Surgical Management of Acute Traumatic Spinal Cord Injury: Contemporary Concepts.

Study DesignReview of the literature with critical appraisal and clinical recommendations.ObjectiveTo highlight contemporary concepts relating to surgical care for acute traumatic spinal cord injury (SCI) based on recent evidence that may be integrated into clinical practice.MethodsThree recent articles relating to the surgical management of acute traumatic SCI were selected and critically appraised. Clinical practice recommendations were developed and graded as strong or conditional.ResultsArticle 1: Early vs late surgical decompression for central cord syndrome. Strong recommendation to consider early surgery (<24 hours) as an option in patients with ASIA Impairment Scale (AIS) grade C central cord syndrome. Article 2: Extent of decompression in motor complete SCI. Conditional recommendation to consider laminectomy, with or without anterior surgery, to achieve circumferential decompression of the spinal cord. Article 3: Use of intra-operative ultrasound. Conditional recommendation to use ultrasound intra-operatively to confirm the adequacy of surgical decompression.ConclusionsTimely and adequate decompression of the spinal cord are critical priorities in the management of acute traumatic SCI. The importance of timeliness extends to central cord syndrome. Careful consideration and use of operative techniques (e.g., addition of laminectomy) and adjuncts (e.g., intra-operative ultrasound) help achieve safe and adequate decompression of the spinal cord.

Spinal cord injury in severely injured patients: results from the Swiss Trauma Registry

Background and objectivesTraumatic spinal cord injuries (SCIs) in the context of severe trauma are rare, and patient demographics are infrequently reported. This study aimed to assess patient demographics in acute traumatic SCI in the context of severe injuries in Switzerland and to evaluate differences in demographics and outcomes stratified by timing of surgery.MethodsWe analyzed data from the Swiss Trauma Registry (STR) from 2015 to 2024. The STR includes patients with major trauma (injury severity score [ISS] ≥ 16 and/or abbreviated injury scale [AIS] head ≥ 3) admitted to any level-one trauma centre in Switzerland. We evaluated patient characteristics, complications, and hospital outcomes, which were further stratified by early (< 24 h) and late (≥ 24 h) surgery.ResultsAmong 24,328 patients, 6,819 (28%) sustained spinal injuries, and 383 (1.6%) had a concurrent SCI with an incidence of 0.44 cases per 100’000 inhabitants. The median age was 52 years (IQR 31–70) and 73.6% were male. The primary causes were falls (63.1%) and road traffic accidents (29.6%). The in-hospital mortality rate was 4.7%. Late surgery patients more often had concomitant moderate or severe traumatic brain injuries (31% vs. 14%, p = 0.009) and were more likely to have no fractures or dislocations of the spine (22.8% versus 6.8%, p = 0.001). Patients who underwent early surgery had shorter hospital stays (9d [5-16], versus 16 d [9-24]; F = 13.92, p < 0.001). Late surgery was associated with a higher likelihood of developing two and more complications (OR 2.57, 95% CI 1.18–5.63, p = 0.018), including urinary tract infections (OR 12.13, 95% CI 2.76–53.41, p = 0.001) and multiple organ failure (OR 12.99, 95% CI 1.64-102.83, p = 0.015).ConclusionsThis study offers insights into the characteristics and outcomes of acute SCI care in severely injured patients. Despite its low incidence, the acute management of this patient population remains highly challenging. Our findings suggest early stabilization of spinal injuries in severely injured patients may reduce hospital stays and complications.

Actively Controlled Exoskeletons Show Improved Function and Neuroplasticity Compared to Passive Control: A Systematic Review.

Study DesignSystematic Review.ObjectivesTo determine whether actively controlled exoskeletons or passively controlled exoskeletons are better at rehabilitating patients with SCIs.MethodsA literature search between January 2011 to June 2023 on Pubmed Central, Pubmed, Web of Science and Embase was carried out. Exoskeletons were classified as actively controlled if they detect bioelectrical signals (HAL). All other exoskeletons were classified as passively controlled (ReWalk, Ekso, H-MEX, Atlante, Indego, Rex Bionics, SuitX Phoenix, Lokomat and HANK). Functional outcomes used were 6 minute walk test (6MWT) distance and 10metre walk test (10MWT) speed. Further subgroup analysis was carried out for acute and chronic SCI patients. All outcomes were examined without the aid of the exoskeleton device. Secondary outcomes including continence, pain and quality of life were also examined.Results555 articles were identified in the initial search and 27 were included in the review resulting in a total of 591 patients and 10 different exoskeleton models. HAL was the only exoskeleton to show improvements in both mobility and all secondary health outcomes. HANK and Ekso also showed improvements in mobility. Rewalk showed improvements in all secondary health outcomes with Ekso only showing improvements in QoL. No other exoskeletons showed significant improvements.ConclusionIn conclusion, the actively controlled exoskeleton HAL showed improvement in all outcomes of interest suggesting that neuroplasticity could be induced with HAL rehabilitation allowing the weakened bioelectrical signals to transcend the SCI to show genuine improvements.

Assessing the predictive value of the Risk Analysis Index for short-term outcomes in acute spinal cord injury surgery.

Acute traumatic spinal cord injury (tSCI) requires rapid surgical intervention to maximize neurological function. Older patients comprise an increasingly larger proportion of SCI patients annually, necessitating accurate preoperative risk stratification tools. This study utilized a frailty-based preoperative risk stratification score to predict adverse events following non-elective neurosurgical intervention for acute tSCI patients. The National Inpatient Sample (NIS) was queried for acute tSCI patients aged ≥18 who underwent spine surgery in 2019-2020. The Risk Analysis Index (RAI) was implemented with crosstabulation, to analyze frailty scores with the following binary outcome measures: overall complications, non-home discharge (NHD), extended length of stay (eLOS) (>75th percentile), and mortality. Area Under the Receiver Operating Characteristic (AUROC) analysis assessed the discriminative threshold of RAI compared to the modified 5-item Frailty Index (mFI-5) for NHD and 30-day mortality. A total of 9995 SCI patients underwent non-elective spine surgery. There were 1525 perioperative complications (15.3%) and 510 (5.1%) mortalities. An increasing RAI score was significantly associated with increasing postoperative mortality rates: RAI 0-20 (1.5%, N.=45), RAI 21-30 (3.4%, N.=110), RAI 31-40 (6.8%, N.=115), and RAI>41 (11.8%, N.=240) (P<0.001). RAI demonstrated superior discrimination compared to the mFI-5 for mortality and NHD with a C-statistic >0.72. Increasing frailty, as measured by RAI, was a reliable predictor of non-home discharge and 30-day mortality for SCI patients who underwent non-elective spinal surgery and RAI demonstrated superior discrimination compared to the mFI-5 for NHD and mortality.

Research on multi-algorithm and explainable AI techniques for predictive modeling of acute spinal cord injury using multimodal data

Machine learning technology has been extensively applied in the medical field, particularly in the context of disease prediction and patient rehabilitation assessment. Acute spinal cord injury (ASCI) is a sudden trauma that frequently results in severe neurological deficits and a significant decline in quality of life. Early prediction of neurological recovery is crucial for the personalized treatment planning. While extensively explored in other medical fields, this study is the first to apply multiple machine learning methods and Shapley Additive Explanations (SHAP) analysis specifically to ASCI for predicting neurological recovery. A total of 387 ASCI patients were included, with clinical, imaging, and laboratory data collected. Key features were selected using univariate analysis, Lasso regression, and other feature selection techniques, integrating clinical, radiomics, and laboratory data. A range of machine learning models, including XGBoost, Logistic Regression, KNN, SVM, Decision Tree, Random Forest, LightGBM, ExtraTrees, Gradient Boosting, and Gaussian Naive Bayes, were evaluated, with Gaussian Naive Bayes exhibiting the best performance. Radiomics features extracted from T2-weighted fat-suppressed MRI scans, such as original_glszm_SizeZoneNonUniformity and wavelet-HLL_glcm_SumEntropy, significantly enhanced predictive accuracy. SHAP analysis identified critical clinical features, including IMLL, INR, BMI, Cys C, and RDW-CV, in the predictive model. The model was validated and demonstrated excellent performance across multiple metrics. The clinical utility and interpretability of the model were further enhanced through the application of patient clustering and nomogram analysis. This model has the potential to serve as a reliable tool for clinicians in the formulation of personalized treatment plans and prognosis assessment.

Establishment of a Nomogram model for individualized prediction of the risk of acute spinal cord injury complicated with respiratory dysfunction

To analyze the risk factors of acute spinal cord injury complicated with respiratory dysfunction, and to construct the clinical prediction model of acute spinal cord injury complicated with respiratory dysfunction. Continuous 170 cases of acute spinal cord injury treated from April 2019 to October 2022 were retrospectively collected, and clinical data were uniformly collected. Patients were divided into respiratory dysfunction group 30 cases and non-respiratory dysfunction group 140 cases according to whether they had respiratory dysfunction during treatment. The predictive factors of acute spinal cord injury complicated with respiratory dysfunction were screened by Lasso analysis, and the risk factors of acute spinal cord injury complicated with respiratory dysfunction were screened by multivariate Logistic regression analysis. R(R4.2.1) software was used to establish a nomogram risk warning model for predicting acute spinal cord injury complicated with respiratory dysfunction, and Hosmer-Lemeshow test was used to evaluate the model fit. Finally, area under receiver operating characteristic(ROC) curve (AUC), calibration curve, and decision curve analysis(DCA) were used to evaluate the differentiation, calibration and clinical impact of the model. The incidence of respiratory dysfunction in 170 patients was 17.65%. Lasso regression analysis selected age, residence, marital status, smoking, hypertension, degree of paralysis, spinal cord injury plane, multiple injuries, spinal cord fracture and dislocation, and ASIA grade as the influencing factors. Multivariate Logistic regression analysis showed that age, smoking, degree of paralysis, level of spinal cord injury, spinal cord injury of fracture and dislocation, and ASIA grade were risk factors for acute spinal cord injury complicated with respiratory dysfunction. The prediction model of acute spinal cord injury complicated with respiratory dysfunction was established by Hosmer-Lemeshow test, χ2=5.830, P=0.67. The AUC value of the model was 0.912. DCA analysis showed that the net benefit value of nomogram prediction of acute spinal cord injury complicated with respiratory dysfunction was higher when threshold probability ranged from 1% to 100%. This column chart can help identify the risk of acute spinal cord injury complicated with respiratory dysfunction in early clinical stage, facilitate early clinical decision-making and intervention, and has important guiding significance for optimizing clinical efficacy and improving prognosis of patients. It is expected to improve and verify this model with larger samples and multi-center in the future.