American Spinal Injury Association Sensory Scores Research Articles

Effectiveness of different surgical methods in the treatment of acute central cord syndrome without fractures and dislocations of the cervical spine.

Acute central cord syndrome (ACCS) without fractures or dislocations is the most common form of incomplete spinal cord injury. To evaluate the effectiveness of different surgical methods in the treatment of acute central cord syndrome without fractures or dislocations of the cervical spine. A total of 164 patients with ACCS without fracture or dislocation of the cervical spine treated in our hospital from May 2012 to October 2019 were recruited and assigned to study group A and study group B according to different treatment modalities, with 82 cases in each group. Study group A underwent anterior cervical discectomy and fusion, and study group B was treated with posterior cervical laminectomy. The American Spinal Injury Association (ASIA) classification and motor scores of all cases at admission and at discharge were recorded, and the treatment outcomes of the two groups were compared. No significant differences were found in the ASIA classification and ASIA motor scores between the two groups at admission (P> 0.05). One year after surgery, the ASIA motor scores and sensory scores were not statistically significant between the two groups (P> 0.05) but showed significant improvement compared to the preoperative scores (P< 0.05). Both anterior cervical discectomy and fusion and posterior cervical laminectomy can improve the ASIA classification, ASIA motor scores, and sensory scores of ACCS patients without fractures or dislocations of the cervical spine. Therefore, surgical methods should be adopted based on the patients' conditions.

Application of Modest Hypothermia in Patients with Acute Traumatic Cervical Spine Injury: A Pilot Study.

This prospective randomized controlled study aimed to examine the role of modest systemic hypothermia in individuals with acute cervical spinal cord injury (SCI) regarding neurological improvement. Studies have shown that the application of hypothermia is safe and that it improves neurological outcomes in patients with traumatic spine injury. Hypothermia helps in decreasing a secondary damage to the cord. Twenty cases of acute post-traumatic cervical SCI with AISA were selected and randomly divided into two treatment groups: Group A-Hypothermia with surgical decompression and stabilization; and Group B-Normothermia with surgical decompression and stabilization. American Spinal Injury Association (ASIA) motor and sensory scores were evaluated at presentation; post-surgery; and at a 2-week, 6-week, and 12-week follow-up. At the final follow-up, the change in ASIA motor scores of Group A was 46 (11.5-70.5) and Group B 13 (4.5-58.0), whereas ASIA sensory scores were 118 (24.75-186.5) and 29 (15.25-124.0) in Group A and Group B, respectively. ASIA scores between the two groups were statistically significantly different at a 2-week follow-up (ASIA motor p=0.04, ASIA sensory p=0.006), showing early improvement in the hypothermia group. There was no significant difference between the two groups on further follow-up. Hypothermia can be applied safely to subjects with acute SCI. Our study showed that hypothermia was beneficial in the early improvement of functional outcomes in acute cervical SCI.

Effects of hyperbaric oxygen therapy on postoperative recovery after incomplete cervical spinal cord injury.

A retrospective study of incomplete cervical spinal cord injury (SCI) treated with and without hyperbaric oxygen (HBO) therapy after operation. To investigate the effects of hyperbaric oxygen therapy on patients' postoperative recovery after incomplete cervical spinal cord injury. Shulan Hangzhou Hospital, Hangzhou, China. We analyzed the clinical data of 78 patients admitted in the Orthopedic Department of our hospital from June 2014 to June 2016, due to trauma-induced incomplete cervical spinal cord injury. All study subjects underwent nerve decompression and internal fixation procedures within 2 weeks of injury. The patients were divided into hyperbaric oxygen therapy (HBO) group (n = 40) and non-hyperbaric oxygen therapy (NHBO) group (n = 38) according to the chosen treatment option. The NHBO group only receive the conventional treatment regimen while the HBO group received a combination of conventional treatment and hyperbaric oxygen therapy. The subsequent changes in spinal functions and activities of daily living (ADL) were assessed by The American Spinal Injury Association (ASIA) scale and the Barthel Index at different time points (pretreatment, 1 month and 3 months of treatment, as well as 6 months, 1 year, 2 years, and 3 years after the surgical procedure). There were no significant differences in age, gender, injury site, and disease condition between patients (p > 0.05). The results showed a significant difference in treatment total effectiveness rate between the HBO and NHBO groups (p < 0.05) (90% and 78.9%, respectively). Analyses of the ASIA scores and Barthel indices between the two groups indicated significant differences at 1 month and 3 months treatment time points, as well as 6 months and 1 year after the initial operation (p < 0.05). It showed that subjects in the HBO group had a better recovery than their NHBO counterparts, with the 1-month treatment time point being the most significant. In addition, the results indicated significant improvements in Barthel Index scores as well as ASIA sensory and motor function scores in both groups after a 1-month treatment, with the HBO group faring significantly better than the NHBO group (p < 0.01). Our results not only showed that hyperbaric oxygen therapy is safe and effective for the treatment of incomplete cervical spinal cord injury but also indicated that the longer the treatment lasts (therapy initiation within 3 months after the surgical operation), the better the effects. In addition, a correct hyperbaric oxygen therapy leads to a peak in recovery within the first postoperative 3 months and can effectively promote spinal cord functions, reduce the disabilities, and improve patients' quality of life.

Evaluation of Surgical Treatment and the Relationship between Thoracolumbar Injury Severity and Classification Score and Preoperative Cross-Sectional Area in Patients with Thoracolumbar and Lumbar Burst Fractures

Background: The aim of the study was to establish a correlation between (1) the Thoracolumbar Injury Severity and Classification score (TLICS) and sensory scores and motors scores of the American Spinal Injury Association (ASIA) Scale (surgical outcome); correlation between preoperative cross-sectional area (CSA) and the ASIA; (2) to establish a correlation between the TLICS and the CSA in thoracolumbar and lumbar burst fracture (TLBF) patients and (3) the evaluation of surgical outcome based on the ASIA scale and its relationship to TLICS. Methods: This was a prospective study and 67 patients (mean age 30.3 ± 8.1 years; 18.2% were female) were assessed. The TLICS was determined and TLICS > 4 was hypothesized to be consistent with an indication for surgery. Nerve injury was assessed according to ASIA. The CSA and the ASIA were measured at two points in time: pre- and postoperative assessments. The surgical outcome and correlations were assessed. Results: Patients were followed an average of 26.2 months. ASIA sensory scores and motor scores were improved significantly at last follow-up. No patient experienced neurological worsening during follow-up. No significant correlations were observed between the ASIA and the CSA at either the pre- or postoperative periods. However, there was a statistically significant correlation between TLICS and the ASIA motor and ASIA sensory (P 4 may be applied in the decision-making process for surgery for TLBF. However, the CSA is not useful for decision making for this pathology.

Spinal Cord Injury-Assessing Tolerability and Use of Combined Rehabilitation and NeuroAiD (SATURN Study): Protocol of An Exploratory Study In Assessing the Safety and Efficacy of NeuroAiD Amongst People Who Sustain Severe Spinal Cord Injury.

BackgroundSpinal cord injury (SCI) is a devastating condition with limited therapeutic options despite decades of research. Current treatment options include use of steroids, surgery, and rehabilitation. Nevertheless, many patients with SCI remain disabled. MLC601 (NeuroAiD), a combination of natural products, has been shown to be safe and to aid neurological recovery after brain injuries and may have a potential role in improving recovery after SCI.ObjectiveThe aim of this study is to evaluate the safety and efficacy of NeuroAiD amongst people who sustain SCI in the study setting.MethodsSpinal Cord Injury—Assessing Tolerability and Use of Combined Rehabilitation and NeuroAiD (SATURN) is a prospective cohort study of patients with moderately severe to severe SCI, defined as American Spinal Injury Association (ASIA) Impairment Scale (AIS) A and B. These patients will be treated with open-label NeuroAiD for 6 months in addition to standard care and followed for 24 months. Anonymized data will be prospectively collected at baseline and months 1, 3, 6, 12, 18, and 24 and will include information on demographics; main diagnostics; and neurological and functional state assessed by the Spinal Cord Independence Measure, ASIA—International Standard for Neurological Classification Spinal Cord Injury, and Short Form (SF-8) Health Survey. In addition, NeuroAiD treatment, compliance, concomitant therapies, and side effects, if any, will be collected. Investigators will use a secured online system for data entry. The study is approved by the ethics committee of Hospital University Kebangsaan Malaysia.ResultsThe coprimary endpoints are safety, AIS grade, and improvement in ASIA motor score at 6 months. Secondary endpoints are AIS grade, ASIA motor scores and sensory scores, Spinal Cord Independence Measure (SCIM), SF-8 Health Survey, and compliance at other time points.ConclusionsSATURN investigates the promising role of NeuroAiD in SCI especially given its excellent safety profile. We described here the protocol and online data collection tool we will use for this prospective cohort study. The selection of moderately severe to severe SCI provides an opportunity to investigate the role of NeuroAiD in addition to standard rehabilitation in patients with poor prognosis. The results will provide important information on the feasibility of conducting larger controlled trials to improve long-term outcome of patients with SCI.Trial RegistrationClinicaltrials.gov NCT02537899; https://clinicaltrials.gov/ct2/show/NCT02537899 (Archived by WebCite at http://www.webcitation.org/6m2pncVTG)

Bilateral transformational thoracolumbar interbody fusion for the treatment of giant central thoracolumbar junction disc herniation: A prospective clinical and radiological study

Study designClinical and radiological assessment of prospective single-center data. BackgroundThe optimal treatment strategy for giant central thoracolumbar junction disc herniation (TLDH) remains controversial. ObjectiveThis study aimed to report the clinical and radiological results of bilateral transformational thoracolumbar interbody fusion (bilateral TTIF) to treat giant central TLDH. MethodsSeventeen consecutive patients with giant central TLDH underwent bilateral TTIF from January 2014 to June 2014 and were followed for 9–15 months. Clinical and radiological data were prospectively examined, including operative time, blood loss, pre- and postoperative American Spinal Injury Association (ASIA) score for sensory and motor function, visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, fusion rate, extent of decompression, rate of instrumentation failure, and complications. ResultsThe average time of surgery was 160±37min, and blood loss was 884±197ml. The ASIA sensory and motor scores improved from 72.76±3.36 to 90.71±2.54 and from 68.47±4.7 to 88.0±3.2, respectively. VAS for back pain and ODI decreased from 6.65±1.93 to 2.23±0.56 and from 42.82±5.08 to 11.3±2.3, respectively. Canal encroachment improved from 50.3±6.6% to 2±0.3% at the last follow-up. Surgery complications were seen in 5 patients (29%), who experienced intraoperative dural tear and cerebrospinal fluid leak. There were no other major complications at the last follow-up. ConclusionsBilateral TTIF produced satisfactory outcomes and may be one of the surgical treatments of choice for myelopathy due to giant central TLDH.

Diagnosis and treatment of skipping amphi-laceration of disco-ligamentous complex combined with hyperextension injury to the cervical spinal cord

Objective To explore the diagnosis and treatment of skipping amphi-laceration of disco-ligamentous complex (DLC) combined with hyperextension injury to the cervical spinal cord. Methods From January 2008 to December 2012, 17 cases of skipping amphi-laceration of DLC combined with hyperextension injury to the cervical spinal cord were surgically treated at our department. They were 15 men and 2 women, 21 to 57 years of age (average, 36. 3 years). Cervical spine MRI and dynamic flexion-extension lateral radiographs were performed in all patients preoperatively. Injured spinal cord segments were determined according to the plane of spinal cord injury and high signal changes in spinal cord on MRI. Segments of DLC laceration were evaluated according to cervical spine MRI and subaxial cervical stability on radiographs preoperatively. The neurological functions were graded according to the American Spinal Injury Association (ASIA) scale (version 2000) at preoperation, 3, 6 and 12 months postoperatively. The ASIA motor scores (AMS) and sensory scores (ASS) were analyzed statistically. Instrument failure and bony fusion were observed by follow-up radiographs. Results The 17 cases were followed up for an average of 28 months (from 12 to 42 months). The AMS and ASS at all postoperative time points were significantly better than those at preoperation in all patients ( P < 0. 05). Moreover, the AMS and ASS significantly improved as the follow-up time increased, with a significant difference between postoperative time points ( P < 0. 05). There was no failure of instrumentation and bony fusion was observed in all cases of bone grafting. Conclusions The skipping amphi-laceration of DLC combined with hyperextension injury to the cervical spinal cord is likely to be missed in diagnosis. The surgical procedures include decompression of the main spinal cord segment with hyperextension injury and DLC laceration and stability reconstruction of the lacerated DLC segment at the other end. Key words: Cervical vertebrae; Spinal cord; Injury; Disco-ligamentous complex

Surgical outcomes and correlation ODI and ASIA scores in patients with thoracolumbar and lumbar burst fractures

Background and Purpose: Decision-making process in Thoracolumbar and Lumbar Burst Fracture (TLBF) patients with Thoracolumbar Injury Severity and Classification Score (TLICS) > 4 is remained controversial. On the other hand, the question is whether that the Oswestry Disability Index (ODI) can be use to assess to clinical outcomes in these patients. We aimed to study the correlation between the ODI and American Spinal Injury Association (ASIA) impairment scale in these patients and evaluation of surgical outcome. Methods: This was a prospective study. The TLICS were determined and TLICS > 4 was included. The nerve injury was assessed according to sensory scores and motors scores of the using ASIA Scale at pre- and postoperative. It was also ODI calculated at last follow-up. In addition, correlation between ASIA and ODI was evaluated at last follow-up. Results: Fifty eight patients (20.7% female) who underwent spinal surgery for TLBF with a minimum follow up of 2 years were studied. The mean age was 30.7 ± 8.7 (24 to 65) years. Automobile accident was the predominant mode of injury. Patients were followed for 25 months on average (24 – 43 months). ASIA sensory scores and motor scores were improved significantly at last follow-up (P 4 surgical outcome is acceptable. It also shows that the ODI and the ASIA scores have a strong correlation in measuring disability in patients with TLBF after at least 2 year follow-up.

Recovery of Sensory and Supraspinal Control of Leg Movement in People With Chronic Paraplegia: A Case Series

ObjectiveTo report on unexpected findings in 4 patients with chronic paraplegia who underwent the laparoscopic implantation of neuroprosthesis procedure in the pelvic lumbosacral nerves. DesignObservational case series. SettingTertiary referral unit specialized in advanced gynecological surgery and neuropelveology. ParticipantsThree patients with incomplete American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade B (n=2) and AIS grade C (n=1) spinal cord injury (SCI) and 1 patient with flaccid complete chronic SCI (AIS grade A) (n=1). InterventionFunctional electrical stimulation (FES)-assisted locomotor training and continuous low-frequency pelvic-lumbosacral neuromodulation. Main Outcome MeasuresChange in ASIA Lower Extremity Motor Scores, ASIA sensory scores for light touch and pinprick sensation, and Walking Index for Spinal Cord Injury scores. ResultsAll 4 patients developed progressive recovery of some sensory and voluntary motor functions below the lesions. Three are currently capable of voluntary weight-bearing standing and walking a few meters with a walker without FES. The first patient with the longest follow-up is even capable of electrically assisted standing/walking with 2 crutches without braces or assistance for a distance of about 900 meters, and of weight-bearing standing and walking for 30 meters with a walker without stimulation. ConclusionsWe report unexpected sensory and locomotor recovery in 4 people with paraplegia with SCI. Our findings suggest that FES-assisted locomotor training with continuous low-frequency pelvic nerve stimulation in patients with SCI may induce changes that affect the central pattern generator and allow supra- and infraspinal inputs to engage residual spinal pathways.

Acidic fibroblast growth factor for repair of human spinal cord injury: a clinical trial

The study aimed to verify the safety and feasibility of applying acidic fibroblast growth factor (aFGF) with fibrin glue in combination with surgical neurolysis for nonacute spinal cord injury. This open-label, prospective, uncontrolled human clinical trial recruited 60 patients with spinal cord injuries (30 cervical and 30 thoracolumbar). The mean patient age was 36.5 ± 15.33 (mean ± SD) years, and the male/female ratio was 3:1. The mean time from injury to treatment was 25.7 ± 26.58 months, and the cause of injury included motor vehicle accident (26 patients [43.3%]), fall from a height (17 patients [28.3%]), sports (4 patients [6.7%]), and other (13 patients [21.7%]). Application of aFGF with fibrin glue and duraplasty was performed via laminectomy, and an adjuvant booster of combined aFGF and fibrin glue (2 ml) was given at 3 and 6 months postsurgery via lumbar puncture. Outcome measurements included the American Spinal Injury Association (ASIA) motor scores, sensory scores, impairment scales, and neurological levels. Examination of functional independence measures, visual analog scale, MR imaging, electrophysiological and urodynamic studies, hematology and biochemistry tests, tumor markers, and serum inflammatory cytokines were all conducted. All adverse events were monitored and reported. Exclusions were based on refusal, unrelated adverse events, or failure to participate in the planned rehabilitation. Forty-nine patients (26 with cervical and 23 with thoracolumbar injuries) completed the 24-month trial. Compared with preoperative conditions, the 24-month postoperative ASIA motor scores improved significantly in the cervical group (from 27.6 ± 15.55 to 37.0 ± 19.93, p < 0.001) and thoracolumbar group (from 56.8 ± 9.21 to 60.7 ± 10.10, p < 0.001). The ASIA sensory scores also demonstrated significant improvement in light touch and pinprick in both groups: from 55.8 ± 24.89 to 59.8 ± 26.47 (p = 0.049) and 56.3 ± 23.36 to 62.3 ± 24.87 (p = 0.003), respectively, in the cervical group and from 75.7 ± 15.65 to 79.2 ± 15.81 (p < 0.001) and 78.2 ± 14.72 to 82.7 ± 16.60 (p < 0.001), respectively, in the thoracolumbar group. At 24-month follow-up, the ASIA impairment scale improved significantly in both groups (30% cervical [p = 0.011] and 30% thoracolumbar [p = 0.003]). There was also significant improvement in neurological level in the cervical (from 5.17 ± 1.60 to 6.27 ± 3.27, p = 0.022) and thoracolumbar (from 18.03 ± 4.19 to 18.67 ± 3.96, p = 0.001) groups. The average sum of motor items in functional independence measure also had significant improvement in both groups (p < 0.05). The walking/wheelchair locomotion subscale showed increased percentages of patients who were ambulatory (from 3.4% to 13.8% and from 17.9% to 35.7% in the cervical and thoracolumbar groups, respectively). There were no related adverse events. The use of aFGF for spinal cord injury was safe and feasible in the present trial. There were significant improvements in ASIA motor and sensory scale scores, ASIA impairment scales, neurological levels, and functional independence measure at 24 months after treatment. Further large-scale, randomized, and controlled investigations are warranted to evaluate the efficacy and long-term results.

Relevance of the diagnosis traumatic cervical Brown-Séquard-plus syndrome: an analysis based on the neurological and functional recovery in a prospective cohort of 148 patients

Prospective multi-center cohort study. To compare the neurological and functional recovery between tetraplegic Brown-Séquard-plus syndrome (BSPS) and incomplete tetraplegia (non-BSPS). European Multicenter Study of Human Spinal Cord Injury (EM-SCI). BSPS was defined as a traumatic incomplete spinal cord injury (SCI) with ipsilateral weakness and contralateral loss of pinprick sensation at neurologic levels C2-T1. Acute (0-15 days) and chronic phase (6 or 12 months) were assessed for the American Spinal Injury Association (ASIA) sensory scores, upper extremity motor scores and lower extremity motor scores. Furthermore, chronic phase scores of all Spinal Cord Independence Measure (SCIM) II items were analyzed. Differences in neurological and functional outcome between BSPS patients and non-BSPS patients were calculated using Student's t-tests and Wilcoxon signed rank tests. Out of 148 tetraplegic patients, 30 were diagnosed with BSPS. Patients with an ASIA impairment scale (AIS) B were significantly (P<0.001) more identified in non-BSPS patients (25%) compared with BSPS patients (3%), respectively. After 12 months, the median scores for sphincter management of the bladder for both BSPS and non-BSPS patients were 15. Both 25 and 75% quartile median scores were 15 for BSPS patients and 12 and 15 for non-BSPS patients (P<0.02). Except for the difference in bladder function, no significant differences were identified in other SCIM II subitems and ASIA motor or sensory scores between BSPS and non-BSPS patients when stratified for injury severity by excluding AIS B patients. Compared with incomplete tetraplegic patients, patients with cervical BSPS have a similar neurological and functional recovery when matched for the AIS.

Course 510: Spinal cord injury: Severity of Sensory Impairment Determines Alterations in Cortical Moto Commands in Chronic Spinal Cord: A Case Series

Objective: The aim of this study was to characterize the relation between changes in cortical motor commands and the severity of motor and sensory impairment after spinal cord injury (SCI). Design: Prospective. Setting: Outpatient. Participants: SCI subjects and healthy volunteers. Interventions: A 64-channel electroencephalogram was used to record movement related brain potentials from 9 chronic (>2y) SCI subjects and 9 neurologically intact volunteers (controls) while they attempted toe flexion. American Spinal Injury Association (ASIA) motor and sensory score and ASIA impairment scale of each SCI subject were evaluated. Main Outcome Measures: The negative slope, a component of movement related brain potentials preceding the onset of movement was identified and the Center of Cortical Activation (CCA) at the time of peak negative slope was calculated on voltage topographic maps. Difference in location of the CCA in SCI subjects compared with controls was taken as evidence of an altered pattern of motor command generation by the brain. Results: CCAs in SCI subjects were displaced posterior as compared with their location in controls. Step-wise linear regression analysis revealed that the degree of posterior displacement had a statistically significant correlation with the ASIA sensory score (P=.013), but not with the ASIA motor score or the impairment scale. Subjects with greater sensory impairment had a more posterior location of the CCA. The location of the CCA in SCI subjects with ASIA sensory scores below the median (66) for the SCI group was significantly different from that in healthy subjects (P<.05) and SCI subjects with an ASIA sensory score greater than the median (P<.05). Conclusions: Severity of sensory impairment is the major determinant of the extent of alteration in premovement cortical motor commands after SCI.

Posterior Reduction/Fusion Followed by Anterior Decompression/Fusion of Unreduced Bilateral Facet Fracture-Dislocation in the Lower Cervical Trauma

We evaluate the results of posterior reduction/fusion followed by anterior fusion in 17 unreduced bilateral cervical facet fracture-dislocations with neurologic deficit. The patients were investigated for neurologic recovery [American Spinal Injury Association (ASIA) motor and sensory scale], fusion rate and period, complications, operating time, and canal-to-body ratio at the region of injury. At the last follow-up, the ASIA motor and sensory scores demonstrated a statistically significant increase. No patient showed aggravation of neurologic symptoms. Canal-to-body ratio was 0.60±0.33 preoperatively and 0.92±0.06 postoperatively, which is a statistically significant increase. Posterior reduction/fusion followed by anterior decompression/fusion in unreduced cervical bilateral facet dislocation should be familiar to spine surgeons. It is not complex and is a relatively nondangerous treatment.

Functional electrical stimulation cycling improves body composition, metabolic and neural factors in persons with spinal cord injury

Persons with spinal cord injury (SCI) are at a heightened risk of developing type II diabetes and cardiovascular disease. The purpose of this investigation was to conduct an analysis of metabolic, body composition, and neurological factors before and after 10 weeks of functional electrical stimulation (FES) cycling in persons with SCI. Eighteen individuals with SCI received FES cycling 2–3 times per week for 10 weeks. Body composition was analyzed by dual X-ray absorptiometry. The American Spinal Injury Association (ASIA) neurological classification of SCI test battery was used to assess motor and sensory function. An oral glucose tolerance (OGTT) and insulin-response test was performed to assess blood glucose control. Additional metabolic variables including plasma cholesterol (total-C, HDL-C, LDL-C), triglyceride, and inflammatory markers (IL-6, TNF-α, and CRP) were also measured. Total FES cycling power and work done increased with training. Lean muscle mass also increased, whereas, bone and adipose mass did not change. The ASIA motor and sensory scores for the lower extremity significantly increased with training. Blood glucose and insulin levels were lower following the OGTT after 10 weeks of training. Triglyceride levels did not change following training. However, levels of IL-6, TNF-α, and CRP were all significantly reduced.

Nerve repair using acidic fibroblast growth factor in human cervical spinal cord injury: a preliminary Phase I clinical study

The aim of this study was to assess functional outcomes of nerve repair using acidic fibroblast growth factor (FGF) in patients with cervical spinal cord injury (SCI). Nine patients who had cervical SCI for longer than 5 months were included in pre- and postoperative assessments of their neurological function. The assessments included evaluating activities of daily living, associated functional ability, and degree of spasticity, motor power, sensation, and pain perception. After the first set of assessments, the authors repaired the injured segment of the spinal cord using a total laminectomy followed by the application of fibrin glue containing acidic FGF. Clinical evaluations were conducted 1, 2, 3, 4, 5, and 6 months after the surgery. Preoperative versus postoperative differences in injury severity and grading of key muscle power and sensory points were calculated using the Wilcoxon signed-rank test. The preoperative degree of injury severity, as measured using the American Spinal Injury Association (ASIA) scoring system, showed that preoperative motor (52.4 +/- 25.9 vs 68.6 +/- 21.5), pinprick (61.0 +/- 34.9 vs 71.6 +/- 31.0), and light touch scores (57.3 +/- 33.9 vs 71.9 +/- 30.2) were significantly lower than the respective postoperative scores measured 6 months after surgery (p = 0.005, 0.012, and 0.008, respectively). Based on the significant difference in ASIA motor and sensory scale scores between the preoperative status and the 6-month postoperative follow-up, this novel nerve repair strategy of using acidic FGF may have a role in the repair of human cervical SCI. Modest nerve regeneration occurred in all 9 patients after this procedure without any observed adverse effects. This repair strategy thus deserves further investigation, clinical consideration, and refinement.

Functional outcome following spinal cord injury: Significance of motor-evoked potentials and ASIA scores

Objective: Prediction of outcome of ambulatory capacity and hand function in tetraplegic patients with spinal cord injury (SCI) using neurologic examination, according to the protocol of the American Spinal Injury Association (ASIA) and motor-evoked potentials (MEP). Design: Correlation study on a prospective cohort. Setting: SCI center, university hospital. Patients: Thirty-six patients with acute and 34 with chronic SCI. Outcome Measures: (1) ASIA motor and sensory scores, (2) MEP recordings of upper and lower limb muscles, and (3) outcome of ambulatory capacity and hand function. Results: In acute and chronic SCI, both the initial ASIA scores and the MEP recordings were significantly related ( p < .0001) to the outcome of ambulatory capacity and hand function. In tetraplegic patients, the MEP of the abductor digiti minimi muscle (Spearman correlation coefficient, .75; p < .0001) and the ASIA motor score for the upper limbs (Spearman correlation coefficient, .83; p < .0001) were most related to the outcome of hand function. Ambulatory capacity could be predicted by the ASIA motor score of the lower limbs (Spearman correlation coefficient, .78; p < .0001) and by MEP recordings of the leg muscles (Spearman correlation coefficient, .77; p < .0001). In patients with acute SCI, for the period 6 months posttrauma, the ASIA motor score increased significantly (ANOVA, p < .05), whereas the ASIA sensory scores and MEP recordings were unchanged (ANOVA, p > 0.1). Conclusion: Both ASIA scores and MEP recordings are similarly related to the outcome of ambulatory capacity and hand function in patients with SCI. MEP recordings are of additional value to the clinical examination in uncooperative or incomprehensive patients. The combination of clinical examination and MEP recordings allows differentiation between the recovery of motor function (hand function, ambulatory capacity) and that of impulse transmission of descending motor tracts.

Ambulatory capacity in spinal cord injury: significance of somatosensory evoked potentials and ASIA protocol in predicting outcome.

Prediction of outcome of ambulatory capacity in patients with acute spinal cord injury (SCI) by the American Spinal Injury Association (ASIA) protocol and somatosensory evoked potentials (SSEP). Correlational study on a prospective cohort. Spinal cord injury center, university hospital. Consecutively sampled, 70 acute and 34 chronic SCI patients. (1) ASIA motor and sensory scores; (2) tibial and pudendal SSEP graded in 5 categories, from normal to absent; (3) ambulatory capacity rated as no, therapeutic, functional, or full. The outcome of the ambulatory capacity was assessed after discharge from the rehabilitation program, at least 6 months after trauma. In acute SCI both the initial ASIA scores and the SSEP recordings are related (p < .001) to the outcome of ambulatory capacity. In acute tetraplegia the pudendal SSEP (spearman corr. coeff. .92; p < .001) and in acute paraplegia the ASIA motor score (spearman corr. coeff. .90; p < .001) were best related to the outcome of ambulatory capacity. In the early stage of acute SCI, ASIA scores and SSEP recordings can help to assess the outcome of ambulatory capacity and, therefore, can contribute to the selection of the appropriate therapeutic approaches during the rehabilitation program. In patients with acute SCI the ASIA motor score significantly increased (p < .05) in the 6 months after trauma, whereas the ASIA sensory scores and SSEP recordings did not change significantly during this same period. ASIA scores and SSEP are related to the outcome of ambulatory capacity in patients with acute spinal cord injury; in noncomprehensive or uncooperative patients the SSEP are of supplemental value to the clinical examination. Therefore, the combination of clinical and electrophysiological examinations can be of additional diagnostic value in the assessment of acute spinal cord injury.