Complete Cord Research Articles

Recovery of independent ambulation after complete spinal cord transection in the presence of the neuroprotectant polyethylene glycol in monkeys

ObjectiveDespite the conventional belief that motor function and sensation distal to the site of a complete spinal cord transection are irretrievable, our research has demonstrated significant motor recovery in mice, rats, and dogs by applying polyethylene glycol (PEG) topically via a syringe directly to the contact interface of transected spinal cord. However, before implementing this technology in human subjects, validating PEG's efficacy and enduring impact through experimentation on non-human primates is imperative. MethodsTwo 4-year-old female Macaca fascicularis monkeys underwent complete dorsal cord transection at T10. Postoperative behavioral assessment, electrophysiologic monitoring, and neuroimaging examinations were recorded, and tissues were obtained for histological examination at the end of study. ResultsThe monkey whose spinal cord had been fully transected in the presence of PEG developed useful recovery already at 3 months and near-complete recovery of motor function in the hind-limbs at 18 months. The control animal without PEG remained paralyzed. Cortical somatosensory evoked potentials recovered postoperatively only in PEG-treated monkey vs none in the control. Diffusion tensor imaging showed re-establishment of continuity of the white matter in PEG-treated monkey, but not in the control. Moreover, histology revealed intact neuronal bodies, axons, and myelin tissue at the spinal cord transection site in PEG-treated monkey only. ConclusionThis report suggests that in primates, an acutely transected spinal cord can be re-fused in the presence of PEG with restoration of neural continuity and functional recovery of motor activity distal to the site of transection.

Tuberculous meningitis causing holocord longitudinally extensive transverse myelitis

ABSTRACT Longitudinally extensive transverse myelitis (LETM) is a neurological entity with characteristic inflammatory lesions in ≥3 vertebral segments of the spinal cord. It is most commonly associated with neuromyelitis optica spectrum disorder. Other causes include infections, autoimmune disorders, and neoplasms. Tuberculosis has been reported as a cause of LETM in few case reports. However, tuberculous meningitis (TBM) as a cause of LETM is extremely rare, more so with involvement of the complete spine cord from the brainstem to the conus medullaris. A 65-year-old female was admitted to our hospital with sudden-onset tetraplegia and sensory, bowel, and bladder involvement. With no significant past history, mild meningeal signs, and normal metabolic profile, cerebrospinal fluid analysis was done revealing polymerase chain reaction test positive for Mycobacterium tuberculosis. Magnetic resonance imaging of the spine was suggestive of complete spinal cord edema extending from the brainstem to the level of conus medullaris without skip lesions. A final impression of holocord LETM caused by TBM was suggested after ruling out other causes. The case highlights TBM as a potential cause of LETM especially in endemic countries, especially Asian and African countries, more so with holocord involvement without skip lesions.

Dysmaturation of sleep state and electroencephalographic activity after hypoxia-ischaemia in preterm fetal sheep

Antenatal hypoxia-ischaemia (HI) in preterm fetal sheep can trigger delayed evolution of severe, cystic white matter injury (WMI), in a similar timecourse to WMI in preterm infants. We therefore examined how severe hypoxia-ischaemia affects recovery of electroencephalographic (EEG) activity. Chronically instrumented preterm fetal sheep (0.7 gestation) received 25 min of complete umbilical cord occlusion (UCO, n = 9) or sham occlusion (controls, n = 9), and recovered for 21 days. HI was associated with a shift to lower frequency EEG activity for the first 5 days with persisting loss of EEG power in the delta and theta bands, and initial loss of power in the alpha and beta bands in the first 14 days of recovery. In the final 3 days of recovery, there was a marked rhythmic shift towards higher frequency EEG activity after UCO. The UCO group spent less time in high-voltage sleep, and in the early evening (7:02 pm ± 47 min) abruptly stopped cycling between sleep states, with a shift to a high frequency state for 2 h 48 min ± 40 min, with tonic electromyographic activity. These findings demonstrate persisting EEG and sleep state dysmaturation after severe hypoxia-ischaemia. Loss of fetal or neonatal sleep state cycling in the early evening may be a useful biomarker for evolving cystic WMI.

Medical Supports for Return to Work after Complete Cervical Cord Injury

Medical Supports for Return to Work after Complete Cervical Cord Injury

Epidemiology of Complete Cervical Cord Injury in Japan

Epidemiology of Complete Cervical Cord Injury in Japan

Thecal sac ligation in the setting of thoracic spondyloptosis with complete cord transection.

Traumatic spondyloptosis (TS) with complete spinal cord transection and unrepairable durotomy is particularly rare and can lead to a difficult-to-manage cerebrospinal fluid (CSF) leak. We performed a systematic review of the literature on TS and discuss the management strategies and outcomes of TS with cord transection and significant dural tear. We also report a novel case of a 26-year-old female who presented with thoracic TS with complete spinal cord transection and unrepairable durotomy with high-flow CSF leak. Of 93 articles that resulted in the search query, 13 described cases of TS with complete cord transection. The approach to dural repair was only described in 8 (n = 20) of the 13 articles. The dura was not repaired in two (20%) of the cases. Ligation of the proximal end of the dural defect was done in 15 (75%) of the cases, all at the same institution. One (5%) case report describes ligation of the distal end; one (5%) case describes the repair of the dura with duraplasty; and another (5%) case describes repair using muscle graft to partially reconstruct the defect. Suture ligation of the thecal sac in the setting of traumatic complete spinal cord transection with significant dural disruption has been described in the international literature and is a safe and successful technique to prevent complications associated with persisting high-flow CSF leakage. To the best of our knowledge, this is the first report of thecal sac ligation of the proximal end of the defect from the United States.

Dissecting the contributions of the peripheral chemoreflex and myocardial hypoxia to fetal heart rate decelerations in near-term fetal sheep.

Brief repeated fetal hypoxaemia during labour can trigger intrapartum decelerations of the fetal heart rate (FHR) via the peripheral chemoreflex or the direct effects of myocardial hypoxia, but the relative contribution of these two mechanisms and how this balance changes with evolving fetal compromise remain unknown. In the present study, chronically instrumented near-term fetal sheep received surgical vagotomy (n=8) or sham vagotomy (control, n=11) to disable the peripheral chemoreflex and unmask myocardial hypoxia. One-minute complete umbilical cord occlusions (UCOs) were performed every 2.5min for 4h or until arterial pressure fell below 20mmHg. Hypotension and severe acidaemia developed progressively after 65.7±7.2 UCOs in control fetuses and 49.5±7.8 UCOs after vagotomy. Vagotomy was associated with faster development of metabolic acidaemia and faster impairment of arterial pressure during UCOs without impairing centralization of blood flow or neurophysiological adaptation to UCOs. During the first half of the UCO series, before severe hypotension developed, vagotomy was associated with a marked increase in FHR during UCOs. After the onset of evolving severe hypotension, FHR fell faster in control fetuses during the first 20s of UCOs, but FHR during the final 40s of UCOs became progressively more similar between groups, with no difference in the nadir of decelerations. In conclusion, FHR decelerations were initiated and sustained by the peripheral chemoreflex at a time when fetuses were able to maintain arterial pressure. After the onset of evolving hypotension and acidaemia, the peripheral chemoreflex continued to initiate decelerations, but myocardial hypoxia became progressively more important in sustaining and deepening decelerations. KEY POINTS: Brief repeated hypoxaemia during labour can trigger fetal heart rate decelerations by either the peripheral chemoreflex or myocardial hypoxia, but how this balance changes with fetal compromise is unknown. Reflex control of fetal heart rate was disabled by vagotomy to unmask the effects of myocardial hypoxia in chronically instrumented fetal sheep. Fetuses were then subjected to repeated brief hypoxaemia consistent with the rates of uterine contractions during labour. We show that the peripheral chemoreflex controls brief decelerations in their entirety at a time when fetuses were able to maintain normal or increased arterial pressure. The peripheral chemoreflex still initiated decelerations even after the onset of evolving hypotension and acidaemia, but myocardial hypoxia made an increasing contribution to sustain and deepen decelerations.

Fetal heart rate responses in chronic hypoxaemia with superimposed repeated hypoxaemia consistent with early labour: a controlled study in fetal sheep.

Deceleration area (DA) and capacity (DC) of the fetal heart rate can help predict risk of intrapartum fetal compromise. However, their predictive value in higher risk pregnancies is unclear. We investigated whether they can predict the onset of hypotension during brief hypoxaemia repeated at a rate consistent with early labour in fetal sheep with pre-existing hypoxaemia. Prospective, controlled study. Laboratory. Chronically instrumented, unanaesthetised near-term fetal sheep. One-minute complete umbilical cord occlusions (UCOs) were performed every 5 minutes in fetal sheep with baseline pa O2 <17 mmHg (hypoxaemic, n=8) and >17 mmHg (normoxic, n=11) for 4 hours or until arterial pressure fell <20 mmHg. DA, DC and arterial pressure. Normoxic fetuses showed effective cardiovascular adaptation without hypotension and mild acidaemia (lowest arterial pressure 40.7 ± 2.8 mmHg, pH 7.35 ± 0.03). Hypoxaemic fetuses developed hypotension (lowest arterial pressure 20.8 ± 1.9 mmHg, P < 0.001) and acidaemia (final pH 7.07 ± 0.05). In hypoxaemic fetuses, decelerations showed faster falls in FHR over the first 40 seconds of UCOs but the final deceleration depth was not different to normoxic fetuses. DC was modestly higher in hypoxaemic fetuses during the penultimate (P=0.04) and final (P=0.012) 20 minutes of UCOs. DA was not different between groups. Chronically hypoxaemic fetuses had early onset of cardiovascular compromise during labour-like brief repeated UCOs. DA was unable to identify developing hypotension in this setting, while DC only showed modest differences between groups. These findings highlight that DA and DC thresholds need to be adjusted for antenatal risk factors, potentially limiting their clinical utility.

Alpha-adrenergic receptor activation after fetal hypoxia-ischaemia suppresses transient epileptiform activity and limits loss of oligodendrocytes and hippocampal neurons

Exposure to hypoxic-ischaemia (HI) is consistently followed by a delayed fall in cerebral perfusion. In preterm fetal sheep this is associated with impaired cerebral oxygenation, consistent with mismatch between perfusion and metabolism. In the present study we tested the hypothesis that alpha-adrenergic inhibition after HI would improve cerebral perfusion, and so attenuate mismatch and reduce neural injury. Chronically instrumented preterm (0.7 gestation) fetal sheep received sham-HI (n = 10) or HI induced by complete umbilical cord occlusion for 25 minutes. From 15 minutes to 8 hours after HI, fetuses received either an intravenous infusion of a non-selective alpha-adrenergic antagonist, phentolamine (10 mg bolus, 10 mg/h infusion, n = 10), or saline (n = 10). Fetal brains were processed for histology 72 hours post-HI. Phentolamine infusion was associated with increased epileptiform transient activity and a greater fall in cerebral oxygenation in the early post-HI recovery phase. Histologically, phentolamine was associated with greater loss of oligodendrocytes and hippocampal neurons. In summary, contrary to our hypothesis, alpha-adrenergic inhibition increased epileptiform transient activity with an exaggerated fall in cerebral oxygenation, and increased neural injury, suggesting that alpha-adrenergic receptor activation after HI is an important endogenous neuroprotective mechanism.

Clinico-Radiological Spectrum of Non-Compressive Myelopathies

Objective: To study the etiology and clinico-radiological profile of non-compressive myelopathies. Methods: 40 consecutive admissions of non-compressive myelopathy were studied for clinical and radiological profile. Statistical methods: Descriptive statistics, linear regression and independent t-test using SPSS 20. Results: Age of the studied population ranged from 2 years to 55 years with a median age of 32.35 years and male:female ratio of 2:1. 87.5% of cases had an acute to subacute presentation. Complete cord syndrome was the most common presentation followed by anterior cord syndrome, central cord syndrome and mixed pattern. LETM was seen in nearly two-thirds of cases. Lesions involving more than two-thirds of the cross section of spinal cord were seen in more than 60% of cases, thereby accounting for significant disability at onset. Most of the lesions were hyperintense on T2 and STIR images and isointense on T1 with only 18.91% showing contrast enhancement. Optic neuritis was recorded with an overall prevalence of 28.26%. EDSS at presentation varied among the subgroups with ADEM, NMOSD and LETM form of ITM having EDSS scores of 9.5,8.0 and 7.5 respectively whereas in MS and Non-LETM form of ITM, EDSS score was 4.0 and 2.5 respectively. Conclusion: Demyelinating disorders contribute to nearly 80% cases of non-compressive myelopathies with NMOSD being the most common pathology. CSF cell count, cross-sectional involvement of spinal cord, pattern of myelitis and aquaporin-4 seropositivity were found to be predictive of the severity at onset i.e., EDSS at presentation with the initial 3 factors also showing predictability of EDSS at last visit.

Socio-demographic factors, clinico-radiological profile of patients with traumatic cervical spine injury in South India, and its association with short-term clinical outcome.

Spinal cord injury is a devastating condition to an individual and his/her family imposing an economic burden on the family, society, and the country. Finding out the demographic and morbidity profile of cervical spine injuries is essential for formulating means and ways for its prevention and treatment. This study aimed at assessing the clinico-radiological and socio-demographic profile of cervical spine injury patients and their association with short-term clinical outcomes. This was a prospective observational study that included 120 patients with cervical spine/cord injury. Social, demographic, clinical, and radiological parameters of the study participants were recorded. Improvement, worsening, and neurological stability at 2 weeks follow-ups were considered as a short-term outcome. The association of neurological outcomes with clinico-radiological profile and socio-demographic characteristics was analyzed to study the level of significance. The study found that nearly 81% of the study participants were involved in heavy physical activity, and 45% of the cases sustained cervical spine injury because of falls from height. About 37% and 55% of patients had complete and incomplete cord injury, respectively. Computerized tomography of the spine injury patients showed a fracture, subluxation, and locked facets. Magnetic resonance imaging showed disco-ligamentous injury and cord contusion in these patients. Nearly 29% of patients showed motor improvement, and around 4% of patients had a worsening of their neurological status after 2 weeks. Most of the people who sustain cervical spine injuries are involved in heavy physical work. Female gender, incomplete cord injury, and unilateral locked facet in subluxation are associated with good neurological outcomes. This study will form a preliminary base to build a larger database on spinal cord injury at the regional and national levels.

Etiology and Factors Related Outcomes of Longitudinally Extensive Transverse Myelitis in Thailand

Objective This study aimed to evaluate the clinical features, etiology, and prognosis of longitudinally extensive transverse myelitis (LETM) patients in Thailand. Background LETM has various etiology and is different in each region. Proper investigations are essential to reduce misdiagnosis and delay in treatments, which affect clinical recovery and prognosis. In Thailand, there is no clinical study on the etiology of LETM. Therefore, our study aimed to evaluate the clinical features, etiology, and prognosis of LETM patients in Thailand. Design/Methods Patients diagnosed with LETM at University Hospital between January 2015 and October 2021 were included. Patient demographics, clinical presentations, Expanded Disability Status Scale (EDSS), imagings, laboratory testing, cerebrospinal fluid profiles, final diagnosis, and treatments were recorded. Factors related to outcomes of LETM were analyzed. Results A total of 40 patients, there were 21 females (52.5%), the mean age of onset was 48.4 years (SD = 15.8). NMOSD was the most common etiology of LETM (n = 15), followed by infection (n = 5), SLE (n = 5), idiopathic causes (n = 4), CIS (n = 3), MS (n = 1), spinal dural AVF (n = 2), ADEM (n = 2), either 1 had spinal cord infarction, schwannoma, and vitamin B12 deficiency. Most patients in this study had severe LETM (n = 31). Complete cord had significantly poorer outcome (p-value = 0.003), while dorsolateral and anterior cord had better outcome (p-value = 0.046, 0.046). Conclusions NMOSD was the most common etiology of LETM, and a history of prior attacks led to the diagnosis of NMOSD. Complete cord lesion on axial spinal cord MRI was sensitive to NMOSD but not specifically. Factors related to the prognosis of LETM included completed cord lesions on MRI axial view trended to have a poor outcome, and dorsolateral and anterior cord lesions had a better prognosis.

Extralaryngeal causes of unilateral vocal cord paralysis: Aetiology and prognosis

Introduction and methodologyUnilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases of the thorax, neck, skull, or systemic disease. The objective is to study the extralaryngeal aetiology of unilateral vocal cord paralysis, its prognosis, and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT ± evaluation by Neurology with brain MRI to establish the aetiology and were followed-up for at least 1 year. ResultsThe most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumour (24.1%). Idiopathic paralysis was the cause in 15.5%. An association was obtained between sex and aetiology (P < .01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumour and idiopathic aetiology predominated in elderly patients; while surgical aetiology predominated in younger patients (P < .01). A total of 18.1% recovered vocal cord mobility. The female sex was related to recovery (P < .01). Tobacco and malignant aetiology were related to persistence (P < .01). ConclusionsThe first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause the condition, in many cases involving a diagnosis of malignant tumours. Recovery is more frequent in female patients, non-smokers and with benign pathology.

IMPACT OF HIGH-FLOW NASAL CANNULA THERAPY ON SWALLOWING: A PROSPECTIVE COHORT STUDY

IMPACT OF HIGH-FLOW NASAL CANNULA THERAPY ON SWALLOWING: A PROSPECTIVE COHORT STUDY

Tumour necrosis factor blockade after asphyxia in foetal sheep ameliorates cystic white matter injury.

Cystic white matter injury is highly associated with severe neurodevelopmental disability and cerebral palsy in preterm infants, yet its pathogenesis remains poorly understood and there is no established treatment. In the present study, we tested the hypothesis that slowly evolving cystic white matter injury after hypoxia-ischaemia is mediated by programmed necrosis initiated by tumour necrosis factor. Tumour necrosis factor blockade was begun 3 days after hypoxia-ischaemia to target the tertiary phase of injury, when most secondary cell death is thought to be complete. Chronically instrumented preterm foetal sheep (0.7 gestation) received 25 min of hypoxia-ischaemia induced by complete umbilical cord occlusion or sham-umbilical cord occlusion (controls, n = 10), followed by intracerebroventricular infusion of the soluble TNF inhibitor, Etanercept, at 3, 8 and 13 days after umbilical cord occlusion (n = 9) or vehicle (n = 9). Foetal brains were processed for histology at 21 days after umbilical cord occlusion. Umbilical cord occlusion with vehicle was associated with a spectrum of macroscopic white matter degeneration, including white matter atrophy, ventriculomegaly and overt temporal lobe cystic white matter injury. Oligodendrocyte maturational arrest and impaired labelling of myelin proteins, characteristic of diffuse white matter injury, was observed in the parietal lobe and surrounding the cystic lesions in the temporal lobe. Etanercept markedly attenuated cystic white matter injury on the side of the intracerebroventricular infusion, with partial contralateral protection. Further, Etanercept improved oligodendrocyte maturation and labelling of myelin proteins in the temporal and parietal lobes. The present study shows that cystic white matter injury reflects late-onset tertiary cell death mediated by delayed neuroinflammation through the tumour necrosis factor pathway. Delayed tumour necrosis factor blockade markedly attenuated cystic white matter injury and restored oligodendrocyte maturation and deficits in myelin protein expression. These data suggest that delayed tumour necrosis factor blockade may represent a viable therapeutic strategy to reduce the risk of cystic and diffuse white matter injury and potentially cerebral palsy after preterm birth, with a surprisingly wide therapeutic window.

85. The neurology stability epidural compression assessment: a new score to establish the need for surgery in spinal metastases

85. The neurology stability epidural compression assessment: a new score to establish the need for surgery in spinal metastases

Bilateral Brown-Sequard syndrome regressing to anterior cord syndrome in spinal impalement: 2 unique cases with management pearls

BackgroundNon-missile impalement spine injuries are quite uncommon. Most of these patients either present with impaling agent in situ or with a part of retained offending agent. Both the scenarios present unique management challenges especially if patients are clinically stable. The injury becomes more complex if multiple compartments like lung and abdomen also get involved. Non-missile penetrating spinal injury is rarely seen in the Indian settings. The world over it approximately accounts for 0.3–2.1% of spinal injuries. In view such meagre occurrence management decisions are usually driven based on surgeons’ experience and patient’s condition. Although conservative approaches for retained products have less complications as compared to surgery, long-term outcomes are not available for comparison. Unique management challenges are noted and described. Physical doctrines for management principles of such injuries are also attempted. Noteworthy is that their regression from complete cord syndrome to anterior cord syndrome is extremely short period.Case presentationWe present 2 unique cases presenting as complete cord transection regressing from bilateral brown Sequard syndrome to anterior cord syndrome following decompression.ConclusionSpinal impalements are very rare especially now with strict societal regulations and criminal justice in place. Still now and then we do come across some staggering cases as described above. To establish a treatment protocol and management guidelines in such scarce scenarios is difficult. We attempt to underlie few basic doctrines in this regard with our experience in a tertiary centre.

Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes.

To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications. PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI). We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16-70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p < 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p < 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3-1.64; I2 = 44%, p = 0.13) nor for incomplete SCIs (OR:1.15, 95% CI, 0.64-2,06; I2 = 40%, p = 0.12). Surgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.

97 Paralysis From an Ear Infection: A Severe Case of Otitis Externa Leading to Acute Complete Cervical Cord Syndrome

Abstract We report a case of a generally fit and well 54-year-old gentleman who presented with a two-day history of worsening left sided ottorhea, headache, neck stiffness, vomiting and pyrexia on the background of a seven-week history of OE. His condition progressed dramatically as he developed symptoms consistent with acute complete cervical cord syndrome with radiological evidence of skull base osteomyelitis, parapharyngeal, retropharyngeal and paravertebral abscesses and sigmoid sinus thrombus. Ultimately, he made a significant, although not complete, recovery. This case is unique in demonstrating how OE can develop into a potentially life-threatening condition. It emphasises the importance of early diagnosis and treatment of OE, the recognition of ‘red flag’ symptoms and highlights the importance of a multi-disciplinary team (MDT) approach when managing complex complications of OE.

131. Risk factors that decrease complete recovery in idiopathic scoliosis surgery associated neurological injuries

<h3>BACKGROUND CONTEXT</h3> Neurological injuries (NI) are devastating complications of idiopathic scoliosis (IS) surgeries. The risk factors for these injuries have been well studied in the literature. However, the prognosis and the factors that impact the prognosis of NIs have been poorly studied. <h3>PURPOSE</h3> The purpose of this study was to summarize the prognosis of the documented 8-year NIs associated with IS surgeries from the Scoliosis Research Society Morbidity and Mortality (SRS M&M) database. <h3>STUDY DESIGN/SETTING</h3> Retrospective study conducted querying the SRS M&M database between 2009 and 2017 for idiopathic scoliosis population who had perioperative neurological deficits from scoliosis surgery. <h3>PATIENT SAMPLE</h3> n= 418; males (n=93; 22.4%), females (n=322, 77.6%), 3 unknown. <h3>OUTCOME MEASURES</h3> To determine the risk factors that decrease the complete recovery of neurological injuries. <h3>Methods</h3> Analyses were made to compare the correlation between the extent of neurological recovery (complete, partial and no change) and time of event occurrence (intraoperative, acute postoperative (<24hrs) and delayed postoperative >24hrs), intraoperative neurophysiological monitoring (IONM) used (yes/no), intra- and postoperative hypotension (yes/no), type of neurological injury (cord, root or both), type of cord injury (complete or incomplete). Chi-square and ANOVA tests were used for analyses. <h3>Results</h3> Data showed: EOIS (n=30), adolescent IS (n=244) and adult IS (n=144); average estimated blood loss, 1.9L; and average follow-up: 180 days. Intraoperative neuromonitoring (IONM) was used in 351 (84%), intraoperative hypotension observed in 73 (18%), and postoperative hypotension observed in 32 (8%). The majority of the NIs were intraoperative 168 (40.2%); postoperative (<24hrs.) 159 (38%); delayed (> 24 hrs) 91 (21.8%). Incomplete cord injuries were 178 (47.7%), complete cord injuries 53 (14.2%), root injuries 142 (38.1%) and no information for 45 patients. Injury level noticed at: cervical=20 (4.8%); thoracic=181 (43.3%), lumbar=187 (44.7%), sacrum=5 (1.2%) and unknown in 25 (6.0%) patients. Complete recovery was noticed in 269 patients (64.4%), partial recovery in 125 patients (29.9%), no recovery in 24 patients (5.7%). Average follow-up length was no different among recovery types: complete=190 days; partial=174 days; and no change=174 days, p=0.35. Complete NI recovery rate was significantly lower for adult IS patients (n= 67, 46.5%) vs EOIS (n=24, 80%) and AIS (n=178, 73%), (p<0.001). There was a significant increase in no recovery NIs status rates for complete cord injuries (n=13, 24.5%) vs incomplete cord (n=4, 2.2%) and root injuries (n=4, 2.8%), p<0.001), IONM abnormalities decreased complete recovery rates for intraoperative NIs (n=4, 33% vs n=109, (76.8%), p=0.001. There was a trend toward lower complete recovery rates in patients who did not use IONM for intraoperative NIs (p=0.06). <h3>Conclusions</h3> Lower complete NI recovery rates were observed in adult IS patients. Complete cord injuries reduced NIs complete recovery rate. IONM signal abnormalities have a potential effect on intraoperative NI prognosis, but not on postoperative or delayed NI prognosis. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.