Spinal Injury Association Impairment Scale Research Articles

MRI variables and peripheral inflammatory response biomarkers predict severity and prognosis in patients with acute cervical traumatic spinal cord injury.

Traumatic spinal cord injury (TSCI) stands as one of the most profoundly damaging and debilitating conditions. This study aims to explore the potential of magnetic resonance imaging (MRI) variables and peripheral inflammatory indicators as promising biomarkers. It aims to understand their significance in evaluating the severity and predicting the prognosis of TSCI. Furthermore, the study aims to ascertain whether combining these indicators could enhance the accuracy of injury assessment and predictive prognostic ability. A multicentre retrospective cohort study was conducted to assess the severity and prognostic value of MRI variables and peripheral inflammatory response biomarkers in patients with acute cervical TSCI. The study involved 374 patients with acute cervical TSCI drawn from the First Affiliated Hospital of Nanchang University and the Second Affiliated Hospital of Nanchang University. The severity and prognosis of patients with acute cervical TSCI were assessed using the American Spinal Injury Association Impairment Scale (AIS). The correlation between MRI variables, peripheral inflammatory response biomarkers, admission severity, and the 1-year follow-up prognosis was analysed. After the initial assessment using the AIS grade system, 169 (49.2%) patients fell into the severe category for cervical TSCI (AIS A-B), while 205 (50.8%) patients were classified as non-severe cases (AIS C-E). The MRI variables (intramedullary lesion length [IMLL], Brain and Spinal Injury Centre [BASIC], maximum spinal cord compression [MSCC], and maximum canal compromise [MCC]) and inflammatory response biomarkers (white blood cells [WBCs], neutrophils, and C-reactive protein [CRP]) exhibited a consistent decrease correlating with the severity grades noted upon admission. Among the 374 patients assessed, 147 (39.3%) experienced a poor prognosis, as indicated by the AIS grade during the 1-year follow-up. MRI variables and peripheral inflammatory response biomarkers declined in correspondence with the follow-up AIS grades. Sex (p < 0.001), IMLL (p < 0.001), MSCC (p < 0.001), MCC (p < 0.001), BASIC (p < 0.001), WBC (p < 0.001), neutrophils (p < 0.001), and CRP (p < 0.001) were statistically significant in predicting poor outcomes. Through multivariate logistic regression analysis, BASIC score and CRP emerged as independent predictors of poor prognosis. Notably, the model combining the BASIC score and CRP yielded a larger area under the curve compared to models using only the BASIC score or CRP individually. The BASIC score and CRP are crucial biomarkers for evaluating the severity of cervical TSCI and predicting prognosis. Their combination proved to be a more robust determinant of injury severity and a better predictor of neurological recovery.

Effects of Exercise Interventions on Cardiac Structure, Function, and Mechanics in Individuals with Chronic Motor-Complete Spinal Cord Injury: An Exploratory Randomized Clinical Trial

Background: Individuals with spinal cord injury (SCI) at or above T6 face increased cardiovascular disease (CVD) risks due to altered autonomic control and physical inactivity. Arm cycle ergometry training (ACET) or body weight-supported treadmill training (BWSTT) may improve cardiovascular health, but the impact on cardiac structure and function remains unclear. Objectives: The study aimed to compare the impact of two exercise interventions on cardiac measures in individuals with chronic SCI. Methods: Participants with motor-complete SCI (C4-T6, American Spinal Injury Association Impairment Scale [AIS] grade A or B) were randomly assigned to perform 72 ACET or BWSTT sessions. Left ventricular (LV) echocardiography assessments were performed pre and post training. Data were analyzed using a two-way repeated measures analysis of variance and effect sizes (Cohen’s d). Results: Twelve participants underwent analysis (6 per group), revealing significant Group (ACET, BWSTT) x Time (pre, post) interactions for global circumferential systolic and diastolic strain rate (SR) and early diastolic filling velocity (p ≤ .018; Cohen’s d &amp;gt; .8/ -.8). Within-group post hoc testing demonstrated a significant decrease in global circumferential systolic SR (p &amp;lt; .001, d = -4.00) and a significant increase in global circumferential diastolic SR (p = .025, d = 2.48) following ACET, with no significant differences following BWSTT. Although there were no statistically significant within-group post hoc changes (p &amp;gt; .58) for diastolic filling, there was a large effect size favoring ACET (d = 1.11). Conclusion: This exploratory study suggests that ACET alters LV mechanics and potentially diastolic function in a cohort of individuals with chronic, cervical or upper thoracic, motor-complete SCI. Conversely, no significant changes were observed following BWSTT. These findings indicate that ACET can improve cardiac function relative to BWSTT in individuals with SCI, though further studies are warranted.

Influence of Diabetes Mellitus on Neurological Recovery in Older Patients With Cervical Spinal Cord Injury Without Bone Injury: A Retrospective Multicenter Study.

Retrospective study. To investigate the impact of diabetes mellitus on neurological recovery and determine the relationship between moderate-severe diabetes and neurological recovery in patients with cervical spinal cord injury (CSCI) without bone injury. A retrospective study was conducted on 389 consecutive patients aged ≥65 years with CSCI without bone injury across 33 medical institutes. The patients were divided into a nondiabetic group (n = 270) and a diabetic group (n = 119). Neurological outcomes were compared between the two groups through propensity score matching. The impact of moderate-severe diabetes (defined as hemoglobin A1c ≥ 7.0% or requiring insulin treatment) on neurological recovery was evaluated through multiple linear regression analysis. Propensity score matching revealed no significant differences between the diabetic and nondiabetic groups in terms of American Spinal Injury Association (ASIA) impairment scale grade and mean total ASIA motor scores (AMS) at 6 months post-injury. Multiple linear regression analysis indicated that age on admission (B = -0.34; 95% confidence interval [CI], -0.59 to -0.08; P = 0.01), dementia (B = -16.50; 95% CI, -24.99 to -8.01; P < 0.01), and baseline total AMS (B = -0.62; 95% CI, -0.72 to -0.51; P < 0.01) were negative predictors of neurological recovery at 6 months post-injury. The presence of moderate-severe diabetes did not influence neurological recovery at 6 months post-injury. Diabetic patients with CSCI without bone injury achieved improvements in neurological function comparable to those of nondiabetic patients. Moderate-severe diabetes did not affect neurological recovery in patients with CSCI without bone injury.

Outcome of posterior decompression by L1 laminectomy, transpedicular fixation, posterolateral fusion in burst fracture L1 with incomplete spinal cord injury

Introduction: Burst fractures are more severe than compression fractures as the bones spread out in all directions and may damage the spinal cord, leading to paralysis or nerve injury. This study aims to find the surgical outcomes of Posterior Decompression by L1 Laminectomy in terms of burst fracture with incomplete spinal cord injury. Methods: 48 adult patients with burst fractures with incomplete spinal injury came to NITR from June 2023 to May 2024. In this non-randomized clinical trial, the outcomes of decompression by L1 laminectomy were analysed by using the canal encroachment ratio, while deformity correction was assessed using the sagittal Cobb angle and the percentage of anterior vertebral height for the treatment of L1 burst fracture with incomplete spinal cord injury. Results: The patients were followed up for an average of 12 months. The mean operation time was 154.53 minutes, mean intraoperative blood loss of 48.84 mL, and the mean incision length was 7.78 cm. The canal encroachment ratio decreased significantly, as well as the sagittal Cobb angle, and anterior vertebral percentage height increased. Oswestry Disability Index, and American Spinal Injury Association impairment scale classification were significant. Conclusions: Posterior decompression combined with Transpedicular Fixation and Posterolateral Fusion in the treatment of Burst Fracture L1 with Incomplete Spinal Cord Injury is safe and effective.

Magnetic Resonance Imaging Parameters in the Subacute Phase after Traumatic Cervical Spinal Cord Injury: A Prospective, Observational Longitudinal Study. Part 1: Conventional Imaging Characteristics.

Magnetic resonance imaging (MRI) remains the gold standard for evaluating spinal cord tissue damage after spinal cord injury (SCI). Several MRI findings may have some prognostic potential, but their evolution over time, especially from the subacute to the chronic phase has not been studied extensively. We performed a prospective observational longitudinal study exploring the evolution of MRI parameters from the subacute to chronic phase after human traumatic cervical SCI. The study, conducted between 2016 and 2021, involved standardized neurological examinations and MRI scans 1 month, 3 months, and 1 year after SCI. The study cohort comprises 52 patients with cervical SCI. Patients were classified into AIS grades (American Spinal Injury Association Impairment Scale), and neurological recovery was assessed using the Integrated Neurological Change Score. The MRI protocol included various routine sequences, allowing the evaluation of established parameters such as intramedullary hemorrhage, lesion dimensions, maximum spinal cord compression, and various grading scales. The persistence of intramedullary hemorrhage one month after injury was associated with worse lower extremity motor scores and pinprick values after 3 months, and also in the chronic phase. In addition, dorsal column T2-weighted hyperintensities detected 3 months post-injury and in the chronic phase were related to lower pinprick sensory scores. The basic score and Sagittal Grade at 1 month were predictive for motor function 3 months after SCI and for neurological recovery between 1 and 3 months after injury. The study contributes valuable insights into the utility of routine MRI sequences for evaluating traumatic cervical SCI during the subacute to chronic phase. The identified MRI parameters and scores offer prognostic information and could support clinical decision-making.

Results of distraction and ligamentotaxis in thoracolumbar fractures without decompression

Background: Thoracolumbar fractures are common spinal injuries often requiring surgical intervention. Traditionally, decompression surgery has been used to relieve neural pressure. This study evaluates the effectiveness of ligamentotaxis with pedicular screw fixation, which minimizes the need for decompression, in treating thoracolumbar fractures. Methods: A retrospective cohort study was conducted at a Government Medical College, Aurangabad involving 30 patients aged 18 and older with thoracolumbar fractures treated with ligamentotaxis and pedicular screw fixation. Clinical outcomes were assessed using the visual analog scale (VAS) for pain, the American spinal injury association (ASIA) impairment scale for neurological function, and forward flexion degrees for spinal mobility. Patients were followed up for 12 months post-operatively. Results: Significant pain reduction was observed, with VAS scores decreasing from 8.5 pre-operatively to 2.5 at 12 months (p&lt;0.001). Neurological function improved, with many patients advancing from ASIA category A pre-operatively to category D by 12 months (p&lt;0.001). Spinal mobility showed considerable recovery, with forward flexion increasing from 0 degrees pre-operatively to 80 degrees at 12 months (p&lt;0.001). Conclusion: Ligamentotaxis with pedicular screw fixation is an effective treatment for thoracolumbar fractures, providing substantial pain relief, neurological improvement, and restored spinal function. While outcomes are generally positive, patient selection remains critical to avoid poor neurological results. Further research is needed to refine indications and optimize treatment protocols.

Plasma fibrinogen level is independent risk factor associated with the incidence of pulmonary infection in patients with spinal cord injury: a retrospective cohort study

BackgroundPatients with spinal cord injury (SCI) are at higher risk of developing pulmonary infection (PI), and plasma fibrinogen level may be an independent risk factor for PI. However, the relationship between fibrinogen level and PI incidence in the SCI population remains unclear. This study aimed to elucidate the association between plasma fibrinogen level and the occurrence of PI among SCI patients.MethodsWe conducted a retrospective analysis of 576 SCI patients admitted to the Rehabilitation Medicine Department between January 1, 2017, and December 31, 2021. Following exclusions, 491 patients were included in the final analysis, with 139 PI cases identified.ResultsSurgery, level of injury and chest comorbidities were covariates in the relationship between fibrinogen level and PI incidence. Other identified potential risk factors for PI included age, D-dimer level, urinary tract infections (UTI), deep vein thrombosis (DVT), anticoagulant therapy, injury mechanism, and the American Spinal Injury Association Impairment Scale (AIS) grades. After adjusting for these factors, we found that for every 1 g/L increase in fibrinogen level, the risk of developing PI increased by 18% (HR = 1.18, P = 0.011), and indicating a positive linear relationship between fibrinogen level and PI incidence.ConclusionPlasma fibrinogen was an independent risk factor for PI in patients with SCI, especially for AIS-B and C grades. Proactive management of fibrinogen level after admission to rehabilitation medicine department could be crucial in reducing the incidence of PI in this vulnerable population.Clinical trial numberNot applicable.

Surgical management of thoracolumbar burst fractures by three different posterior techniques: A prospective comparative study

Study designProspective Comparative Study. ObjectivesThis study aims to study the outcome of thoracolumbar burst fractures by comparison of 3 different posterior constructs groups of patients treated by the posterior approach. SettingUniversity level Tertiary care Centre of Northern India. MethodsSingle centre study conducted from September 2020 to April 2022, the study included patients aged 18–50 years with burst fractures in the thoracolumbar region, TLICS score ≥4, and injury surgery duration <3 weeks. Sixty patients were divided into three groups: Group I (short segment with index screw(s) in the fractured vertebrae), Group II (short segment with interbody cage fusion), and Group III (long segment without index screw or interbody cage). Clinical and radiological assessments were performed over a 6-month follow-up period. Outcome measures included the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment scale, and radiological parameters. ResultsAmong 60 patients, 38 were male, and 22 were female, with a mean age of 33.37 ± 12.26 years. The most common injury mechanisms were falls from heights (85 %). Group I had the lowest estimated blood loss (395 ± 36.20 ml) and shortest surgery duration (140 ± 26.56 min), while Group III had the highest blood loss (744.25 ± 113.69 ml) and longest surgery duration (203.50 ± 23.40 min). No statistically significant differences were observed in kyphosis correction, canal clearance, or fusion status among the groups. Neurological and functional outcomes improved across all groups, with no significant intergroup differences. ConclusionAll three posterior instrumentation constructs provided effective management of thoracolumbar burst fractures, demonstrating high rates of fusion, significant kyphosis correction, and minimal loss of alignment. Despite variations in surgical parameters such as estimated blood loss and surgery duration, the clinical and radiological outcomes were comparable. Level of evidenceIII.

Cardiovascular autonomic function in middle-aged people with long-term cervical and upper thoracic spinal cord injuries

Objectives To examine cardiovascular autonomic function in middle-aged people with long-term cervical and upper thoracic spinal cord injury (SCI) compared with the general population, and explore if the neurological level of injury (NLI) is related to cardiovascular autonomic function. Design Population-based cross-sectional study with matched controls. Setting Outpatient SCI unit in Southern Sweden. Participants Twenty-five individuals (20% women, mean age 58 years and mean time since injury 28 years, NLI C2-T6, American Spinal Injury Association Impairment Scale A-C) from the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA). Matched controls were obtained from the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) at a ratio of 5:1. Interventions Not applicable. Outcome measures 24 h electrocardiography and deep breathing tests. 24 h ambulatory blood pressure (BP) monitoring and orthostatic BP tests. Results In individuals with SCI compared with controls, heart rate variability (24h mean SD of the normal-to-normal interval 112 ms vs 145 ms, P < 0.001) and diastolic orthostatic BP increase (2.0 and 9.4 mmHg, P < 0.001), were significantly lower, whereas BP variability was significantly higher (24h mean systolic SDBP 17.8 mmHg vs 15.7 mmHg, P = 0.029). Circadian patterns of heart rate variability and BP (lack of nocturnal dip) were significantly different among the individuals with SCI than controls. Higher NLI was significantly (P < 0.05) correlated with impairments to various cardiovascular autonomic function variables. Conclusions This exploratory study indicates that cardiovascular autonomic function is impaired in middle-aged people with long-term cervical and upper thoracic SCI compared with the general non-SCI population, and more pronounced with a higher NLI. Future research is needed to understand the pathophysiological mechanisms underlying these impairments, and the prognostic significance for individuals with SCI. Trial registration ClinicalTrials.gov identifier: NCT03515122.

Intravenous Infusion of Autologous Mesenchymal Stem Cells Expanded in Auto Serum for Chronic Spinal Cord Injury Patients: A Case Series

Objective: The safety, feasibility, and potential functional improvement following the intravenous infusion of mesenchymal stem cells (MSCs) were investigated in patients with chronic severe spinal cord injury (SCI). Methods: The intravenous infusion of autologous MSCs cultured in auto-serum under Good Manufacturing Practices (GMP) was administered to seven patients with chronic SCI (ranging from 1.3 years to 27 years after the onset of SCI). In addition to evaluating feasibility and safety, neurological function was evaluated using the American Spinal Injury Association Impairment Scale (AIS), International Standards for Neurological Classification of Spinal Cord Injury (ISCSCI-92), and Spinal Cord Independence Measure III (SCIM-III). Results: No serious adverse events occurred. Neither CNS tumors, abnormal cell growth, nor neurological deterioration occurred in any patients. While this initial case series was not blinded, significant functional improvements and increased quality of life (QOL) were observed at 90 and 180 days post-MSC infusion compared to pre-infusion status. One patient who had an AIS grade C improved to grade D within six months after MSC infusion. Conclusions: This case series suggests that the intravenous infusion of autologous MSCs is a safe and feasible therapeutic approach for chronic SCI patients. Furthermore, our data showed significant functional improvements and better QOL after MSC infusion in patients with chronic SCI. A blind large-scale study will be necessary to fully evaluate this possibility.

Invasive devices to monitor the intraspinal perfusion pressure in the hemodynamic management of acute spinal cord injury: A systematic scoping review.

Various methods for measuring intrathecal pressure (ITP) after spinal cord injury (SCI) to guide hemodynamic management have been investigated. To synthesize the current literature, this current study conducted a scoping review of the use of intrathecal devices to monitor ITP during acute management of SCI with the aim of understanding the association between ITP monitoring with physiological and clinical outcomes. A systematic review of literature following the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. All eligible studies were screened for inclusion and exclusion criteria. Data extracted included number of patients included, severity of injury, characteristics of the intervention-intrathecal device used to record the ITP, outcomes -hemodynamic parameters observed, changes in the American Spinal Injury Association (ASIA) Impairment Scale (AIS), total motor scores, association of ITP with other physiological variables. The search yielded a total of 1,698 articles, of which 30 observational studies and 2 randomized clinical trials were deemed eligible based on their use of an intrathecal invasive device to monitor spinal cord perfusion pressure (SCPP) in patients with SCI. Of these, 9 studies used a lumbar drain, 23 a Codman pressure probe and 1 study that used both. These studies underscore the crucial interplay between ITP, the SCPP and physiological variables, with neurological outcome. It is still unclear whether monitoring from a lumbar drain is accurate enough to highlight what is occurring at the site of SCI, which is the main advantage of Codman Probe, however, the latter requires specialized personnel that may not be available in most settings. Minor adverse effects were associated with lumbar drain catheters, while cerebrospinal fluid leak requiring repair (~ 7%) is the main concern with Codman Probes. Future investigation of SCPP protocols via lumbar drains and Codman probes ought to involve multi-centered randomized controlled trials and continued translational investigation with animal models.

Acute Implantation of a Bioresorbable Polymer Scaffold in Patients With Complete Thoracic Spinal Cord Injury: A Randomized Controlled Trial (INSPIRE 2.0).

Traumatic spinal cord injury (SCI) remains a devastating condition with no proven effective treatment options available. In a prior single-arm study of patients with thoracic complete SCI (INSPIRE; ClinicalTrials.gov, NCT02138110), acute implantation of an investigational bioresorbable polymer scaffold (Neuro-Spinal Scaffold [NSS]) appeared to be safe through 24 months postimplantation and was associated with an American Spinal Injury Association Impairment Scale (AIS) conversion rate that exceeded historical controls. Here, we evaluated whether NSS implantation demonstrates probable benefit for safety and neurological recovery in patients with thoracic complete SCI vs standard-of-care spine surgery. INSPIRE 2.0 was a randomized, controlled, parallel, multicenter study conducted at Level I trauma centers in the United States (ClinicalTrials.gov, NCT03762655; funded by InVivo Therapeutics Corporation). Patients with AIS grade A, thoracic (T2-T12), nonpenetrating SCI requiring spine surgery ≤7 days postinjury were randomized (1:1, computer-generated allocation) to undergo NSS implantation or spine surgery alone (control group). Patients and follow-up International Standards for Neurological Classification of SCI assessors were blinded. A predefined study success criterion required the proportion of patients with improvement of ≥1 AIS grade at 6 months postsurgery (primary endpoint) to be ≥20% higher in the NSS group than in the control group. Target enrollment was reached (N = 20) with 10 patients randomized and analyzed in each group. At 6 months postsurgery, an improvement in the AIS grade was reported in 2 NSS patients (20%; both to AIS C) and 3 control group patients (30%; to AIS B [n = 2] or AIS C [n = 1]). No serious or unanticipated adverse device effects were reported. The study was closed to further follow-up because of not meeting its primary endpoint. In this small group of patients with thoracic complete (AIS A) SCI, implantation of an intraparenchymal bioresorbable scaffold did not produce probable clinical benefit. However, this study provides evidence that surgical intervention in an injured spinal cord parenchyma may be performed safely.

The correlation of neurosurgery motor examinations with ISNCSCI motor examinations in patients with spinal cord injury: a multicenter TRACK-SCI study.

The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) assessment is the gold standard for evaluation of neurological function after spinal cord injury (SCI). Although it is an invaluable tool for diagnostic and research purposes, it is time consuming and can be impractical in acute injury settings. Clinical neurosurgery motor examinations (NMEs) could serve as an expeditious surrogate for SCI research when ISNCSCI motor examinations are not feasible. The aim of this study was to evaluate the agreement between motor examinations performed by the neurosurgery clinical team and ISNCSCI examiners. The multicenter prospective Transforming Research and Clinical Knowledge in Spinal Cord Injury (TRACK-SCI) registry was queried to identify patients with recorded neurosurgery and research motor examinations within 24 hours of each other. Pearson correlations and modified Bland-Altman analyses were performed using data from matching upper-extremity, lower-extremity, and combined examinations. Kappa analysis was used to test interrater reliability with respect to determination of American Spinal Injury Association Impairment Scale (AIS) grade. There were 72 pairs of matching clinical and research examinations in 63 patients. NME scores were strongly correlated with ISNCSCI motor scores (R = 0.962, p < 0.001). Both upper- and lower-extremity NME scores were strongly correlated with upper- and lower-extremity ISNCSCI motor scores, respectively (R = 0.939, p < 0.001; and R = 0.959, p < 0.001, respectively). In modified Bland-Altman analyses, total, upper-extremity, and lower-extremity NME scores and ISNCSCI motor scores showed low systematic bias and high agreeability (total: bias = 0.3, limit of agreement [LoA] = 36.6; upper extremity: bias = -0.5, LoA = 17.6; lower extremity: bias = 0.8, LoA = 24.0). There were 66 pairs of examinations that had thorough sensory and rectal examinations for AIS grade calculation. Using kappa analysis to test the interrater reliability of AIS grade calculation using NME versus ISNCSCI motor scores, the authors found a weighted kappa of 0.883 (SE 0.061, 95% CI 0.736-0.976), indicating strong agreement. Overall, this study suggests that ISNCSCI motor scores and NME scores are strongly correlated and highly agreeable. When conducting SCI research, a thorough clinical motor examination may be a useful surrogate when ISNCSCI examinations are missing.

An Update on Spinal Cord Injury and Current Management

» Spinal cord injury is associated with increased lifelong cost and decreased life expectancy.» Current treatment guidelines have been limited to studies of small effect sizes and limited availability of randomized control trials.» Recovery is best correlated with the initial American Spinal Injury Association impairment scale grade with A and B less likely to recover regarding ambulation as compared with C and D grades.» Surgical intervention within less than 24 hours, especially in the cervical spine, has been associated with some motor improvement.» The use of mean arterial pressure goals and steroids to maintain perfusion and decrease secondary injury requires further study to elucidate clearer evidence-based results.

Development and Validation of a Novel Nomogram for Predicting Mechanical Ventilation After Cervical Spinal Cord Injury

ObjectiveTo investigate the risk factors relating to the need for mechanical ventilation (MV) in isolated patients with cervical spinal cord injury (cSCI) and to construct a nomogram prediction model. DesignRetrospective analysis study. SettingNational Spinal Cord Injury Model System Database (NSCID) observation data were initially collected during rehabilitation hospitalization. ParticipantsA total of 5784 patients (N=5784) who had a cSCI were admitted to the NSCID between 2006 and 2021. InterventionsNot applicable. Main Outcome Measure(s)A univariate and multivariate logistic regression analysis was used to identify the independent factors affecting the use of MV in patients with cSCI, and these independent influencing factors were used to develop a nomogram prediction model. The area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA) were used to evaluate the efficiency and the clinical application value of the model, respectively. ResultsIn a series of 5784 included patients, 926 cases (16.0%) were admitted to spinal cord model system inpatient rehabilitation with the need for MV. Logistic regression analysis demonstrated that associated injury, American Spinal Cord Injury Association Impairment Scale (AIS), the sum of unilateral optimal motor scores for each muscle segment of upper extremities (sUEM), and neurologic level of injury (NLI) were independent predictors for the use of MV (P<.05). The prediction nomogram of MV usage in patients with cSCI was established based on the above independent predictors. The AUROC of the training set, internal verification set, and external verification set were 0.871 (0.857-0.886), 0.867 (0.843-0.891), and 0.850 (0.824-0.875), respectively. The calibration curve and DCA results showed that the model had good calibration and clinical practicability. ConclusionsThe nomograph prediction model based on sUEM, NLI, associated injury, and AIS can accurately and effectively predict the risk of MV in patients with cSCI, to help clinicians screen high-risk patients and formulate targeted intervention measures.

Surgery do save life in cervical spinal injury: 5 years study of a tertiary care in East Java, Indonesia

Cervical spine has the most movement in spine therefore it has high risk of injury which may involve vertebrae, soft tissue and spinal cord. Trauma to cervical has highest risk of neurologic deficits due to spinal cord injury (SCI) causing high number of morbidity and mortality. Retrospective study was conducted with descriptive-analytic design by total sampling of cervical spinal injury patients in Dr. Soetomo General Academic Hospital from January 2018 to June 2023. Patient demographic and survival analysis of patients was described using Kaplan-Meier chart and logistic regression test to find factors contributing to patients’ survival. Gender, age, mechanism of injury, surgical approach, duration, intra-operative bleeding, lesion level, time to surgery, and initial blood laboratory had no significant impact while neurological status and operative treatment have significant survival probability. Patients with American Spinal Injury Association Impairment Scale (AIS) A score have lower survival rate which associated with respiratory muscle weakness, cardiovascular and autonomic nervous system dysfunction. Any unstable cervical fracture is advised for surgery while decompression surgery is recommended for improving outcome and ease of rehabilitation. Clinical implication of this study recommends surgery for cervical spinal injury with 5.6 times more chance of survival than non-operative patients. Initial AIS neurological status and surgery performed contributes to survival. Level of cervical lesion, age, gender, mechanism of injury, surgical approach, duration, blood laboratory tests do not have a significant impact on survival while fastest time admission to surgery does not reflect higher chance of survival probability.

Long-term outcome and predictors of neurological recovery in cervical spinal cord injury: a population-based cohort study

This retrospective study analyzed prognostic factors for neurological improvement and ambulation in 194 adult patients (≥ 15 years) with traumatic cervical spinal cord injuries treated at the neurological SCI unit (SCIU) at the Karolinska University Hospital Stockholm, Sweden, between 2010 and 2020. The primary outcome was American spinal injury association impairment scale (AIS) improvement, with secondary focus on ambulation restoration. Results showed 41% experienced AIS improvement, with 51% regaining ambulation over a median follow-up of 3.7 years. Significant AIS improvement (p < 0.001) and reduced bladder/bowel dysfunction (p < 0.001) were noted. Multivariable analysis identified initial AIS C-D (< 0.001), central cord syndrome (p = 0.016), and C0–C3 injury (p = 0.017) as positive AIS improvement predictors, while lower extremity motor score (LEMS) (p < 0.001) and longer ICU stays (p < 0.001) were negative predictors. Patients with initial AIS C-D (p < 0.001) and higher LEMS (p < 0.001) were more likely to regain ambulation. Finally, older age was a negative prognostic factor (p = 0.003). In conclusion, initial injury severity significantly predicted neurological improvement and ambulation. Recovery was observed even in severe cases, emphasizing the importance of tailored rehabilitation for improved outcomes.

Noncompressive myelopathy in acute community-acquired bacterial meningitis: Report of seven cases and review of literature.

Bacterial meningitis is a severe disease with high rates of complications and unfavorable outcome. Complications involving the spinal cord are rarely reported. Cases of noncompressive myelopathy were identified from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands. The American Spinal Injury Association Impairment Scale was used to classify the severity of spinal cord dysfunction. Subsequently, we reviewed the literature on noncompressive myelopathy as a complication of bacterial meningitis. Noncompressive myelopathy was reported in seven of 3047 episodes of community-acquired bacterial meningitis (0.2%). The median age of these patients was 51 years (range = 17-77). Causative pathogens were Streptococcus pneumoniae in three, Streptococcus agalactiae in two, and Neisseria meningitidis and Haemophilus influenzae both in one. Paresis of legs (n = 6) or arms and legs (n = 1) was the presenting symptom, occurring after a median duration of 9 days after admission (range = 2-28). Spinal magnetic resonance imaging showed T2-weighted abnormalities of the spinal cord in six of seven patients. Improvement of spinal cord function during admission was noted in four of seven patients. The literature review yielded 15 additional cases. Among patients from our cohort and the literature, there was no significant association between immunosuppressive therapy and subsequent improvement of spinal cord function (5/8 patients with immunosuppressive therapy [63%] vs. 5/14 without immunosuppressive therapy [36%], p = 0.44). Noncompressive myelopathy is an uncommon but severe complication of bacterial meningitis. Improvement after diagnosis is expected, but all patients had persistent neurological deficits.

Robotic exoskeleton-assisted gait training in patients with motor incomplete myelopathy

Objectives: To assess the effect of gait training with robotic exoskeleton-assisted rehabilitation systems on gait parameters, balance, and overall disability in motor incomplete myelopathy. Design: Prospective pre-post study. Setting: Neurological rehabilitation unit in a tertiary university teaching hospital. Participants: Thirty-four motor incomplete myelopathy patients [22 males, mean age 36.7 y (12.7)] were included in this prospective, pre-post study. Twenty-two had nontraumatic etiology, and 17 had tetraplegia. American Spinal Injury Association impairment scale suggested 23 as C and 11 as American Spinal Injury Association impairment scale-D. The mean duration of the lesion was 333 days. Intervention: Twenty-four sessions of robotic gait training (1-h session, 5–6 sessions/wk) for 4–6 weeks. Outcome measures: Gait speed was assessed using a 10-meter walk test (10MWT), endurance with a 2-minute walk test (2MWT) and 6-minute walk test (6MWT), walking ability by Walking Index in Spinal Cord Injury-walking index for spinal cord injury II, functionality using Spinal cord Independence Measure-SCIM III, and balance by Timed-up-and-go (TUG) test. Results: At baseline, 20 patients were nonwalkers-NWB, and 14 were walkers-WB. The walking index for spinal cord injury II and SCIM III suggested significant improvement in both groups by the end of the study (P&lt;0.05). Among the WB group, 10MWT, 2MWT, and TUG showed significant improvement (P=0.004, 0.02, and 0.01, respectively) with training. Patients in NWB group were able to perform 10MWT, 2MWT, 6MWT, and TUG by the end of the study. Conclusions: Gait training with robotic exoskeleton-assisted rehabilitation systems can lead to a significant improvement in gait endurance, speed, balance, and functional outcomes in individuals with incomplete myelopathy. The effect is more pronounced among already ambulatory patients.

Extent of Traumatic Spinal Cord Injury Is Lesion Level Dependent and Predictive of Recovery: A Multicenter Neuroimaging Study.

Assessing the extent of the intramedullary lesion after spinal cord injury (SCI) might help to improve prognostication. However, because the neurological level of injury impacts the recovery potential of SCI patients, the question arises whether lesion size parameters and predictive models based on those parameters are affected as well. In this retrospective observational study, the extent of the intramedullary lesion between individuals who sustained cervical and thoracolumbar SCI was compared, and its relation to clinical recovery was assessed. In total, 154 patients with subacute SCI (89 individuals with cervical lesions and 65 individuals with thoracolumbar lesions) underwent conventional clinical magnetic resonance imaging 1 month after injury and clinical examination at 1 and 12 months. The morphology of the focal lesion within the spinal cord was manually assessed on the midsagittal slice of T2-weighted magnetic resonance images and compared between cervical and thoracolumbar SCI patients, as well as between patients who improved at least one American Spinal Injury Association Impairment Scale (AIS) grade (converters) and patients without AIS grade improvement (nonconverters). The predictive value of lesion parameters including lesion length, lesion width, and preserved tissue bridges for predicting AIS grade conversion was assessed using regression models (conditional inference tree analysis). Lesion length was two times longer in thoracolumbar compared with cervical SCI patients (F = 39.48, p < 0.0001), whereas lesion width and tissue bridges width did not differ. When comparing AIS grade converters and nonconverters, converters showed a smaller lesion length (F = 5.46, p = 0.021), a smaller lesion width (F = 13.75, p = 0.0003), and greater tissue bridges (F = 12.87, p = 0.0005). Using regression models, tissue bridges allowed more refined subgrouping of patients in AIS groups B, C, and D according to individual recovery profiles between 1 month and 12 months after SCI, whereas lesion length added no additional information for further subgrouping. This study characterizes differences in the anteroposterior and craniocaudal lesion extents after SCI. The two times greater lesion length in thoracolumbar compared with cervical SCI might be related to differences in the anatomy, biomechanics, and perfusion between the cervical and thoracic spines. Preserved tissue bridges were less influenced by the lesion level while closely related to the clinical impairment. These results highlight the robustness and utility of tissue bridges as a neuroimaging biomarker for predicting the clinical outcome after SCI in heterogeneous patient populations and for patient stratification in clinical trials.