Spinal Patients Research Articles

Insiden Syok Neurogenik pada Pasien dengan Cedera Tulang Belakang

Neurogenic shock is mostly associated with cervical and thoracic spine injuries. Neurogenic shock after complete spinal cord injury is difficult to treat and the prognosis remains severe most of the time. Research objectives iThis is to find out the incidence of neurogenic shock in patients with spinal cord injuries based on the location of the injury and the patient's mortality.This type of research uses the methodnarrative reviewand data collection was carried out from several literatures in accredited international journals. The results showed that neurogenic shock was 13.0% in living patients and 38.0% of patients who died after experiencing traumatic spinal cord injury and the incidence of neurogenic shock based on the location of the injury, Ruiz et al., in Canada as much as 29.1% cervical 18.5% thoracic. Wechtet al., in the United States as many as 38.7% cervical, 22.2% high thoracic, 22.7% low thoracic. Gulyet al., in England, 19.3% cervical, 7.0% thoracic, 3.0% lumbar. Ravensbergenet al., in the Netherlands as much as 45.6% cervical, 26.3% thoracic, 23.8% lumbar. Katzelnicket al., in the United States, as many as 11% cervical, 8% high thoracic, 0% low thoracic. Based on the results of a review of some of the literature, it can be concluded that the incidence of neurogenic shock in patients with spinal cord injuries based on the location of the injury was mostly at the cervical level and based on the patient's mortality status, it was found that more patients died after experiencing traumatic spinal cord injury.

Chaotic Model of Muscle and Joint Interactions Based on CPG for Rehabilitation of Incomplete Spinal Cord Injury Patients

The aim of modeling musculoskeletal systems is to understand the mechanisms of locomotion control in terms of neurophysiology and neuroanatomy. The complexity and unique nature of neuromuscular systems, however, make control problems in these systems very challenging due to several characteristics including speed and precision. Thus, their investigation requires the use of simple and analyzable methods. Consequently, taking into account the central pattern generator’s (CPG) function, we attempted to create a structured chaotic model of how human joints and muscles interact for the purpose of facilitating gait and rehabilitation in patients with incomplete spinal cord injury. The four muscle groups used in this model are gluteus, and hip flexor groups for flexion and extension of the hip joints as well as hamstring muscles and vasti muscles for flexion and extension of the knee joint. The results indicate that the output of the chaotic model of muscle and joint interactions in a healthy state would be chaotic, while in the incomplete spinal cord injury state, it would remain a fixed point. For model rehabilitation, afferent nerve stimulation is used in a CPG model; based on the modeling results, by applying coefficients of 1.98, 2.21, and 3.1 to the values of Ia, II, and Ib afferent nerves, the incomplete spinal cord injury model state is changed from a fix-point to periodic in a permanent fashion, suggesting locomotion with rehabilitation in our model. Based on the results obtained from the chaotic model of muscle and joint interactions as well as the comparisons made with reference papers, it can be stated that this model has acceptable output while enjoying simple computations and can predict different norms.

Design Optimization of the Lift Mechanism in the Robotic Walking Training Device Using the Engineering Design Methodology

Partial paralysis caused by spinal cord injury (SCI) or stroke are two of the most prevalent forms of physical disability. Through proper gait training, people with incomplete SCI have more potential to retain or regain the ability to walk than those with complete SCI. To help patients who have these disabilities regain the function of walking unassisted, the robotic walking training device (RWTD) has been developed to perform gait rehabilitation. This research plays a pivotal role in advancing medical robotic technology and gait rehabilitation by conducting a comprehensive evaluation and comparison of three lift mechanisms. Specifically, the lift mechanisms are designed to reposition a patient, using the RWTD, from a supine to a vertical position. Addressing a crucial gap in supporting and placing patients in gait rehabilitation devices, design optimization was performed using the engineering design process. This approach utilizes sophisticated techniques, including CAD modeling, motion analysis, structural analysis using finite element analysis, and a Pugh decision matrix. The findings offer valuable insights for optimizing lift mechanisms for the RWTD, contributing to the enhancement of patient-centric care. This research ensures a focus on safety, efficiency, and comfort in the gait rehabilitation process, with broader implications for the evolution of medical robotic devices.

Beneficial carry-over effects of chronic at-home genital nerve stimulation on incontinence in individuals with spinal cord injury: A pragmatic trial

BackgroundGenital nerve stimulation (GNS) is a promising, but under-researched, alternative treatment for neurogenic detrusor overactivity (NDO) in those with spinal cord injury (SCI). ObjectivesTo investigate the urodynamic, quality-of-life (QOL) and carry-over effects of GNS when applied at home for 2 weeks by participants with incomplete SCI and NDO during activities of daily living. MethodsSeven men and 1 woman participated in this 1-month protocol study. Urodynamic and QOL data were gathered during week 1 (baseline measurements), followed by 2 weeks of daily GNS at home using a portable device. GNS was applied either on-demand or thrice daily, depending on the individual's sensation. At week 4, post-stimulation tests were repeated to record any carry-over effect from the GNS. Participants maintained voiding diaries throughout the study. Assessments were carried out at the end of each protocol period in a randomized order. Clinical procedures were conducted at Taipei Medical University Hospital (Taipei, Taiwan). ResultsEveryone completed the study but only 7 of the 8 participants completed their voiding diary. Two weeks after GNS, average cystometric bladder capacity was increased by 30 % compared to baseline (P< 0.05). A 1-week carry-over effect was demonstrated as this capacity remained, on average, 35 % greater than baseline in week 4 after GNS was stopped (P< 0.05). Incontinence frequency significantly decreased by the end of week 3 (P< 0.05) but no significant improvements were recorded for either detrusor pressure or bladder compliance. ConclusionsChronic at-home GNS improved cystometric bladder capacity and reduced urinary incontinence for individuals with incomplete SCI and NDO. A carry-over effect of 1 week was observed following GNS treatment. The use of portable GNS treatment that can be applied by the individual at home merits further investigation as alternative treatment for NDO in those with SCI.

Spontaneous regeneration of cholecystokinergic reticulospinal axons after a complete spinal cord injury in sea lampreys

In contrast to humans, lampreys spontaneously recover their swimming capacity after a complete spinal cord injury (SCI). This recovery process involves the regeneration of descending axons. Spontaneous axon regeneration in lampreys has been mainly studied in giant descending neurons. However, the regeneration of neurochemically distinct descending neuronal populations with small-caliber axons, as those found in mammals, has been less studied. Cholecystokinin (CCK) is a regulatory neuropeptide found in the brain and spinal cord that modulates several processes such as satiety, or locomotion. CCK shows high evolutionary conservation and is present in all vertebrate species. Work in lampreys has shown that all CCKergic spinal cord axons originate in a single neuronal population located in the caudal rhombencephalon. Here, we investigate the spontaneous regeneration of CCKergic descending axons in larval lampreys following a complete SCI. Using anti-CCK-8 immunofluorescence, confocal microscopy and lightning adaptive deconvolution, we demonstrate the partial regeneration of CCKergic axons (81% of the number of axonal profiles seen in controls) 10 weeks after the injury. Our data also revealed a preference for regeneration of CCKergic axons in lateral spinal cord regions. Regenerated CCKergic axons exhibit colocalization with synaptic vesicle marker SV2, indicative of functional synaptic connections. We also extracted swimming dynamics in injured animals by using DeepLabCut. Interestingly, the degree of CCKergic reinnervation correlated with improved swimming performance in injured animals, suggesting a potential role in locomotor recovery. These findings open avenues for further exploration into the role of specific neuropeptidergic systems in post-SCI spinal locomotor networks.

The Circumstances and Measures of Return to Work for Patients with Complete Cervical Spinal Cord Injury：From the Standpoint of a Comprehensive Rehabilitation Unit in Nara Prefecture

The Circumstances and Measures of Return to Work for Patients with Complete Cervical Spinal Cord Injury：From the Standpoint of a Comprehensive Rehabilitation Unit in Nara Prefecture

Preventing Complications After Complete Cervical Spinal Cord Injury：Bladder and Bowel Management

Preventing Complications After Complete Cervical Spinal Cord Injury：Bladder and Bowel Management

Preventing Complications of Complete Cervical Spinal Cord Injury：Pressure Sore Management

Preventing Complications of Complete Cervical Spinal Cord Injury：Pressure Sore Management

Challenges in Returning to Work for Patients with Complete Cervical Spinal Cord Injury

Challenges in Returning to Work for Patients with Complete Cervical Spinal Cord Injury

Incomplete spinal cord injury following minor trauma in two siblings with spondylocostal dysostis type 6.

Biallelic pathogenic variants of the RIPPLY2 gene have been recognized to cause a subtype of autosomal recessive spondylocostal dysostosis (SCDO6), characterized by predominant cervical spine malformation with minor or absent involvement of the ribs. To date, RIPPLY2 associated SCDO6 has been described in ten patients in five studies with accompanying clinical symptoms varying from transient and recurrent torticollis to flaccid quadriplegia. Here, we describe two additional patients in one family in which the c.A238T:p.Arg80* RIPPLY2 mutation in the homozygous state, was associated with severe malformation of the posterior elements of the cervical vertebral column. In both cases neurological symptoms occurred early in life due to spinal cord compromise. These two cases, in keeping with previous reports, highlight the early and progressive natural history of cervical deformity in this rare skeletal dysplasia and the need for close neurological and radiological surveillance. Surgical decision-making needs to carefully balance the need for early intervention to protect spinal cord function on one hand, with the problem of bone malformation and skeletal immaturity on the other.

Consecutive Transcutaneous and Epidural Spinal Cord Neuromodulation to Modify Clinical Complete Paralysis—the Proof of Concept

ObjectiveTo evaluate the effect of transcutaneous (tSCS) and epidural electrical spinal cord stimulation (EES) in facilitating volitional movements, balance, and nonmotor functions, in this observational study, tSCS and EES were consecutively tested in 2 participants with motor complete spinal cord injury (SCI). Participants and MethodsTwo participants (a 48-year-old woman and a 28-year-old man), both classified as motor complete spinal injury, were enrolled in the study. Both participants went through a unified protocol, such as an initial electrophysiological assessment of neural connectivity, consecutive tSCS and EES combined with 8 wks of motor training with electromyography (EMG) and kinematic evaluation. The study was conducted from May 1, 2019, to December 31, 2021. ResultsIn both participants, tSCS reported a minimal improvement in voluntary movements still essential to start tSCS-enabled rehabilitation. Compared with tSCS, following EES showed immediate improvement in voluntary movements, whereas tSCS was more effective in improving balance and posture. Continuous improvement in nonmotor functions was found during tSCS-enabled and then during EES-enabled motor training. ConclusionResults report a significant difference in the effect of tSCS and EES on the recovery of neurologic functions and support consecutive tSCS and EES applications as a potential therapy for SCI. The proposed approach may help in selecting patients with SCI responsive to neuromodulation. It would also help initiate neuromodulation and rehabilitation therapy early, particularly for motor complete SCI with minimal effect from conventional rehabilitation.

Home-based arm cycling exercise improves trunk control in persons with incomplete spinal cord injury: an observational study

Arm cycling is used for cardiorespiratory rehabilitation but its therapeutic effects on the neural control of the trunk after spinal cord injury (SCI) remain unclear. We investigated the effects of single session of arm cycling on corticospinal excitability, and the feasibility of home-based arm cycling exercise training on volitional control of the erector spinae (ES) in individuals with incomplete SCI. Using transcranial magnetic stimulation, we assessed motor evoked potentials (MEPs) in the ES before and after 30 min of arm cycling in 15 individuals with SCI and 15 able-bodied controls (Experiment 1). Both groups showed increased ES MEP size after the arm cycling. The participants with SCI subsequently underwent a 6-week home-based arm cycling exercise training (Experiment 2). MEP amplitudes and activity of the ES, and movements of the trunk during reaching, self-initiated rapid shoulder flexion, and predicted external perturbation tasks were measured. After the training, individuals with SCI reached further and improved trajectory of the trunk during the rapid shoulder flexion task, accompanied by increased ES activity and MEP amplitudes. Exercise adherence was excellent. We demonstrate preserved corticospinal drive after a single arm cycling session and the effects of home-based arm cycling exercise training on trunk function in individuals with SCI.

Mimicked Spinal Cord Fibers Trigger Axonal Regeneration and Remyelination after Injury.

Spinal cord injury (SCI) causes tissue structure damage and composition changes of the neural parenchyma, resulting in severe consequences for spinal cord function. Mimicking the components and microstructure of spinal cord tissues holds promise for restoring the regenerative microenvironment after SCI. Here, we have utilized electrospinning technology to develop aligned decellularized spinal cord fibers (A-DSCF) without requiring synthetic polymers or organic solvents. A-DSCF preserves multiple types of spinal cord extracellular matrix proteins and forms a parallel-oriented structure. Compared to aligned collagen fibers (A-CF), A-DSCF exhibits stronger mechanical properties, improved enzymatic stability, and superior functionality in the adhesion, proliferation, axonal extension, and myelination of differentiated neural progenitor cells (NPCs). Notably, axon extension or myelination has been primarily linked to Agrin (AGRN), Laminin (LN), or Collagen type IV (COL IV) proteins in A-DSCF. When transplanted into rats with complete SCI, A-DSCF loaded with NPCs improves the survival, maturation, axon regeneration, and motor function of the SCI rats. These findings highlight the potential of structurally and compositionally biomimetic scaffolds to promote axonal extension and remyelination after SCI.

Early Short Segment Pedicle Screw Fixation Including Fractured Vertebra of Thoracolumbar Burst Fracture with Incomplete Spinal Cord Injury

Background: Fractures of the thoracolumbar region are the most common injuries of the vertebral column; among them burst fractures are the most frequent. Several studies were done to see the surgical outcome of thoracolumbar burst fracture hence surgery was recommended for a better outcome. So, the current study aimed to evaluate the clinical, functional, and radiological outcome of short-segment pedicle screw fixation including the fractured vertebral body. Objectives: The primary aim of this study is to comprehensively evaluate the functional and radiological outcomes of early short-segment pedicle screw fixation, particularly in cases involving fractured vertebrae in thoracolumbar burst fractures accompanied by incomplete spinal cord injuries. Materials &amp; Method: In this prospective observational study, 31 cases were included between April 2017 and July 2018 through non-randomized purposive sampling. All patients, aged 15 to 60 years, underwent posterior decompression and short-segment pedicle screw fixation, including the fractured vertebral body, within 21 days of the fracture. Postoperative functional outcomes were clinically assessed using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS), American Spinal Injury Association (ASIA) scale, Denis Work Scale, and radiologically evaluated by Cobb's kyphotic angle, kyphotic deformation, Beck index, and Bridwell criteria. Postoperative follow-ups were conducted at the 6th, 12th, and 24th weeks. Results: In this study, 31 cervical spinal injury patients underwent operative treatment with a 3 to 12-month follow-up. Most were day laborers (35.48%), experiencing falls from height (80.65%), mainly at L1 (54.84%). Initial ASIA grade D improved to E (54.58%). Postoperatively, significant improvements in kyphotic angles, Beck index, and vertebral height were noted, with some correction loss at the final follow-up. Complications occurred in 22.58% of cases, including per-operative hemorrhage, dural tear, .......

Healthcare Experience of People with Acute Spinal Cord Injury: A Phenomenological Study.

Living with spinal cord injury (SCI) is a challenge that begins in the acute phase, when the disease, the limitations, and the treatments fill the days at the hospital. This study aims to understand the healthcare experience of the person with SCI in the acute phase, based on the Activities of Living Nursing Model (ALNM). It is a qualitative and phenomenological study based on the Standards for Reporting Qualitative Research. Data were collected via semi-structured interviews. Content analysis was performed using the ATLAS.ti software and Bardin's methodology. The article was written following the COREQ guidelines. The categories were defined using the Roper-Logan-Tierney Model for Nursing. The sample included 16 people with incomplete SCI, different etiology, and neurological levels. Eleven of the twelve ALNM emerged from the interviews. The activities of mobilizing, eliminating, maintaining a safe environment, and communicating were emphasized the most. Controlling body temperature was not relevant. Mobility deficits and pain increased dependence. Feelings of motivation, encouragement, and frustration were highlighted. Professional expertise, rehabilitation resources, and support equipment promoted independence. The results in this sample revealed that people with SCI in the acute phase have complex challenges related to dependence awareness and treatments, but they always keep recovery expectations in mind.

“I am just trying to live a life!” –a qualitative study of the lived experience of pressure ulcers in people with spinal cord injuries

BackgroundPressure ulcers (PUs) are frequently reported in people with spinal cord injuries (SCI). Wound management in people with SCI involves relieving pressure on the affected area by means of immobilisation and bed rest. The healing time of a PU can vary, but often takes several months or even years, causing people to stay in bed for prolonged periods of time. Objective: This study aims to explore the perspectives and lived experiences of people with SCI who are affected by PUs. Designand method: This study is a qualitative explorative study that employs individual semi-structured in-depth interviews to obtain the narratives of people with SCI and a pressure ulcer. We used a phenomenological-hermeneutic approach that was inspired by Ricoeur's theory of interpretation. The analysis was performed in three levels: Naïve reading, structural analysis and critical interpretation and discussion. Participantsand setting: Ten people with SCI who were being treated in the Danish healthcare system for their PU participated in this study: six participants had experienced a complete traumatic SCI, three had an incomplete traumatic SCI, and one had a non-traumatic complete SCI. The study included nine men and one woman, aged 49–81 years (mean 64). Nine had a PU in the seating area, while one had the ulcer on the leg. ResultsThe analysis revealed three themes: 1. Struggling to balance prevention with an active, meaningful life, 2. Challenges and consequences of pressure relief protocols and bed rest, 3. Experiencing prolonged and incoherent treatment with varying levels of staff engagement and competencies. ConclusionsPeople with SCI and a PU have difficulty balancing their active, redefined lives when subjected to a strict pressure relief protocol. The consequences of immobility caused by pressure relief include reduced social and community participation and decreased quality of life. PU treatment is experienced as incoherent and unnecessarily lengthy, leading to a deterioration in the wounds. Improving PU treatment for people with SCI is of utmost importance and has the potential to benefit not only the people with SCI but also the healthcare system and the economy.

Polysomnography in patients with spinal cord injury who underwent robotic assisted gait training

IntroductionObstructive sleep apnea in spinal cord injured (SCI) patients is an important but underestimated clinical problem. Spinal cord injury weakens the muscles responsible for breathing, resulting in a reduction in lung capacity. Training of respiratory muscles may present an effective method of increasing respiratory muscle strength and lung volume.AimThe aim of study was to evaluate the effectiveness of robot-assisted gait training (RAGT) in 34 patients with SCI in sleep-disordered breathing (SDB) reduction.Material and methodsWe conducted a control trail to compare RAGT (exoskeleton EKSO-GT or Locomat Pro) with conventional gait training using conventional physiotherapy with dynamic parapodium. We included patients with SCI (above T8 level of injury) recruited between 3 months and 2 years post injury. Polysomnographic studies were performed before and after the completion of the 7-week rehabilitation program. Patients were divided into 2 groups above and up 40 years old.Results and discussionThe comparison of all polysomnographic parameters before and after rehabilitation with RAGT revealed the decline in all polysomnographic parameters (the apnea-hypopnea index – AHI; score reached statistically significant value – &lt;i&gt;P&lt;/i&gt; &lt; 0.02). In comparison in patients aged up to 40 years with conventional gait rehabilitation the number of apnoea’s and shortness of breath during sleep even increased: the AHI index increased after rehabilitation from 1.7 to 3.2 values.ConclusionsRAGT therapy should be considered as a therapeutic option for SDB reduction in patients after SCI. Additionally, the study identified the need to conduct further studies on larger groups of patients.

A nonlinear modelling approach to quantify sitting control in individuals with sensorimotor impairments

AbstractFew biomechanical models of sitting stability have been proposed over the last decades and most of them control the trunk position through a lumbar torque. Unfortunately, this type of model is not valid for individuals living with a complete thoracic spinal cord injury (SCI) who generally experience paralysis of their abdominal and lower back muscles. Instead, individuals with SCI often engage their upper limbs as a compensatory strategy to control their sitting position. A new nonlinear biomechanical model is introduced to take into consideration the influence of the upper limbs for sitting control study of people living with SCI. The inherent nonlinearity of the model is taken into account via the Takagi–Sugeno (T‐S) framework. To estimate the internal controlling torques without measurements, an unknown input observer (UIO) is created. Its convergence is expressed by linear matrix inequalities (LMI), which are solved by convex optimization techniques. Numerical simulations with perturbations are used to assess the adequacy of the methodology and preliminary experimental data of one person living with SCI performing a sitting stabilization exercise is used to estimate internal torques of the upper limbs. The main contribution of this work is to provide a way to estimate human joint torques without invasive measurements; the results highlight the validity of both goals of this article, the nonlinear biomechanical modelling and the UIO methodology.

Epidemiology of Gunshot-Related Spinal Injuries and Related Risk Factors for In-Hospital Mortality in the United States from 2015-2019: A National Trauma Data Bank Analysis.

Firearm injuries in the U.S. pose a significant public health burden, but data on gunshot wounds (GSWs) specifically involving the spine are scarce. We examined epidemiological trends in GSWs to the spine and associated spinal cord injury (SCI) and mortality rates. This was a cross-sectional study of data from level I-III trauma centers in the U.S. participating in the American College of Surgeons National Trauma Data Bank (ACS NTDB) in 2015-2019. We identified adult and pediatric patients presenting with GSW and evaluated those with Abbreviated Injury Scale codes indicating spinal involvement and SCI. We assessed in-hospital mortality and GSW-related SCI. A total of 5,021,316 patients were enrolled in the ACS NTDB. Of the 107,233 patients (2.1% of total) presenting with GSW, 9023 (8.4%) patients had spine involvement. Overall rates of GSW and spinal GSW were similar across years. The most common cause of spinal GSW injury was assault (86.7%). The cervical spine was involved in 24.2% of patients, thoracic spine in 42.8%, and lumbar spine in 39.7%. Cervical SCI was present in 8.7% of all spinal GSW (35.7% of cervical GSW), thoracic SCI in 17.4% (40.6% of thoracic GSW), and lumbar SCI in 8.1% (20.3% of lumbar GSW). The mean patient age was 29.0 ± 12.2 years, 88.5% were male, 62.4% were black, 23.7% were white, and 13.9% were another race. Blood alcohol content was ≥0.08 in 12.1%, and illicit drugs were positive in 24.4%. In-hospital mortality was high in patients with spinal GSWs (8.1%), and mortality was significantly higher with cervical involvement (18.1%), cervical SCI (30.7%), or thoracic incomplete SCI (13.6%) on univariate analysis. On multi-variate analysis of age (excluding patients <16 years of age), sex, Injury Severity Score (ISS), complete SCI, and spinal area of involvement, only greater patient age (age 40-65 years: adjusted odds ratio [aOR] 1.52, 95% confidence interval [CI] 1.09-2.11, p = 0.014; age >65 years: aOR 3.90, 95% CI 2.10-7.27, p < 0.001) and higher ISS (ISS 9-15: aOR 6.65, 95% CI 2.38-18.54, p < 0.001; ISS 16-24: aOR 18.13, 95% CI 6.65-49.44, p < 0.001; ISS >24: aOR 68.44, 95% CI 25.39-184.46, p < 0.001) were independently associated with in-hospital mortality risk after spinal GSW. These results demonstrate that spinal GSW is not uncommon and that older patients with more severe systemic injuries have higher in-hospital mortality risk.

Factors influencing withdrawal of life-supporting treatment in cervical spinal cord injury: a large multicenter observational cohort study

BackgroundTraumatic spinal cord injury (SCI) leads to profound neurologic sequelae, and the provision of life-supporting treatment serves great importance among this patient population. The decision for withdrawal of life-supporting treatment (WLST) in complete traumatic SCI is complex with the lack of guidelines and limited understanding of practice patterns. We aimed to evaluate the individual and contextual factors associated with the decision for WLST and assess between-center differences in practice patterns across North American trauma centers for patients with complete cervical SCI.MethodsThis retrospective multicenter observational cohort study utilized data derived from the American College of Surgeons Trauma Quality Improvement Program database between 2017 and 2020. The study included adult patients (> 16 years) with complete cervical SCI. We constructed a multilevel mixed effect logistic regression model to adjust for patient, injury and hospital factors influencing WLST. Factors associated with WLST were estimated through odds ratios with 95% confidence intervals. Hospital variability was characterized using the median odds ratio. Unexplained residual variability was assessed through the proportional change in variation between models.ResultsWe identified 5070 patients with complete cervical SCI treated across 477 hospitals, of which 960 (18.9%) had WLST. Patient-level factors associated with significantly increased likelihood of WLST were advanced age, male sex, white race, prior dementia, low presenting Glasgow Coma Scale score, having a pre-hospital cardiac arrest, SCI level of C3 or above, and concurrent severe injury to the head or thorax. Patient-level factors associated with significantly decreased likelihood of WLST included being racially Black or Asian. There was significant variability across hospitals in the likelihood for WLST while accounting for case-mix, hospital size, and teaching status (MOR 1.51 95% CI 1.22–1.75).ConclusionsA notable proportion of patients with complete cervical SCI undergo WLST during their in-hospital admission. We have highlighted several factors associated with this decision and identified considerable variability between hospitals. Further work to standardize WLST guidelines may improve equity of care provided to this patient population.