Traumatic Cervical Spinal Cord Injury Research Articles

Evaluation of clinical factors predicting dysphagia in patients with traumatic and non-traumatic cervical spinal cord injury: a retrospective study

IntroductionDysphagia is a common complication in patients with cervical spinal cord injury (C-SCI) and can cause various pulmonary complications, such as aspiration pneumonia and mechanical airway obstruction increasing mortality and morbidity. This study evaluated the clinical factors that predict dysphagia in patients with traumatic and non-traumatic C-SCI.MethodsNinety-eight patients with C-SCI were retrospectively enrolled in this study and were divided into those with and without dysphagia. Clinical factors such as age, sex, tracheostomy, spinal cord independence measure, pulmonary function test (PFT) including forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and FVC/FEV1, American Spinal Cord Injury Association score, Berg Balance Scale, and surgical approach were investigated retrospectively.ResultsMultivariate logistic regression analysis revealed that FVC and the presence of tracheostomy were significantly correlated with dysphagia in patients with C-SCI (p < 0.05). FVC and the presence of tracheostomy are useful tools for detecting dysphagia in patients with C-SCI.ConclusionConsidering the results of our study, early PFTs, especially FVC, in patients with C-SCI and early initiation of dysphagia management and treatment in patients with C-SCI and tracheostomy will be advantageous in lowering the mortality and morbidity due to pulmonary aspiration in these patients.

Impact of Cardiac Pacemaker Implantation in Patients With Acute Traumatic Cervical Spinal Cord Injury.

Cardiac pacemaker implantation may be indicated in patients with refractory bradycardia following a cervical spinal cord injury (CSCI). However, evidence about the impact of this procedure on outcomes is lacking. We planned a study to assess whether the implantation of a pacemaker would decrease mortality and hospital resource utilization in patients with CSCI. Adult patients with CSCI in the Trauma Quality Improvement Program (TQIP) database between 2016 and 2019 were retrospectively analyzed. Patients were divided into "pacemaker" and "non-pacemaker" groups, and their baseline characteristics and clinical outcomes were analyzed. A total of 6774 cases were analyzed. The pacemaker group showed higher in-hospital rates of cardiac arrest, myocardial infarction, and longer duration of mechanical ventilation and ICU stay than the non-pacemaker group. Nevertheless, pacemaker placement was associated with a significant decrease in mortality (4.2% vs 26.0%, P < .01). Patients with CSCI requiring a pacemaker placement had better survival than those treated without a pacemaker. Pacemaker implantation should be highly considered in patients who develop refractory bradycardia after CSCI.

469 Recovery Rate of Motor Function During Rehabilitation After Traumatic Cervical Spinal Cord Injury Predicts Functional Status at Years 1 and 5 After Surgery: A Multicenter, Longitudinal Cohort Study

INTRODUCTION: Traumatic spinal cord injury (SCI) is a devastating condition. Early surgical decompression and rehabilitative efforts in cervical SCI patients has been shown to improve neurological outcomes. METHODS: A longitudinal, retrospective cohort study was conducted from the multicenter Spinal Cord Injury Model Systems (SCIMS) database on patients with motor Functional Independence Measure (FIM) scores at admission to and discharge from rehabilitation, year 1, and year 5. Patients who underwent surgical decompression with neurological levels of injury limited to the cervical region and those with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A and B were included. The FIM score was utilized to calculate changes in motor FIM scores over each respective time period. Multivariate logistical regression was performed to identify longitudinal predictors associated with functional independence. RESULTS: A total of 351 patients met the inclusion criteria. The change in motor FIM score during the inpatient rehab period was a significant predictor of achieving FI at 1 and 5 years (year 1: aOR = 15.6, 95% CI 3.94-77.6, p &lt; 0.0001; year 5: aOR = 28.0, 95% CI 6.13-173.6, p &lt; 0.0001). For patients not achieving FI at year 1, the change in motor FIM score during inpatient rehab was a greater predictor of FI at year 5 (aOR = 64.7, 95% CI 5.15-1717.3, p = 0.0004). CONCLUSIONS: Inpatient rehabilitation efforts may lead to greater long-term functional status and carry emphasized importance for patients who do not attain functional independence by year 1.

Advances in Medical and Surgical Care of Acute Spinal Cord injury

Acute cervical spinal cord injury (SCI) represents a significant challenge, with substantial implications for individual well-being and societal costs. In this chapter, we highlighted the importance of early surgical intervention within a critical time frame following injury to mitigate the risk of secondary damage and optimize neurological recovery. The chapter also delineated the dichotomy of primary and secondary injuries in traumatic cervical SCI, elucidating the pathophysiological mechanisms underlying each phase. Insights into the inflammatory cascade and cellular responses offer a nuanced understanding of injury progression, paving the way for targeted therapeutic interventions. Therefore, we delved into the current landscape of traumatic cervical SCI, addressing the advances in the medical and surgical care. Regarding surgical management, attention was directed towards established practices such as immobilization, respiratory support, and optimal timing of surgery, alongside emerging modalities including intraspinal pressure management, stem cell therapy, and nerve/tendon transfer. Similarly, the medical management section highlighted the importance of spinal cord perfusion, neurogenic shock management, and the role of steroids, while also exploring novel avenues such as genetic modification for spinal recovery. Overall, this chapter underscored the dynamic nature of SCI care, advocating for a holistic approach that integrates traditional and innovative treatment modalities.

Impact of malnutrition on mortality and neurological recovery of older patients with spinal cord injury

This retrospective cohort study established malnutrition’s impact on mortality and neurological recovery of older patients with cervical spinal cord injury (SCI). It included patients aged ≥ 65 years with traumatic cervical SCI treated conservatively or surgically. The Geriatric Nutritional Risk Index was calculated to assess nutritional-related risk. Overall, 789 patients (mean follow-up: 20.1 months) were examined and 47 had major nutritional-related risks on admission. One-year mortality rate, median survival time, neurological recovery, and activities of daily living (ADL) at 1 year post-injury were compared between patients with major nutrition-related risk and matched controls selected using 1:2 propensity score matching to adjust for age, pre-traumatic neurological impairment, and activity. In the Kaplan–Meier analysis, the median survival times were 44.9 and 76.5 months for patients with major nutrition-related risk and matched controls, respectively (p = 0.015). Matched controls had more individuals with a neurological improvement of American Spinal Injury Association Impairment Scale ≥ 1 grade (p = 0.039) and independence in ADL at 1 year post-injury than patients with major nutrition-related risk (p < 0.05). In conclusion, 6% of older patients with cervical SCI had major nutrition-related risks; they showed a significantly higher 1 year mortality rate, shorter survival time, poorer neurological improvement, and lower ADL at 1 year post-injury than matched controls.

Quantifying the Association Between Surgical Spine Approach and Tracheostomy Timing After Traumatic Cervical Spinal Cord Injury.

Recent evidence suggests earlier tracheostomy is associated with fewer complications in patients with complete cervical spinal cord injury (SCI). This study aims to evaluate the influence of spine surgical approach on the association between tracheostomy timing and in-hospital adverse events treating patients with complete cervical SCI. This retrospective cohort study was performed using Trauma Quality Improvement Program data from 2017 to 2020. All patients with acute complete (American Spinal Injury Association-A) cervical SCI who underwent tracheostomy and spine surgery were included. Tracheostomy timing was dichotomized to early (within 1 week after surgery) and delayed (more than 1 week after surgery). Primary outcome was the occurrence of major in-hospital complications. Secondary outcomes included occurrences of immobility-related complications, surgical-site infection, hospital and intensive care unit length of stay, and time on mechanical ventilation. The study included 1592 patients across 358 trauma centers. Mean time to tracheostomy from surgery was 8.6 days. A total of 495 patients underwent anterior approach, 670 underwent posterior approach, and 427 underwent combined anterior and posterior approach. Patients who underwent anterior approach were significantly more likely to have delayed tracheostomy compared with posterior approach (53% vs 40%, P < .001). Early tracheotomy significantly reduced major in-hospital complications (odds ratio 0.67, 95% CI 0.53-0.84) and immobility complications (odds ratio = 0.78, 95% CI 0.6-1.0). Those undergoing early tracheostomy spent 6.0 (95% CI -8.47 to -3.43) fewer days in hospital, 5.7 (95% CI -7.8 to -3.7) fewer days in the intensive care unit, and 5.9 (95% CI -8.2 to -3.7) fewer days ventilated. Surgical approach had no significant negative effect on the association between tracheostomy timing and the outcomes of interest. Earlier tracheostomy for patients with cervical SCI is associated with reduced complications, length of stay, and ventilation time. This relationship appears independent of the surgical approach. These findings emphasize that tracheostomy need not be delayed because of the SCI treatment approach.

Influential factors of the prognosis of patients with winter sports-induced traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema after emergency surgical treatment.

To explore relevant influencing factors of the prognosis of patients with winter sports-induced traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema after emergency surgical treatment. A retrospective analysis was performed on 73 cases of traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema in The First Hospital Affiliated to Hebei North University from January 2020 to October 2022. The enrolled patients were divided into the good prognosis (n=17) group and poor prognosis (n=56) group according to the recovery of neurological function after six months of follow-up. The risk factors affecting the prognosis of patients with traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema after emergency surgery were analyzed by binary Logistic regression. Among the enrolled 73 patients with traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema, 56 cases showed significant improvement in ASIA Grade-6 months after operation, with an improvement rate of 76.71%. Further Logistic regression analysis revealed that concomitant diabetes, preoperative MSCC>40.83% and recovery rate of AMS <40.13% 3d after operation were independent risk factors affecting the poor prognosis of patients with traumatic cervical spinal cord injury complicated with intramedullary hemorrhage and edema. Emergency surgery can improve the neurological function of patients with cervical spinal cord injury complicated with intramedullary hemorrhage and edema caused by winter sports. Concomitant diabetes, preoperative MSCC and recovery rate of AMS 3d after operation are the main factors affecting the prognosis of patients with emergency surgery.

Segmental infralesional pathological spontaneous activity in subacute traumatic spinal cord injury.

There is a dearth of knowledge regarding the status of infralesional lower motor neurons (LMNs) in individuals with traumatic cervical spinal cord injury (SCI), yet there is a growing need to understand how the spinal lesion impacts LMNs caudal to the lesion epicenter, especially in the context of nerve transfer surgery to restore several key upper limb functions. Our objective was to determine the frequency of pathological spontaneous activity (PSA) at, and below, the level of spinal injury, to gain an understanding of LMN health below the spinal lesion. Ninety-one limbs in 57 individuals (53 males, mean age = 44.4 ± 16.9 years, mean duration from injury = 3.4 ± 1.4 months, 32 with motor complete injuries), were analyzed. Analysis was stratified by injury level as (1) C4 and above, (2) C5, and (3) C6-7. Needle electromyography was performed on representative muscles innervated by the C5-6, C6-7, C7-8, and C8-T1 nerve roots. PSA was dichotomized as present or absent. Data were pooled for the most caudal infralesional segment (C8-T1). A high frequency of PSA was seen in all infralesional segments. The pooled frequency of PSA for all injury levels at C8-T1 was 68.7% of the limbs tested. There was also evidence of PSA at the rostral border of the neurological level of injury, with 58.3% of C5-6 muscles in those with C5-level injuries. These data support a high prevalence of infralesional LMN abnormalities following SCI, which has implications to nerve transfer candidacy, timing of the intervention, and donor nerve options.

Traumatic cervical spinal cord injury: Comparison of two different blood pressure targets on neurological recovery.

Controversy exists whether blood pressure augmentation therapy benefits patients suffering from spinal cord injury (SCI). This retrospective comparative study was designed to assess the impact of two different mean arterial pressure (MAP) targets (85-90 mmHg vs. 65-85 mmHg) on neurological recovery after traumatic cervical SCI. Fifty-one adult patients with traumatic cervical SCI were retrospectively divided into two groups according to their intensive care unit (ICU) MAP targets: 85-90 mmHg (higher MAP group, n = 32) and 65-85 mmHg (lower MAP group, n = 19). Invasive MAP measurements were stored as 2-min median values for 3-7 days. The severity of SCI (AIS grade and neurological level) was evaluated upon ICU stay and during rehabilitation. Neurological recovery was correlated with individual mean MAP values and with the proportion of MAP values ≥85 mmHg upon the first 3 days (3d-MAP%≥85 ). The initial AIS grades were A 29.4%, B 17.6%, C 31.4%, and D 21.6%. AIS grade improved in 24 patients (47.1%). During ICU care, 82.0% and 36.8% of the measured MAP values reached ≥85 mmHg in the higher and the lower MAP groups, respectively (p < .001). The medians of individual mean MAP values were different between the groups (90.2 mmHg vs. 81.4 mmHg, p < .001). Similarly, 3d-MAP%≥85 was higher in the higher MAP group (85.6% vs. 50.0%, p < .001). However, neurological recovery was not different between the groups, nor did it correlate with individual mean MAP values or 3d-MAP%≥85 . The currently recommended MAP target of 85-90 mmHg was not associated with improved outcomes compared to a lower target in patients with traumatic cervical SCI in this cohort.

Exploring factors associated with heart rate variability in newly injured traumatic cervical spinal cord injury patients

Background: Assessment of heart rate variability (HRV) in traumatic cervical spinal cord injury (SCI) patients is widely reported, but few studies have examined the HRV in the newly injured. Further, there is paucity of data relating HRV to factors that might have a bearing on the extent of variability in them. Aim and Objectives: The current study explored the factors associated with the HRV of newly injured cervical SCI American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade A/B patients. Materials and Methods: A secondary analysis of HRV data acquired from 24 newly injured tetraplegic patients in a previously published study compared the HRV between AIS grade A and B patients, and across cervical levels of lesion. In addition, the correlation of HRV indices with duration since injury and the patients’ age was examined. Results: The ratio of low to high frequency power was significantly lower in AIS B compared to AIS A patients, and significantly negatively correlated with duration since injury. Conclusion: The ratio of modulations of cardiac sympatho-vagal supply was lower in AIS B patients and reduced with increasing duration since injury. AIS grade and duration since injury need to be considered when interpreting the HRV data of newly injured tetraplegic patients.

Changing trends in traumatic spinal cord injury in an aging society: Epidemiology of 1152 cases over 15 years from a single center in Japan.

Traumatic spinal cord injury (TSCI) causes an insult to the central nervous system, often resulting in devastating temporary or permanent neurological impairment and disability, which places a substantial financial burden on the health-care system. This study aimed to clarify the up-to-date epidemiology and demographics of patients with TSCI treated at the largest SCI center in Japan. Data on all patients admitted to the Spinal Injuries Center with TSCI between May 2005 and December 2021 were prospectively collected using a customized, locally designed SCI database named the Japan Single Center Study for Spinal Cord Injury Database (JSSCI-DB). A total of 1152 patients were identified from the database. The study period was divided into the four- or five-year periods of 2005-2009, 2010-2013, 2014-2017, and 2018-2021 to facilitate the observation of general trends over time. Our results revealed a statistically significant increasing trend in age at injury. Since 2014, the average age of injury has increased to exceed 60 years. The most frequent spinal level affected by the injury was high cervical (C1-C4: 45.8%), followed by low cervical (C5-C8: 26.4%). Incomplete tetraplegia was the most common cause or etiology category of TSCI, accounting for 48.4% of cases. As the number of injuries among the elderly has increased, the injury mechanisms have shifted from high-fall trauma and traffic accidents to falls on level surfaces and downstairs. Incomplete tetraplegia in the elderly due to upper cervical TSCI has also increased over time. The percentage of injured patients with an etiology linked to alcohol use ranged from 13.2% (2005-2008) to 19% (2014-2017). Given that Japan has one of the highest aging populations in the world, epidemiological studies in this country will be very helpful in determining health insurance and medical costs and deciding strategies for the prevention and treatment of TSCI in future aging populations worldwide.

Unrecognised autonomic dysreflexia in neurogenic lower urinary tract dysfunction with spinal cord injury as a reason for admission to a cardiac surgical unit

BACKGROUND: In Russia, spinal cord injury occurs in 0.7–6.8% of total injuries. Due to emergence of new rehabilitation protocols, it is extremely important to know the time of occurrence of consequences of spinal cord injury and adequate diagnosis of complications, which allows timely identification of life-threatening conditions of one of the body systems.&#x0D; Clinical case description. We present a clinical case of autonomic dysreflexia in neurogenic lower urinary tract dysfunction after traumatic cervical spinal cord injury in a 17-year-old girl. In traumatic spinal cord injury above the level of the sixth thoracic vertebra, autonomic dysreflexia as a variant of autonomic dysfunction is a common complication. This clinical case will be of interest to clinicians of all specialties who encounter patients with spinal cord injury. It is shown that misinterpreted symptoms of increased blood pressure during bladder filling were the cause of observation and treatment by a cardiologist for arterial hypertension, as well as hospitalization in the cardiac surgery department for planned surgical treatment of renal artery stenosis, which was thought to be the cause of the episodic increases in blood pressure. Lack of knowledge about the presence of autonomic dysfunction in spinal cord injury patients may have led to unnecessary surgical treatment. During the joint management of the patient with a pediatric cardiac surgeon, signs of autonomic dysreflexia were detected against the background of traumatic spinal cord disease at the level of the cervical spine, hypotensive treatment and planned surgical intervention were canceled.&#x0D; Conclusion. Subsequently, an adequate regimen of periodic bladder catheterization and antimuscarinic drug therapy was prescribed, which successfully reduced the dysreflexia.

Predicting extubation in patients with traumatic cervical spinal cord injury using the diaphragm electrical activity during a single maximal maneuver

BackgroundThe unsuccessful extubation in patients with traumatic cervical spinal cord injuries (CSCI) may result from impairment diaphragm function and monitoring of diaphragm electrical activity (EAdi) can be informative in guiding extubation. We aimed to evaluate whether the change of EAdi during a single maximal maneuver can predict extubation outcomes in CSCI patients.MethodsThis is a retrospective study of CSCI patients requiring mechanical ventilation in the ICU of a tertiary hospital. A single maximal maneuver was performed by asking each patient to inhale with maximum strength during the first spontaneous breathing trial (SBT). The baseline (during SBT before maximal maneuver), maximum (during the single maximal maneuver), and the increase of EAdi (ΔEAdi, equal to the difference between baseline and maximal) were measured. The primary outcome was extubation success, defined as no reintubation after the first extubation and no tracheostomy before any extubation during the ICU stay.ResultsAmong 107 patients enrolled, 50 (46.7%) were extubated successfully at the first SBT. Baseline EAdi, maximum EAdi, and ΔEAdi were significantly higher, and the rapid shallow breathing index was lower in patients who were extubated successfully than in those who failed. By multivariable logistic analysis, ΔEAdi was independently associated with successful extubation (OR 2.03, 95% CI 1.52–3.17). ΔEAdi demonstrated high diagnostic accuracy in predicting extubation success with an AUROC 0.978 (95% CI 0.941–0.995), and the cut-off value was 7.0 μV.ConclusionsThe increase of EAdi from baseline SBT during a single maximal maneuver is associated with successful extubation and can help guide extubation in CSCI patients.

Lower Extremity Somatosensory Evoked Potentials Predict Functional Outcomes in Complete Traumatic Cervical Spinal Cord Injury

Traumatic cervical spinal cord injury (tCSCI) is often a debilitating injury, making early prognosis important for medical and surgical planning. Currently, the best early predictors of prognosis are the physical examination, imaging studies, and patient demographics. Despite these factors, patient outcomes continue to vary significantly. The purpose of this study was to evaluate the prognostic value of somatosensory evoked potentials (SSEPs) with functional outcomes in tCSCI patients. A retrospective study was conducted on prospectively collected data from two academic institutions. Patients 18 years and older who had tCSCI and underwent posterior cervical decompression and stabilization with intraoperative neuromonitoring were reviewed. The outcomes of interest were the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and ASIA motor score at follow-up. Outcomes measures were assessed via student t-tests, chi-squared tests, and multivariable regression analysis. A total of 79 patients were included. In complete injuries, detectable lower extremity SSEPs were associated with higher ASIA motor scores at follow-up (p=0.002), greater increases in ASIA motor scores at follow-up (p=0.009), and a greater likelihood of clinically important improvement in ASIA motor score (p=0.024). Incomplete, AIS grade C injuries has higher rates of grade conversion (p=0.019) and clinically important improvement in ASIA motor score (p=0.010), compared to AIS grade A or B injuries. The detection of lower extremity SSEP signals during initial surgical treatment of tCSCI is associated with greater improvement in ASIA motor scores postoperatively. The association is most applicable to patients with complete injury.

DiSCIoser: unlocking recovery potential of arm sensorimotor functions after spinal cord injury by promoting activity-dependent brain plasticity by means of brain-computer interface technology: a randomized controlled trial to test efficacy

BackgroundTraumatic cervical spinal cord injury (SCI) results in reduced sensorimotor abilities that strongly impact on the achievement of daily living activities involving hand/arm function. Among several technology-based rehabilitative approaches, Brain-Computer Interfaces (BCIs) which enable the modulation of electroencephalographic sensorimotor rhythms, are promising tools to promote the recovery of hand function after SCI. The “DiSCIoser” study proposes a BCI-supported motor imagery (MI) training to engage the sensorimotor system and thus facilitate the neuroplasticity to eventually optimize upper limb sensorimotor functional recovery in patients with SCI during the subacute phase, at the peak of brain and spinal plasticity. To this purpose, we have designed a BCI system fully compatible with a clinical setting whose efficacy in improving hand sensorimotor function outcomes in patients with traumatic cervical SCI will be assessed and compared to the hand MI training not supported by BCI.MethodsThis randomized controlled trial will include 30 participants with traumatic cervical SCI in the subacute phase randomly assigned to 2 intervention groups: the BCI-assisted hand MI training and the hand MI training not supported by BCI. Both interventions are delivered (3 weekly sessions; 12 weeks) as add-on to standard rehabilitation care. A multidimensional assessment will be performed at: randomization/pre-intervention and post-intervention. Primary outcome measure is the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) somatosensory sub-score. Secondary outcome measures include the motor and functional scores of the GRASSP and other clinical, neuropsychological, neurophysiological and neuroimaging measures.DiscussionWe expect the BCI-based intervention to promote meaningful cortical sensorimotor plasticity and eventually maximize recovery of arm functions in traumatic cervical subacute SCI. This study will generate a body of knowledge that is fundamental to drive optimization of BCI application in SCI as a top-down therapeutic intervention, thus beyond the canonical use of BCI as assistive tool.Trial registrationName of registry: DiSCIoser: improving arm sensorimotor functions after spinal cord injury via brain-computer interface training (DiSCIoser). Trial registration number: NCT05637775; registration date on the ClinicalTrial.gov platform: 05-12-2022.

Changes in respiratory structure and function after traumatic cervical spinal cord injury: observations from spinal cord and brain.

Respiratory difficulties and mortality following severe cervical spinal cord injury (CSCI) result primarily from malfunctions of respiratory pathways and the paralyzed diaphragm. Nonetheless, individuals with CSCI can experience partial recovery of respiratory function through respiratory neuroplasticity. For decades, researchers have revealed the potential mechanism of respiratory nerve plasticity after CSCI, and have made progress in tissue healing and functional recovery. While most existing studies on respiratory plasticity after spinal cord injuries have focused on the cervical spinal cord, there is a paucity of research on respiratory-related brain structures following such injuries. Given the interconnectedness of the spinal cord and the brain, traumatic changes to the former can also impact the latter. Consequently, are there other potential therapeutic targets to consider? This review introduces the anatomy and physiology of typical respiratory centers, explores alterations in respiratory function following spinal cord injuries, and delves into the structural foundations of modified respiratory function in patients with CSCI. Additionally, we propose that magnetic resonance neuroimaging holds promise in the study of respiratory function post-CSCI. By studying respiratory plasticity in the brain and spinal cord after CSCI, we hope to guide future clinical work.

Investigation of the neurological prognosis after traumatic cervical spinal cord injury in Rasoul Akram Hospital in the period 2011-2016

Background: Cervical spine trauma may be associated with neurological disorders depending on the mechanism of trauma, the cross-sectional area affected by the trauma, and the severity of the trauma;the occurence of these neurological disorders may also affect the surgical treatment prognosis. The aim of the present study was to investigate the neurological prognosis after traumatic cervical spinal cord injury. Materials and Methods: In this retrospective study, the intended data were collected through the admission hospital records and imaging archives of Rasoul Akram Hospital during 2011-2016. The records of patients who were treated for cervical spinal cord injury in the last year were collected and then age, gender, and other variables were extracted for each patient. The data were entered into the SPSS software and the results were reported. Results: The results showed that falls (41.2%) and motorcycle accidents (54.9%) were the most common cause of trauma, andthat the lower level of the cervical spine (C3-C7) was most commonly affected. The overall prevalence of neurological lesions at the time of admission to the department room was 29.4%, and 7.8% had died during hospitalization and before surgery. Predictive factors for neurological disorders were female sex, direct trauma during fightsand trauma to the lower cervical area. Conclusion: The present results indicate that the prevalence of complications and neurologic disorders after cervical spinal cord injuries is approximately 30% and that the extent of these complications in these patients is related to gender, trauma mechanism, and cross-sectional area of ‌‌ the injured cervical spine.

Student Competition (Knowledge Generation) ID 1987946

Background/Objectives NX210c is a 12-amino acid peptide derived from conserved thrombospondin type 1 repeat sequences in the subcommissural organ-spondin, which has a unique multifunctional mechanism of action to ameliorate outcomes following neurological injuries. The aim of this study was to evaluate the efficacy of NX210c to promote functional recovery and tissue repair in a cervical traumatic spinal cord injury (SCI) model. Methods/Overview Adult female Wistar rats were subjected to a C6/C7 clip compression-contusion injury and treated once daily with intraperitoneal injections of NX210c (8 mg/kg) or its vehicle for 8 weeks, beginning 4 hours (h) or 8h post-injury (n=16-17/group), with concurrent neurobehavioural tests. Results Earlier NX210c administration at 4h increased forelimb grip strength (p&amp;lt;0.05) and improved several static and dynamic aspects of locomotion including regularity index and base of support of the forelimbs (CatWalk) (p&amp;lt;0.05). Delaying initial administration of NX210c to 8h, promoted weight gain, accelerated bladder control recovery from 14 to 9 days post-injury, and improved trunk balance (inclined plane) as early as one-week post-injury (p&amp;lt;0.05). 94% of NX210c-treated rats compared to 75% of vehicle controls observed weight support at the delayed initial injection timepoint. Histology (n=6/group) demonstrated greater white matter preservation and reduced cavity size at the injury epicenter, and higher neuronal soma counts caudally, with NX210c starting 8h post-injury compared to the vehicle (p&amp;lt;0.05). Conclusions NX210c targets various aspects of SCI, improving motor function, bladder control, white matter preservation, and neuronal counts, with more benefits observed at the later initial injection timepoint.

Precision medicine for traumatic cervical spinal cord injuries: accessible and interpretable machine learning models to predict individualized in-hospital outcomes

BACKGROUND CONTEXTA traumatic spinal cord injury (SCI) can cause temporary or permanent motor and sensory impairment, leading to serious short and long-term consequences that can result in significant morbidity and mortality. The cervical spine is the most commonly affected area, accounting for about 60% of all traumatic SCI cases. PURPOSEThis study aims to employ machine learning (ML) algorithms to predict various outcomes, such as in-hospital mortality, nonhome discharges, extended length of stay (LOS), extended length of intensive care unit stay (ICU-LOS), and major complications in patients diagnosed with cervical SCI (cSCI). STUDY DESIGNOur study was a retrospective machine learning classification study aiming to predict the outcomes of interest, which were binary categorical variables, in patients diagnosed with cSCI. PATIENT SAMPLEThe data for this study were obtained from the American College of Surgeons (ACS) Trauma Quality Program (TQP) database, which was queried to identify patients who suffered from cSCI between 2019 and 2021. OUTCOME MEASURESThe outcomes of interest of our study were in-hospital mortality, nonhome discharges, prolonged LOS, prolonged ICU-LOS, and major complications. The study evaluated the models' performance using both graphical and numerical methods. The receiver operating characteristic (ROC) and precision-recall curves (PRC) were used to assess model performance graphically. Numerical evaluation metrics included AUROC, balanced accuracy, weighted area under PRC (AUPRC), weighted precision, and weighted recall. METHODSThe study employed data from the American College of Surgeons (ACS) Trauma Quality Program (TQP) database to identify patients with cSCI. Four ML algorithms, namely XGBoost, LightGBM, CatBoost, and Random Forest, were utilized to develop predictive models. The most effective models were then incorporated into a publicly available web application designed to forecast the outcomes of interest. RESULTSThere were 71,661 patients included in the analysis for the outcome mortality, 67,331 for the outcome nonhome discharges, 76,782 for the outcome prolonged LOS, 26,615 for the outcome prolonged ICU-LOS, and 72,132 for the outcome major complications. The algorithms exhibited an AUROC value range of 0.78 to 0.839 for in-hospital mortality, 0.806 to 0.815 for nonhome discharges, 0.679 to 0.742 for prolonged LOS, 0.666 to 0.682 for prolonged ICU-LOS, and 0.637 to 0.704 for major complications. An open access web application was developed as part of the study, which can generate predictions for individual patients based on their characteristics. CONCLUSIONSOur study suggests that ML models can be valuable in assessing risk for patients with cervical cSCI and may have considerable potential for predicting outcomes during hospitalization. ML models demonstrated good predictive ability for in-hospital mortality and nonhome discharges, fair predictive ability for prolonged LOS, but poor predictive ability for prolonged ICU-LOS and major complications. Along with these promising results, the development of a user-friendly web application that facilitates the integration of these models into clinical practice is a significant contribution of this study. The product of this study may have significant implications in clinical settings to personalize care, anticipate outcomes, facilitate shared decision making and informed consent processes for cSCI patients.

160. Artificial intelligence in acute traumatic cervical spinal cord injury: harnessing the power of machine learning for predicting in-hospital outcomes

160. Artificial intelligence in acute traumatic cervical spinal cord injury: harnessing the power of machine learning for predicting in-hospital outcomes