Traumatic Spinal Cord Injury Research Articles

Sex-Related Differences in Functional and Neurological Outcomes of Spinal Cord Injury.

Traumatic spinal cord injury (SCI) tends to occur in different demographics and with differing etiology between males and females. Sex-related differences may influence recovery, but there remains a lack of evidence on this subject. Our objective was to quantify the influence of sex on functional and neurological outcomes of SCI. This was a retrospective cohort study of the multicenter, prospectively maintained SCI Model Systems database from 1992 to 2016. Traumatic SCI patients (≥15 years old) enrolled in a participating inpatient rehabilitation center within 30 days of injury with follow-up at 1 year were included. The primary outcome was the Functional Independence Measure (FIM), which quantifies independence in 13 activities of daily living. Secondary outcomes were individual FIM items, American Spinal Injury Association (ASIA) Motor Index Score at 1 year postinjury, and improvement in ASIA Impairment Scale (AIS). The impact of sex on each outcome was evaluated using propensity score-weighted multivariable regression analyses while controlling for covariates such as age, injury severity, and baseline function. The analysis included 3924 patients (20% female). Multivariable linear regression showed that female sex was associated with worse FIM scores at 1 year postinjury (B = -3.1, 95% CI: -4.4 to -1.8). The FIM items with the greatest differences in independence between males and females were bladder management and transfers, which favored males. For ASIA Motor Score, while females had 10-point greater absolute scores at 1 year (P = .03) and 2-point greater improvement (P = .03) compared with males, no effect was present after adjusting for confounding variables in multivariable regression. The rate of ASIA Impairment Scale improvement was higher in females (P = .04), but this was not significant in multivariable regression (odds-ratio: 1.25, 95% CI: 0.96-1.63). Male sex is associated with greater functional independence, despite equal or greater motor recovery in female patients. Female SCI patients may benefit from targeted interventions to improve independence.

Effect of blood pressure threshold on adverse outcomes in patients with acute spinal cord injury: a systematic review and meta-analysis.

Inadequate spinal perfusion in acute spinal cord injury (SCI) can exacerbate secondary injury. While current guidelines recommend maintaining mean arterial pressure (MAP) ≥ 75-80mmHg post-injury, no quantitative analysis on effects of blood pressure on neurological outcomes exists. We aim to address this gap and evaluate the impact of blood pressure thresholds on adverse outcomes in acute traumatic and non-traumatic SCI to inform current guidelines. The project adhered to PRISMA and MOOSE guidelines and was registered in PROSPERO (CRD42024550044). We searched seven databases: MEDLINE, Embase, Cochrane Central, Cochrane Reviews, CINAHL, Scopus, and Web of Science. We included studies involving patients ≥ 16yrs with acute SCI, randomized control trials, prospective cohorts, and retrospective (case-control, cohort) studies. Excluded were chronic SCI and studies mentioning induced hypotension. The main outcome was the relationship between blood pressure thresholds and adverse functional outcome at up to one-year post-injury. Outcomes (unadjusted odds ratios (uOR) and adjusted odds ratios (aOR)) were calculated using a random-effect model with 95% confidence intervals (CI). Quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Of 16,366 identified articles, 38 (n = 7,167, 73% male) were included in the qualitative and 14 (n = 2,553, 76% male) in the quantitative analysis. Pooled analysis found an increase in adverse functional outcomes in patients with below threshold blood pressures (uOR, 3.28; 95% CI, 2.39-4.50; aOR, 1.04; 95% CI, 1.03-1.05). Subgroup analyses consistently showed that lower blood pressure thresholds were associated with worse outcomes across all subgroups. Risk of bias was low to moderate in most studies. Heterogeneity was moderate to high (I2: 69.88%). Lower blood pressure thresholds were consistently associated with worse functional outcomes in patients with acute SCI. While these findings support the rationale for MAP augmentation, they should be interpreted cautiously due to the observational nature of the data and high heterogeneity. High-quality prospective studies are needed to determine optimal blood pressure targets.

Dysarthria and Dysphagia in Traumatic Spinal Cord Injury: Frequency and Comorbidity in a Cross- Sectional Study

Introduction: To determine the frequency, comorbidities, and relationship between dysarthria and dysphagia in patients with traumatic spinal cord injury (tSCI). Materials and Methods: A descriptive-analytical cross-sectional study was conducted enrolling 61 patients with tSCI from rehabilitation centers in Tehran Province, Iran between January and September 2024. Dysarthria and dysphagia were assessed using the Persian- adapted versions of the frenchay dysarthria assessment (FDA) and northwestern dysphagia patient check sheet (NDPCS), respectively. Logistic regression analysis was employed to evaluate the relationship between these conditions, with odds ratios (ORs) calculated to quantify the strength of the relationship. Results: Dysarthria was observed in 87% of participants, with mixed dysarthria being the most prevalent subtype (34%). Dysphagia was identified in 49% of participants, of whom 49% exhibited both disorders concurrently. Logistic regression analysis indicated that patients with dysarthria were approximately nine times more likely to experience dysphagia (odds ratio [OR]=9.69, P<0.05), even after adjusting for weight and sex. Conclusion: This study underscores the high prevalence and significant comorbidity of dysarthria and dysphagia in patients with tSCI, with dysarthria identified as a robust predictor of dysphagia. These results highlight the necessity of concurrent assessment and integrated rehabilitation approaches targeting both disorders to improve patient outcomes and quality of life

Epidemiology of traumatic spinal cord injury in Catalonia, Spain: a 50 years' experience of a referral center.

Hospital-based retrospective epidemiological research. To describe the epidemiological and demographic characteristics of patients with traumatic spinal cord injury (TSCI) in Catalonia from 1972-2022. Neurological university hospital in Catalonia. All patients diagnosed with TSCI admitted to the hospital from 1972-2022 were retrospectively reviewed. Etiology categories, neurological level of injury, American Spinal Injury Association Impairment Scale (AIS), Functional Independence Measure (FIM), and crude incidence rates were analyzed. A total of 3092 individuals with TSCI met the criteria. The crude annual incidence rate was 0.94/100,000 inhabitants. Mean age rose significantly over the years, from 27.7 (SD = 10.9) during 1972-1981 to 41.8 (SD = 17.1) during 2012-2022. The proportion of females constantly increased during 1982-2022 (18.4-23.1%). Etiologies were traffic accidents (51.8%), falls (22.0%), sports (9.8%), work-related (9.1%), suicide attempts (4.6%) and violence (2.7%). The proportion of traffic accidents dropped from 62.4% during 1982-1991 to 37.5% during 2012-2022, whereas falls increased from 14.5% during 1982-1991 to 26.0% during 2012-2022. Suicide attempts was the only etiology constantly increasing during 1972-2022 from 1-8% and with highest proportion of females (55.9%). Thoracic injuries dropped from 57.9% (1972-1981) to 38.3% (2012-2022), while cervical injuries constantly increased up to 48.8% in 2012-2022 with AIS A cases dropping and AIS D increasing. During 2002-2022, the etiologies with highest proportion of poor motor FIM at admission were sports (68.9%) and falls (63.1%). Our results suggest the need on prevention strategies specially addressing falls and female suicide attempts.

Design and protocol for the decompression-plus trial: a phase 1 clinical study of dorsal myelotomy and expansive duroplasty with or without autologous nerve grafting in acute traumatic spinal cord injury

Design and protocol for the decompression-plus trial: a phase 1 clinical study of dorsal myelotomy and expansive duroplasty with or without autologous nerve grafting in acute traumatic spinal cord injury

The neuroprotective role of riluzole in spinal cord injury: a systematic review and meta-analysis.

We systematically reviewed the evidence for the efficacy of riluzole on functional recovery and lesion size following spinal cord injury (SCI). The search was conducted on Medline, Embase, Scopus, and Web of Science by November 2024 for studies evaluating the utility of riluzole administration following SCI in rodents and humans. Neurological and histopathological outcomes were extracted for subjects treated and not treated with Riluzole. Pooled effect estimates were calculated using the random-effects model. Heterogeneity was assessed using the I2 and Chi2 tests. Fifteen preclinical studies were included. Meta-analysis demonstrated that riluzole significantly improves locomotion recovery (standardized mean difference (SMD) = 0.70; 95% confidence interval (CI): 0.46, 0.95; p < 0.0001; I2 = 0.00%) and subsides the lesion size (SMD = -1.74; 95% CI: -2.47 to -1.01; p < 0.0001; I2 = 55.84%). The improvement in locomotion was not significantly different between mild to moderate and severe injuries (meta-regression coefficient = -0.22; 95% CI: -0.74, 0.30; p = 0.403). Notably, riluzole significantly improves motor function and reduces lesion size in animals with acute traumatic SCI. The improvement only occurs with multi-dose administration of riluzole (SMD = 0.76; 95% CI: 0.49, 1.03; p < 0.0001), and no significant effect was observed with single-dose therapies (SMD = 0.49; 95% CI: -0.05, 1.02; p = 0.074). Most human studies also report motor function improvements, further suggesting riluzole's potential as a therapeutic agent in SCI. These findings support further research and trials to confirm its efficacy in clinical settings.

Nomogram prediction model for DVT in traumatic cervical spinal cord injury patients during hospitalization.

Nomogram prediction model for DVT in traumatic cervical spinal cord injury patients during hospitalization.

Neuromethods and assessment tools for traumatic spinal cord injury in rodents: A mini review.

Neuromethods and assessment tools for traumatic spinal cord injury in rodents: A mini review.

Special Pediatric Considerations in the Management of Severe Traumatic Brain Injury and Spinal Cord Injury.

Special Pediatric Considerations in the Management of Severe Traumatic Brain Injury and Spinal Cord Injury.

The Synergistic Effect of Acute Traumatic Brain Injury and Spinal Cord Injury on the Development of Chronic Pain: A Populational Cohort Study on Neurotrauma Patients in Canada

Background: The impact of concomitant traumatic brain injury (TBI) and spinal cord injury (SCI) on the development of problematic chronic pain has never been studied. We hypothesized that concomitant TBI increases the rates of problematic chronic pain outcomes in SCI individuals. Objectives: To examine the association between concomitant TBI-SCI (as opposed to isolated TBI or SCI) and the development of problematic chronic pain outcomes, including referral to a specialized pain clinic or long-term usage of opioids or other chronic pain medications. Methods: A retrospective observational cohort study on 18,861 neurotrauma patients from prospective governmental populational databases from the province of Quebec, Canada (population ~8 million) was conducted. The main independent variable was the nature of neurotrauma sustained at the time of the accident: TBI only versus SCI only versus concomitant TBI-SCI. Problematic chronic pain was defined as (1) receiving a formal diagnosis of chronic pain, (2) using significant amounts of opioids, or (3) receiving a referral to a chronic pain clinic. Results: Out of the all the included patients, 16,472 (87%) had TBI only, 1528 had TSCI only (8.1%), and 861 (4.6%) had concomitant TBI-SCI diagnosis. At the group level, patients with concomitant TBI-SCI presented markedly higher use of opioid/chronic pain medication than patients with SCI or TBI only (15.3% vs. 8.5% vs. 0.5%; P &amp;lt; .001). At the multivariate level, the nature of neurotrauma sustained remained significantly associated with all 3 outcomes that were used to define problematic chronic pain. Finally, a synergistic effect between SCI and TBI was confirmed for the development of chronic use of opioids and other pain medications (odds ratio [OR] 1.92; P &amp;lt; .001). Conclusion: This study supports a synergistic effect of TBI and SCI for the development of chronic use of opioids and other pain medications. Clinicians should be aware of potential underlying TBI in SCI patients in order to address potential chronic pain issues after neurotrauma.

Traumatic Spinal Cord Injury Due to Horse Riding Accident in A Patient with Klippel-Feil Syndrome: A Case Report

Background: Spinal cord injury is a severe medical illness that frequently leaves patients permanently disabled and with severe morbidity. In some cases, sports may be one of the factors causing spinal cord injuries, like horse riding. Anatomical variation in the vertebra may become a potential risk factor for an injury such as Klippel-Feil syndrome. Case: A 30-year-old female came to the emergency room after falling while riding a horse. The patient complained of not being able to move her hands and feet and feeling numb from the neck area to the feet. X-rays of the cervical spine showed an anatomical variation in fusion at the C4 and C5 vertebrae, known as Klippel-Feil syndrome. No visible fracture or dislocation was found. The MRI results showed intramedullary lesions at the C3 to C5 vertebral bodies level and compression fracture of the C4-C5 vertebral body accompanied by narrowing of the C4-C5 intervertebral disc. Discussion: Patients with Klippel-Feil syndrome may be more vulnerable to transient neurologic deficits after minor trauma. The fused segments' altered mechanical force transfer, which results in the adjacent non-fused segments moving excessively, is most likely related to this. Conclusion: Serious medical conditions like spinal cord injuries often leave victims severely sick and permanently incapacitated. Sports such as horse riding are associated with traumatic spinal cord injuries. Patients with Klippel-Feil syndrome may be more susceptible to this trauma.

Fundamentals of Acute Care for Patients with Traumatic Spinal Cord Injury.

Fundamentals of Acute Care for Patients with Traumatic Spinal Cord Injury.

Challenges in Pulmonary Management after Traumatic Brain and Spinal Cord Injury.

Challenges in Pulmonary Management after Traumatic Brain and Spinal Cord Injury.

Thrombosis and Coagulopathy.

Thrombosis and Coagulopathy.

Development of a machine learning model and a web application for predicting neurological outcome at hospital discharge in spinal cord injury patients.

Development of a machine learning model and a web application for predicting neurological outcome at hospital discharge in spinal cord injury patients.

Demographic Profile Of Spinal Cord Injury (Sci) Patients Admitted To Tertiary Care Hospital Of Western Maharashtra

Background: Spinal cord injury (SCI) represents a significant health burden worldwide, with its prevalence influenced by factors such as age, gender, etiology, and neurological region of injury. This study aims to examine the demographic profile, causes, and functional outcomes of SCI patients admitted to a tertiary care hospital in Western Maharashtra. Methods: A retrospective analysis was conducted using the medical records of 180 SCI patients admitted between 2018 and 2024. Data regarding age, gender, ASIA, neurological level and cause of injury were collected and analyzed. Statistical tests were used to assess the significance of various factors. Results: The majority of SCI patients were young adults, with the 21-40 years age group accounting for 58.4% of cases. Male patients dominated the cohort, representing 88.9% of the total. Traumatic SCI, particularly due to road traffic accidents, was the leading cause (91.7%), with thoracic and cervical regions most frequently affected. The findings emphasize the importance of targeted rehabilitation for individuals with thoracic and cervical injuries. Non-traumatic SCI accounted for 8.3%, with conditions such as infections and degenerative diseases identified as contributing factors. Conclusions: The results of this study indicate that SCI is predominantly a traumatic condition, affecting young males with significant implications for mobility and quality of life. Early intervention, prevention strategies, and gender-specific rehabilitation programs are crucial for improving outcomes. These findings underline the need for specialized rehabilitation centers and public health policies focused on injury prevention, particularly in high-risk groups such as young adults involved in road traffic accidents

Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative Study.

Spinal cord injury (SCI) results in significant physical, emotional, and social consequences, often leading to profound grief and unresolved emotional burdens. While expressive writing has shown potential in facilitating emotional processing and in aiding coping after trauma, loss, and health-related adversity, its impact on individuals who have suddenly lost physical abilities due to SCI remains underexplored. The study aimed to examine the experiences of adults with SCI who participated in a 10-week web-based coach-guided expressive writing program to understand its impact using a qualitative research design with a phenomenological approach. Participants were recruited through various outreach strategies based on a set of predefined criteria. A total of 50 individuals from 23 states expressed interest in the expressive writing program. Of those who met the eligibility criteria, 29 individuals completed the preprogram questionnaire. A total of 5 participants did not complete the postprogram assessments, including the exit interview. The program sessions were structured with reflective prompts designed to explore their emotions and life experiences related to their conditions. Qualitative data were collected through postprogram semistructured interviews and analyzed using thematic analysis to identify themes related to participants' experiences and program impact. The analysis was conducted without any preset theoretical framework of reference. A total of 24 adults with SCI, aged between 34 and 76 years (average age 51, SD 12 years), participated in the expressive writing program and the exit interview. Of these, 19 participants were White, and 17 were female. In total, 18 participants had sustained a traumatic SCI; of these, 10 had quadriplegia, 12 had paraplegia, and 2 had monoplegia. Qualitative analysis revealed three overarching themes: (1) supportive environment: the program provided participants a space that encouraged open reflection on past events and personal struggles, and the guidance of patient and empathetic coaches offered a sense of comfort, direction, and motivation. (2) Cathartic experience: the program helped them process complex emotions, reframe their perspectives, and cultivate a more positive outlook on life and their injury. Many participants, new to guided expressive writing, found the process therapeutic and transformative. (3) Acceptance of life: the cumulative impact of the sessions fostered self-compassion, forgiveness, empowerment, and self-advocacy. Participants reported reduced feelings of loneliness, a greater sense of community, and profound positive changes, expressing the desire to continue writing beyond the program. The sudden onset of lifelong disability due to SCI leads to profound physical, mental, and social challenges. The coach-guided expressive writing program enhanced the emotional processing and articulation, coping mechanisms, and overall well-being of the participants. These results highlight the potential of expressive writing programs as accessible and valuable rehabilitative interventions for individuals with SCI.

Health care utilization and cost in the dual diagnosis of combined traumatic spinal cord injury and traumatic brain injury compared to traumatic brain injury alone: An analysis using MarketScan.

Health care utilization and cost in the dual diagnosis of combined traumatic spinal cord injury and traumatic brain injury compared to traumatic brain injury alone: An analysis using MarketScan.

Phenserine Mitigates Neuroinflammation, Apoptosis, and Behavioural Deficits to Enhance Motor Function and Recovery in a Mouse Model of Spinal Cord Injury.

Spinal cord injury is a debilitating medical condition that results in paralysis and loss of sensorimotor function below the level of injury. The pathological cascade following the injury involves inflammation, apoptosis, blood-spinal cord barrier integrity disruption, axonal damage, glial scarring, and demyelination. This study evaluates the therapeutic potential of phenserine, a lipophilic phenyl carbamate derivative with neuroprotective, anti-inflammatory, and anti-apoptotic properties, in a compression-induced spinal cord injury model in C57bl/6 mice. Intraperitoneal administration of phenserine (5mg/kg, twice daily for 5days) significantly reduced inflammatory responses and blood-spinal cord barrier permeability at 1day post-injury. By 7days, it attenuated apoptotic signalling, and by 28days, it reduced glial scarring and enhanced markers of axonal integrity and myelination. Neurobehavioral assessments further indicated that phenserine treatment improved motor and functional recovery outcomes. Collectively, our findings highlight phenserine as a promising therapeutic candidate that targets multiple secondary injury mechanisms to promote neuroprotection and functional restoration following spinal cord injury, marking a novel approach in managing traumatic spinal cord injury.

Development and Validation of Machine Learning Models for Predicting 7-Day Mortality in Critically Ill Patients with Traumatic Spinal Cord Injury: A Multicenter Retrospective Study.

Traumatic spinal cord injury (TSCI), a severe central nervous system injury, despite treatment advances, critically ill patients with TSCI face high short-term mortality. This study leverages machine learning to integrate standard intensive care unit (ICU) indicators, identifying 7-day high-mortality risk patients with TSCI to optimize treatment. Using critically ill patients with TSCI data from the Medical Information Mart for Intensive Care 2.2 database, this study employs the Boruta and LASSO regression algorithms to identify key features, developing a 7-day mortality risk prediction model in critically ill patients with TSCI using ten machine learning algorithms including Adaptive Boosting, Categorical Boosting, Gradient Boosting Machine, k-Nearest Neighbors, Light Gradient Boosting Machine, Logistic Regression, Neural Network, Random Forest (RF), Support Vector Machine, and Extreme Gradient Boosting. Model Performance is evaluated via receiver operating characteristic curves, calibration curves, decision curve analysis, accuracy, sensitivity, specificity, precision, and F1 score, whereas Shapley Additive Explanations ensure model interpretability. External validation with ICU data from the First Affiliated Hospital of Xinjiang Medical University further assesses the model's generalizability. This study, collecting data from 261 and 45 critically ill patients with TSCI from the Medical Information Mart for Intensive Care database and the First Affiliated Hospital ofXinjiang Medical University's ICU, respectively, identified ten key features for model development, in which the RF model consistently outperformed others across raw and Synthetic Minority Over-sampling Technique-balanced synthetic datasets in receiver operating characteristic curves, calibration curves, decision curve analysis, and performance metrics. Shapley Additive Explanation analysis highlighted minimum body temperature, lowest systolic blood pressure, and Charlson Comorbidity Index as critical predictors in the RF model. External validation initially demonstrated the model's robustness and clinical applicability, leading to an online calculator that enables clinicians to estimate the 7-day survival probability of critically ill patients with TSCI. The RF model exhibits favorable performance in predicting 7-day mortality risk among critically ill patients with TSCI, indicating its potential utility in supporting clinical decision-making.