Early clinical predictors of functional recovery following traumatic spinal cord injury: a population-based study of 143 patients

Wichmann, Thea Overgaard; Jensen, Mette Haldrup; Kasch, Helge; Rasmussen, Mikkel Mylius

doi:10.1007/s00701-020-04701-2

Cited by 11 publications

(6 citation statements)

References 35 publications

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“…The limited number of individuals with SCI currently included in EMSCI did not allow to add both age and gender as matching criteria in the present study. The age in the HO cohort, although not significantly higher, may nevertheless have contributed to the observed differences in functional outcomes (Jakob et al, 2009 ; Kaminski et al, 2017 ; Geuther et al, 2019 ; Kirshblum et al, 2021b ; Wichmann et al, 2021 ). Gender, which was not equally distributed in both groups, has not been identified as a confounder in this context.…”

Section: Discussionmentioning

confidence: 98%

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury

Franz

Rust

Heutehaus

et al. 2022

Front. Cell. Neurosci.

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Objective: In spinal cord injury (SCI), heterotopic ossification is a frequent secondary complication, commonly associated with limited range of motion of affected joints, which could lead to secondary disability in activities of daily living. Additionally, heterotopic ossifications might challenge the effect of regeneration-promoting therapies on neurological and functional recovery. This study evaluated the impact of heterotopic ossification on clinical recovery within the first year after SCI.Methods: The study was conducted as a monocentric longitudinal paired cohort study. Recruitment was based on consecutive sampling in the framework of the European Multicenter about Spinal Cord Injury (EMSCI). Recovery profiles were determined using standardized neurological and functional clinical assessments within the 1st year following SCI. All study participants underwent at least two comprehensive standardized neurological and functional clinical examinations according to the International Standards for Neurological Classification of SCI and the Spinal Cord Independence Measure, respectively. Data regarding the diagnosis and treatment of heterotopic ossification were obtained by reviewing the patient medical records. The most similar “digital twin” from the entire EMSCI database were matched in terms of age, acute neurological and functional status to each individual with SCI, and heterotopic ossification.Results: Out of 25 participants diagnosed with heterotopic ossification, 13 individuals were enrolled and matched to control individuals. Most individuals presented with motor complete injury (75%). Ossifications were most frequently located at the hip joints (92%) and mainly occurred within the first 3 months after SCI. Individuals with heterotopic ossification achieved around 40% less functional improvement over time compared to their matched counterparts, whereas neurological recovery was not altered in individuals with SCI and heterotopic ossification.Conclusion: Heterotopic ossification—a common complication of SCI—unfavorably affects functional recovery, which in the end is most relevant for the best possible degree of independence in activities of daily living. Upon presentation with heterotopic ossification, neurological improvement achieved through potential restorative therapies might not translate into clinically meaningful functional improvement. Diagnostic algorithms and effective early prevention/treatment options for heterotopic ossification need to be established to ensure the best possible functional outcome.Clinical Trial Registration: NCT01571531 (https://clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 98%

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury

Franz

Rust

Heutehaus

et al. 2022

Front. Cell. Neurosci.

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“…et.al. States TSCI patients with the greatest potential for functional recovery up to 1 year after injury seems to be patients who immediately after trauma present with few or no comorbidities and secondary complications, who sustain motor-incomplete injuries and who undergo early decompressive surgery 20 . Early and continued physiotherapy also plays an important role in steady progress in patients' functional capacity.…”

Section: Discussionmentioning

confidence: 99%

Functional Independence and Quality of Life in Traumatic Below T6 Level Spinal Cord Injury at Different Time Spans

G Chavhan,

Mehta,

Iyer

2024

Int J Health Sci Res

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Background: Trauma is the most frequent cause of spinal cord injury in Indian adult populations. Injury results from damage caused by traumatic events such as motor vehicle accidents (40.4%), falls (27.9%), violence (15.0%), and sports (8.0%). Aim: To find out the level of functional independence and quality of life in a person with traumatic below T6 level spinal cord injury as time progresses Study Design & Setting: observational study & Tertiary care center, neuro-rehabilitation center. Methods and Material: The sample size was 45 and each group had 15 spinal cord injury individuals. Inclusion was of both genders, traumatic incomplete below T6 level of spinal cord injury and sub-acute to chronic phase spinal cord injury were taken. The exclusion was a traumatic head injury and recent trauma to the lower limb. Statistical analysis: Analysis was done using SPSS V 26. Krushkal Wallis test was used for the non-parametric data, and the mean and standard deviation were calculated. Results: WHOQOL and SCIM were the scales used and mean values of the same at 3 different time spans are as follows: for WHOQOL, Physical domain 48, 56, 56., Psychological 39, 51, 54. c) Social 54, 60, 59, Environmental 52, 62, 64. Similarly, SCIM showed 36, 47 and 52 Conclusion: The study concludes that quality of life and functional capacity show a much better and significant improvement in the acute and subacute stage post-injury after which their stagnancy is observed Key words: Quality of life, Traumatic, Spinal cord injury, Functional independence

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“…Another clinical study on incomplete SCI combined LEM scores with pinprick scores or age-predicted walking ability in patients at 6 months post-SCI [ 55 ]. A recent study successfully predicted the recovery of independent function by using the AIS grade and LEM scores [ 56 ] but discovered that the strongest outcome predictor (LEM score) was different from that (sensory score for light touch) found in a previous study [ 57 ]. The inconsistency of the present study with previous studies may be attributed to two reasons: (i) The exclusion of sensory-related variables from our metrics may have affected our ability to reveal the connection between early and chronic gait performance.…”

Section: Discussionmentioning

confidence: 99%

MRI metrics at the epicenter of spinal cord injury are correlated with the stepping process in rhesus monkeys

et al. 2022

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Clinical evaluations of long-term outcomes in the early-stage spinal cord injury (SCI) focus on macroscopic motor performance and are limited in their prognostic precision. This study was designed to investigate the sensitivity of the magnetic resonance imaging (MRI) indexes to the data-driven gait process after SCI. Ten adult female rhesus monkeys were subjected to thoracic SCI. Kinematics-based gait examinations were performed at 1 (early stage) and 12 (chronic stage) months post-SCI. The proportion of stepping (PS) and gait stability (GS) were calculated as the outcome measures. MRI metrics, which were derived from structural imaging (spinal cord cross-sectional area, SCA) and diffusion tensor imaging (fractional anisotropy, FA; axial diffusivity, λ // ), were acquired in the early stage and compared with functional outcomes by using correlation analysis and stepwise multivariable linear regression. Residual tissue SCA at the injury epicenter and residual tissue FA/remote normal-like tissue FA were correlated with the early-stage PS and GS. The extent of lesion site λ // /residual tissue λ // in the early stage after SCI was correlated with the chronic-stage GS. The ratios of lesion site λ // to residual tissue λ // and early-stage GS were predictive of the improvement in the PS at follow-up. Similarly, the ratios of lesion site λ // to residual tissue λ // and early-stage PS best predicted chronic GS recovery. Our findings demonstrate the predictive power of MRI combined with the early data-driven gait indexes for long-term outcomes. Such an approach may help clinicians to predict functional recovery accurately.

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Early clinical predictors of functional recovery following traumatic spinal cord injury: a population-based study of 143 patients

Cited by 11 publications

References 35 publications

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury

Functional Independence and Quality of Life in Traumatic Below T6 Level Spinal Cord Injury at Different Time Spans

MRI metrics at the epicenter of spinal cord injury are correlated with the stepping process in rhesus monkeys

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