Factors Predicting Motor Recovery and Functional Outcome After Traumatic Central Cord Syndrome

Dvorak, Marcel F.; Fisher, Charles G.; Hoekema, Joel; Boyd, Michael; Noonan, Vanessa K.; Wing, Peter; Kwon, Brian K.

doi:10.1097/01.brs.0000182304.35949.11

Cited by 118 publications

(97 citation statements)

References 27 publications

(35 reference statements)

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“…In agreement with others, prior outcome was the strongest predictor in our study, 17,32 which alone explained 51% to 82% of the variance. The finding that characteristics such as sex and level of lesion were of little prognostic value (in addition to prior physical capacity), suggests that prior outcome may encapsulate the variance caused by these characteristics.…”

Section: Prior Physical Capacity As a Predictor Of Outcome At Follow-upsupporting

confidence: 93%

“…The positive predictive value of education has been reported previously, 17,47 but it seems contradictory to the finding by Eastwood et al 34 that the less educated had a shorter inpatient rehabilitation stay. Hypothesizing, it might be that those with lower levels of education did physically more demanding work before injury, which may have made it easier to learn (wheelchair) skills.…”

Section: Prognostic Factorsmentioning

confidence: 64%

“…44 Contrary to others, our models revealed a positive predictive effect of both conservative and surgical stabilization of the spine. 17,21 Perhaps the immobilization period is shorter after surgical stabilization, resulting in an early start of rehabilitation and insignificant deconditioning. 24 Because stabilization appeared to have no prognostic value after discharge, its influence may be restricted to an early phase of recovery.…”

Section: Prognostic Factorsmentioning

confidence: 99%

“…15,16 Third, earlier studies did not always report the prediction accuracy of models. 17 A model's accuracy, that is, whether the outcome it predicts corresponds with the observed outcome, partly determines its clinical relevance. 18,19 The rehabilitation of patients with SCI would not only benefit from an accurate prediction of outcome, but also from the identification of predictors that can be modified.…”

mentioning

confidence: 99%

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Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

Haisma¹,

Woude²,

Stam³

et al. 2007

Archives of Physical Medicine and Rehabilitation

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ABSTRACT. Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, de Groot S, Dallmeijer AJ, Bussmann JB. Prognostic models for physical capacity at discharge and 1 year postdischarge from rehabilitation in persons with spinal cord injury. Arch Phys Med Rehabil 2007;88:1694-703.Objective: To develop prognostic models for physical capacity at discharge and 1 year after discharge from inpatient rehabilitation in persons with spinal cord injury (SCI).Design: Inception cohort; data collected at start of rehabilitation (nϭ104), at discharge (nϭ81), and 1 year later (nϭ74).Setting: Eight Dutch rehabilitation centers. Participants:Patients with SCI at initial rehabilitation.Interventions: Not applicable. Main Outcome Measures: Physical capacity determined by endurance capacity (peak oxygen uptake [VO 2 peak, in L/min] and power output [POpeak, in watts]) during a maximal exercise test, arm muscle strength, and respiratory function. Multiple regression models, either with or without prior outcome, evaluated subject, lifestyle, and lesion-related predictors.Results: Only start VO 2 peak contributed to the prediction of discharge VO 2 peak (R 2 ϭ.51). Discharge VO 2 peak contributed to its prediction 1 year later (R 2 ϭ.75). Start POpeak, sex, age, and level of lesion contributed to discharge POpeak (R 2 ϭ.73). Discharge POpeak, hours of employment before injury, and level of lesion contributed to POpeak 1 year later (R 2 ϭ.81). Models without prior outcome explained less variance. Education, employment, body mass index, not smoking, and conservative stabilization of the spine positively contributed to endurance capacity. Muscle strength was well predicted (R 2 range, .68Ϫ.84). Without prior outcome, respiratory function was poorly predicted.Conclusions: Because prior outcome contributed to an accurate prediction, the early assessment of physical capacity is important in establishing prognoses. Although their accuracy warrants caution in their application, models could complement clinical expertise when informing patients about expected physical outcome and identifying those at risk of low physical capacity.

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Section: Prior Physical Capacity As a Predictor Of Outcome At Follow-upsupporting

confidence: 93%

Section: Prognostic Factorsmentioning

confidence: 64%

Section: Prognostic Factorsmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

Haisma¹,

Woude²,

Stam³

et al. 2007

Archives of Physical Medicine and Rehabilitation

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“…While numerous studies have been designed to evaluate different treatment variables, such as the presence and timing of surgery, often only a cursory analysis is performed to account for patient specific variables. [4][5][6]10 It is possible that patients with baseline chronic SCI have a different injury profile than patients with an acute injury. While not a perfect surrogate for spinal cord health, the presence of changes in the signal intensity of the spinal cord on MRI has been associated with both reversible injuries such as edema and ischemia, and permanent damage such as necrosis and myelomalacia.…”

mentioning

confidence: 99%

The effect of increased T2 signal intensity in the spinal cord on the injury severity and early neurological recovery in patients with central cord syndrome

Schroeder

Hjelm²,

Vaccaro

et al. 2016

SPI

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OBJECTIVE The aim of this paper was to compare the severity of the initial neurological injury as well as the early changes in the American Spinal Injury Association (ASIA) motor score (AMS) between central cord syndrome (CCS) patients with and without an increased T2 signal intensity in their spinal cord. METHODS Patients with CCS were identified and stratified based on the presence of increased T2 signal intensity in their spinal cord. The severity of the initial neurological injury and the progression of the neurological injury over the 1st week were measured according to the patient's AMS. The effect of age, sex, congenital stenosis, surgery within 24 hours, and surgery in the initial hospitalization on the change in AMS was determined using an analysis of variance. RESULTS Patients with increased signal intensity had a more severe initial neurological injury (AMS 57.6 vs 75.3, respectively, p = 0.01). However, the change in AMS over the 1st week was less severe in patients with an increase in T2 signal intensity (−0.85 vs −4.3, p = 0.07). Analysis of variance did not find that age, sex, Injury Severity Score, congenital stenosis, surgery within 24 hours, or surgery during the initial hospitalization affected the change in AMS. CONCLUSIONS The neurological injury is different between patients with and without an increased T2 signal intensity. Patients with an increased T2 signal intensity are likely to have a more severe initial neurological deficit but will have relatively minimal early neurological deterioration. Comparatively, patients without an increase in the T2 signal intensity will likely have a less severe initial injury but can expect to have a slight decline in neurological function in the 1st week.

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Early vs Late Surgical Decompression for Central Cord Syndrome

et al. 2022

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ImportanceThe optimal clinical management of central cord syndrome (CCS) remains unclear; yet this is becoming an increasingly relevant public health problem in the face of an aging population.ObjectiveTo provide a head-to-head comparison of the neurologic and functional outcomes of early (&lt;24 hours) vs late (≥24 hours) surgical decompression for CCS.Design, Setting, and ParticipantsPatients who underwent surgery for CCS (lower extremity motor score [LEMS] − upper extremity motor score [UEMS] ≥ 5) were included in this propensity score–matched cohort study. Data were collected from December 1991 to March 2017, and the analysis was performed from March 2020 to January 2021. This study identified patients with CCS from 3 international multicenter studies with data on the timing of surgical decompression in spinal cord injury. Participants were included if they had a documented baseline neurologic examination performed within 14 days of injury. Participants were eligible if they underwent surgical decompression for CCS.ExposuresEarly surgery was compared with late surgery.Main Outcomes and MeasuresPropensity scores were calculated as the probability of undergoing early compared with late surgery using the logit method and adjusting for relevant confounders. Propensity score matching was performed in a 1:1 ratio by an optimal-matching technique. The primary end point was motor recovery (UEMS, LEMS, American Spinal Injury Association [ASIA] motor score [AMS]) at 1 year. Secondary end points were Functional Independence Measure (FIM) motor score and complete independence in each FIM motor domain at 1 year.ResultsThe final study cohort consisted of 186 patients with CCS. The early-surgery group included 93 patients (mean [SD] age, 47.8 [16.8] years; 66 male [71.0%]), and the late-surgery group included 93 patients (mean [SD] age, 48.0 [15.5] years; 75 male [80.6%]). Early surgical decompression resulted in significantly improved recovery in upper limb (mean difference [MD], 2.3; 95% CI, 0-4.5; P = .047), but not lower limb (MD, 1.1; 95% CI, −0.8 to 3.0; P = .30), motor function. In an a priori–planned subgroup analysis, outcomes were comparable with early or late decompressive surgery in patients with ASIA Impairment Scale (AIS) grade D injury. However, in patients with AIS grade C injury, early surgery resulted in significantly greater recovery in overall motor score (MD, 9.5; 95% CI, 0.5-18.4; P = .04), owing to gains in both upper and lower limb motor function.Conclusions and RelevanceThis cohort study found early surgical decompression to be associated with improved recovery in upper limb motor function at 1 year in patients with CCS. Treatment paradigms for CCS should be redefined to encompass early surgical decompression as a neuroprotective therapy.

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Factors Predicting Motor Recovery and Functional Outcome After Traumatic Central Cord Syndrome

Cited by 118 publications

References 27 publications

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

The effect of increased T2 signal intensity in the spinal cord on the injury severity and early neurological recovery in patients with central cord syndrome

Early vs Late Surgical Decompression for Central Cord Syndrome

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