Inflammatory Myelopathies and Traumatic Spinal Cord Lesions: Comparison of Functional and Neurological Outcomes

Abstract

Background and Purpose Outcomes knowledge is essential to answer patients' questions regarding function, to plan the use of resources, and to evaluate treatments to enhance recovery. The purpose of this study was to compare the outcomes of patients with traumatic spinal cord injury (SCI) with those of patients with inflammatory spinal cord lesions (ISCLs). Subjects and Methods The authors evaluated 181 subjects with traumatic SCI and 67 subjects with ISCLs. Using a matching cohorts procedure, 38 subjects were selected from each group. The measures used were the American Spinal Injury Association (ASIA) Impairment Scale (motor function), the Barthel Index (BI), the Rivermead Mobility Index (RMI), and the Walking Index for Spinal Cord Injury (WISCI). Results The subjects in the ISCL group were older than those in the SCI group, with a longer interval from onset of lesion to rehabilitation admission and more incomplete lesions. In the matching cohorts, at admission, the traumatic SCI group had RMI and WISCI scores comparable to those of the ISCL group, but the traumatic SCI group had lower scores on the BI (greater dependence on assistance for activities of daily living). At discharge, the 2 groups had comparable functional outcomes. The neurological status of the 2 groups was comparable at admission and discharge. Discussion and Conclusion The results indicate that, at admission, patients with SCI have a greater physical dependence for assistance with activities of daily living than patients with ISCLs who have comparable neurological status. Such a difference depends on factors not related to the spinal cord lesion, such as the presence of associated lesions, the need to wear an orthotic device, or the sequelae of surgery. The outcomes of patients with SCI are determined more by factors such as lesion level and severity and age than by etiology. This finding could have implications for health care planning and rehabilitation research.

Ambulation and Spinal Cord Injury

“…29 This study showed that the functional outcome was determined by lesion level, severity, and age rather than by cause. On the other hand, in a study of elderly patients with nontraumatic SCI, differences based on cause were found in rehabilitation length of stay and functional outcomes.…”

Important Clinical Rehabilitation Principles Unique to People with Non-traumatic Spinal Cord Dysfunction

“…27 A study of people with SCDys due to spinal cord abscess compared to a sample with SCI reported a greater AIS improvement in the abscess group. 28 A number of studies have compared rehab ilit ation outcomes in different SCDys etiologies 9,27,[29][30][31][32][33][34][35][36] We recommend that the International Spinal Cord Injury Data Sets for Non-traumatic Spinal Cord Injury 1 be used when classifying the etiology of SCDys in clinical practice and research.…”

Impact of bladder, bowel and sexual dysfunction on health status of people with thoracolumbar spinal cord injuries living in the community

“…A review of studies focusing on cauda equina injuries caused by lumbar disc herniation alone reported a prevalence that ranged between 13-90% with an average follow-up of 17 months. 11 From a clinical management perspective, studies have highlighted that neurologic recovery does not correspond to improvement in voiding function 12,13 and that commonly used neurological indicators, such as pinprick sensation and bulbocavernosus reflex, are not predictors for bladder recovery. 13,14 Less is known about bowel or sexual dysfunction in this patient population; the prevalence is reported to be high but varies among the studies, [15][16][17] likely a result of differing definitions, metrics, follow-up times and measures utilized.…”