Is the outcome in acute spinal cord ischaemia different from that in traumatic spinal cord injury? A cross-sectional analysis of the neurological and functional outcome in a cohort of 93 paraplegics

Abstract

Study design: Retrospective cohort study. Objectives: To compare the neurological outcome between paraplegic patients with acute spinal cord ischaemia syndrome (ASCIS) or traumatic spinal cord injury (tSCI) and to investigate the influence of SCI aetiology on the total Spinal Cord Independence Measure (SCIM)-II score. Setting: Level 1 trauma centre. Methods: Initial (0-40 days) and chronic-phase (6-12 months) American Spinal Injury Association (ASIA) sensory scores, lower extremity motor score (LEMS) and chronic-phase total SCIM-II scores were analysed. Differences between ASCIS and tSCI patients were calculated using Student's t-tests and Wilcoxon signed-rank tests. To assess which variables give rise to the prediction of total SCIM-II score, a multiple linear regression analysis was used. These predictor variables included complete (ASIA impairment scale A) or incomplete SCI (AIS B, C, and D), aetiology, age and gender. Results: Out of 93 included patients, 20 ASCIS and 73 tSCI patients were identified. In the complete SCI group, the initial pinprick scores were higher (Po0.05) in ASCIS patients compared with tSCI patients, 37.9 (95% Confidence Interval (CI), 23.3-52.5) and 27.3 (95% CI, 24.1-30.4), respectively. No other relevant differences in neurological outcome were identified between ASCIS and tSCI patients; however, the total SCIM-II scores were higher (Po0.05) in tSCI patients after 12 months. Using the linear regression analysis, we were able to predict 31.4% of the variability. The aetiology was not significant in this model. Conclusion: The neurological outcome was independent of the diagnosis ASCIS or tSCI. Furthermore, the diagnosis ASCIS or tSCI was not a significant predictor for total SCIM II scores after 12 months. Sponsorship: This study was granted by the 'Internationale Stiftung für Forschung in Paraplegie' (IFP), Zürich, Switzerland.

Recovery following ischemic myelopathies and traumatic spinal cord lesions

“…The neurological improvement (in terms of AIS grade conversion and motor score improvement) that we observed in the two populations is consistent with previous studies. [3][4][5]8 Our statistical analysis clearly demonstrates that neurological recovery is not influenced by lesion etiology. By logistic regression, AIS grade conversion depended primarily on age.…”

“…Although neurological improvement has been correlated with lesion level and AIS grade, 17,21,22 its relationship with age remains unsubstantiated. Recently Pouw et al 8 observed that neurological recovery was the same in paraplegic TSCI and ISCI patients; further, because ISCI patients were older than the traumatic population, the authors concluded that neurological recovery was independent of age. Similarly, Furlan et al 23 did not observe a correlation between age and neurological recovery in patients with TSCI.…”

“…In our model, age, AIS level at admission and lesion level were the major predictors of BI improvement, consistent with previous studies. Recently, Pouw et al 8 found that etiology (traumatic or ischemic) is not a significant predictor of functional outcome, as evaluated using the Spinal Cord Independence Measure. In their prediction model, lesion completeness, age and gender were the only significant determinants of functional outcome, consistent with our data.…”

“…2 Likely because of its rarity, little data exist on spinal cord ischemia. The largest series [2][3][4][5][6][7][8] have been primarily reported on neurological, bladder and walking recovery. Moreover, few studies have compared spinal cord ischemia with traumatic injuries, 4,5 and only two 5,8 have corrected for the effects of differences between these populations.…”

“…The largest series [2][3][4][5][6][7][8] have been primarily reported on neurological, bladder and walking recovery. Moreover, few studies have compared spinal cord ischemia with traumatic injuries, 4,5 and only two 5,8 have corrected for the effects of differences between these populations. Patients with traumatic spinal cord injury (TSCI) are typically younger, often present with complete lesions, and have shorter times between the development of the lesion to admission for rehabilitation 9 than those with nontraumatic lesionsFthese disparities render the two populations incomparable.…”