Long-term Outcomes After Periprocedural and Spontaneous Spinal Cord Infarctions

Abstract

Background and Objectives:Spinal cord infarction (SCInf) is a rare condition where consensus regarding diagnostic criteria is lacking and mis- or delayed diagnosis can be detrimental. The aim of this study was to describe baseline findings and predictors of long-term functional outcome in a population-based cohort of patients with SCInf.Methods:All adult patients (≥18 years) treated at the Spinal Cord Injury Unit of the study center, between 2006–2019, and discharged with a G95 diagnosis(“other and unspecified disease of the spinal cord”) were screened for inclusion. The diagnostic criteria proposed by Zalewski et al. were retrospectively applied to evaluate the certainty of the SCInf diagnosis.Results:270 patients were screened and 57 were included in the study, of whom 30 had a spontaneous and 27 had a periprocedural SCInf. The median American Spinal Cord Injury Association Impairment Scale (AIS) on admission was C, which at median follow-up of 2.1 years had improved to D (p=0.002). Compared to periprocedural cases, spontaneous SCInf showed significantly better admission-AIS (median AIS D vs. B, p<0.001), fewer multilevel SCInf (27% vs. 59%, p=0.029), shorter hospital stay (median 22 vs. 44 days, p<0.001), as well as better AIS (median AIS D vs. C, p<0.001) and ambulatory status on long-term follow-up (66% vs. 1%, p<0.001). Regression analyses revealed that spontaneous SCInfs (OR=5.91 [1.92–18.1], p=0.002) and more favorable admission-AIS (OR=33.6 [7.72–146], p<0.001) were significant predictors of more favorable AIS at follow-up, with admission-AIS demonstrating independent predictive ability (OR=35.9 [8.05–160], p<0.001).Discussion:SCInf is a rare neurological emergency lacking specific management guidelines. While the presumptive diagnosis is based on the typical presentation and clinical findings, T2-weighted and diffusion-weighted MRI were the most useful diagnostic tools in establishing a definitive diagnosis. Our data shows that spontaneous SCInf mostly affected a single spinal cord segment while periprocedural cases were more extensive, had poorer AIS on admission, poorer ambulatory function, and longer hospital stays. Regardless of the etiology, significant neurological improvements were seen at long-term follow-up, highlighting the importance of active rehabilitation.

Vascular Myelopathies

“…Accurate guidance on outcomes is further confounded by small sample sizes and the need to adjust for the initial mode of spinal cord infarction (eg, periprocedural versus spontaneous) as well as the severity of spinal cord infarction. 16,30 Nedeltchev and colleagues 31 reported on a single-center study of 57 patients classified as having spinal cord infarction based on clinical findings and MRI confirmation on T2-weighted imaging. Etiologies of the spinal cord infarctions were atherosclerosis (33.3%), aortic pathology with or without surgery (15.8%), degenerative spine disease (15.8%), other (7.1%), and unknown (28%).…”

Spinal Cord Infarction Thrombolysed at Seven Hours: A Case Report and Review of Literature

“…Currently, there are no guidelines for the treatment of spinal cord injuries. In a retrospective evaluation of 57 spinal cord infarction patients with a median follow-up of 2.1 years, only 21 (38%) were ambulatory with or without walking aid, and 12 (21%) died [3]. The severity of motor deficits at presentation and advanced age are poor prognostic factors [4].…”

Extensive Spinal Cord Infarction: A Rare Challenging Entity

“…Our aim is to comment on recent literature about challenging extensive SCIs (2) , (3) , (4) , (5) . Chiew YR, et al reported the case study of a 58-year-old male, who had the diagnosis of an extensive SCI established by the contrast-enhanced thoracic spine MRI diffusion-weighted imaging and apparent diffusion coefficient (DWI and ADC) evaluations (2) .…”

“…The authors concluded that the initial MRI images may be normal, the SCIs between T4 and T7 and those due to trauma or systemic/chronic causes have worst outcomes, and the cerebrospinal fluid drainage and antiplatelet aggregate therapy are more effective tools (4) . Stenimahitis V, et al evaluated data of 57 patients aged 18 years or older and presenting SCIs between 2006 and 2019; 30 had spontaneous SCIs, and 27 periprocedural SCIs (5) . They highlighted that MRI DWI is the main tool for diagnosis; spontaneous SCIs often affect a unique segment and the periprocedural are more extensive, with more impairment and longer hospital stay; and the main goal of management is preventing complications (5) .…”

“…Stenimahitis V, et al evaluated data of 57 patients aged 18 years or older and presenting SCIs between 2006 and 2019; 30 had spontaneous SCIs, and 27 periprocedural SCIs (5) . They highlighted that MRI DWI is the main tool for diagnosis; spontaneous SCIs often affect a unique segment and the periprocedural are more extensive, with more impairment and longer hospital stay; and the main goal of management is preventing complications (5) .…”