Neurologic Improvement After Thoracic, Thoracolumbar, and Lumbar Spinal Cord (Conus Medullaris) Injuries

Harrop, James S.; Naroji, Swetha; Maltenfort, Mitchell; Ratliff, John K.; Tjoumakaris, Stavropoula; Frank, Brian; Anderson, D. Greg; Albert, Todd J.; Vaccaro, Alexander R.

doi:10.1097/brs.0b013e3181fd6b36

Cited by 53 publications

(46 citation statements)

References 17 publications

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“…But in some cases, this could mask the prognosis-worsening effect of the combined peripheral nerve injury in SCI. Harrop et al [14] found that SCI at the thoracolumbar level, when combined with lower motor neuron lesions, such as cauda equina lesions, showed to be contrary to our result by having better outcomes than SCI at the upper-thoracic level. However, because most of the subjects in that study had mild injury (AIS D), it is possible that SCI itself is not obvious when combined with lower motor neuron lesions.…”

Section: Discussioncontrasting

confidence: 99%

Prognosis for Patients With Traumatic Cervical Spinal Cord Injury Combined With Cervical Radiculopathy

Kim

Lee

et al. 2014

Ann Rehabil Med

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ObjectiveTo delineate cervical radiculopathy that is found in combination with traumatic cervical spinal cord injury (SCI) and to determine whether attendant cervical radiculopathy affects the prognosis and functional outcome for SCI patients.MethodsA total of 66 patients diagnosed with traumatic cervical SCI were selected for neurological assessment (using the International Standards for the Neurological Classification of Spinal Cord Injury [ISNCSCI]) and functional evaluation (based on the Korean version Modified Barthel Index [K-MBI] and Functional Independence Measure [FIM]) at admission and upon discharge. All of the subjects received a preliminary electrophysiological assessment, according to which they were divided into two groups as follows: those with cervical radiculopathy (the SCI/Rad group) and those without (the SCI group).ResultsA total of 32 patients with cervical SCI (48.5%) had cervical radiculopathy. The initial ISNCSCI scores for sensory and motor, K-MBI, and total FIM did not significantly differ between the SCI group and the SCI/Rad group. However, at discharge, the ISNCSCI scores for motor, K-MBI, and FIM of the SCI/Rad group showed less improvement (5.44±8.08, 15.19±19.39 and 10.84±11.49, respectively) than those of the SCI group (10.76±9.86, 24.79±19.65 and 17.76±15.84, respectively) (p<0.05). In the SCI/Rad group, the number of involved levels of cervical radiculopathy was negatively correlated with the initial and follow-up motors score by ISNCSCI.ConclusionCervical radiculopathy is not rare in patients with traumatic cervical SCI, and it can impede neurological and functional improvement. Therefore, detection of combined cervical radiculopathy by electrophysiological assessment is essential for accurate prognosis of cervical SCI patients in the rehabilitation unit.

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Section: Discussioncontrasting

confidence: 99%

Prognosis for Patients With Traumatic Cervical Spinal Cord Injury Combined With Cervical Radiculopathy

Kim

Lee

et al. 2014

Ann Rehabil Med

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“…2 The patient in Case 4 had such an injury and not only became independent but was also ambulatory following recovery. Data from a retrospective analysis 48 indicate that about 3%-6% of persons with complete thoracic SCI might expect some degree of motor recovery. Three (50%) of the 6 patients in our series with thoracic SCI regained some degree of motor control, including 1 who became ambulatory.…”

Section: Discussionmentioning

confidence: 99%

Local cooling for traumatic spinal cord injury: outcomes in 20 patients and review of the literature

Hansebout

2014

SPI

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Object In this prospective study, the authors offered protocol-selected patients a combination of parenteral steroids, decompression surgery, and localized cooling to preserve viable spinal cord tissue and enhance functional recovery. Methods After acquiring informed consent, the authors offered this regimen with localized deep cord cooling (dural temperature 6°C) to 20 patients with a neurologically complete spinal cord injury to begin within 8 hours of injury. After decompression, the cord was locally cooled through the intact dura using a suspended extradural saddle at the site of injury for up to 4 hours, during which time spinal fusion was performed. Sensation and motor function were evaluated directly after the injury and again over a year later. The patients were evaluated using the 2011 amendment to the American Spinal Injury Association (ASIA) Impairment Scale. Results Eighty percent of the 20 patients (12 with cervical and 4 thoracic injuries) with an initial neurologically complete cord injury had some recovery of sensory or motor function. All patients initially had ASIA Grade A impairment. Of 14 patients with quadriplegia, 5 remained ASIA Grade A, 5 improved to ASIA Grade B, 3 to ASIA Grade C, and 1 to ASIA Grade D. The remaining 6 patients had suffered a thoracic spinal cord injury, and of these 2 remained ASIA Grade A, 1 recovered to ASIA Grade B, 2 to ASIA Grade C, and 1 ASIA Grade D. All considered, of 20 patients, 35% remained ASIA Grade A, 30% improved to ASIA Grade B, and 25% to ASIA Grade C. Impairment in 2 (10%) of 20 patients improved to ASIA Grade D. The mean improvement in neurological level of injury in all patients was 1.05, the mean improvement in motor level was 1.7, and the mean improvement in sensory level was 2.8. Two patients recovered the ability to walk, 2 could extend their legs, 5 could sense bladder fullness, and 3 had partial ability to void voluntarily. Four males recovered subnormal ability to have voluntary erection sufficient for limited sexual activity. Conclusions The authors present here results of 20 patients with neurologically complete spinal cord injury treated with a combination of surgical decompression, glucocorticoid administration, and regional hypothermia. These patients experienced a better recovery than might have been expected had traditional forms of treatment been used. The benefit of steroid treatment for cord injury has been debated in the last decade, but the authors feel that research into the effects of cord cooling should be expanded. Given that the optimal neuroprotective temperature after acute trauma has not yet been defined, and may well be below that which is considered safely approachable through systemic cooling, methods that allow for the early attainment of such a temperature locally should be further explored. The results are encouraging enough to suggest the undertaking of controlled clinical trials of treatment using localized spinal cord cooling, where such treatment can be instituted within hours following injury.

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“…As a result spontaneous neurological recovery has been reported only in 6-13% of patients with only 2% gaining any functional recovery. [113][114][115][116].…”

Section: Discussionmentioning

confidence: 99%

Mesenchymal Stem Cells in Spinal Cord Injury

Venkataramanaa¹,

Pal²

2014

Topics in Paraplegia

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Neurologic Improvement After Thoracic, Thoracolumbar, and Lumbar Spinal Cord (Conus Medullaris) Injuries

Cited by 53 publications

References 17 publications

Prognosis for Patients With Traumatic Cervical Spinal Cord Injury Combined With Cervical Radiculopathy

Prognosis for Patients With Traumatic Cervical Spinal Cord Injury Combined With Cervical Radiculopathy

Local cooling for traumatic spinal cord injury: outcomes in 20 patients and review of the literature

Mesenchymal Stem Cells in Spinal Cord Injury

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