P.220 Mechanism of injury is associated with neurological outcomes in
                        cervical sensorimotor complete traumatic spinal cord injury

Background: There is significant heterogeneity in neurological recovery after complete (ASIA A) traumatic spinal cord injury (tSCI). Neurological recovery is often associated with a conversion to a higher letter grade of the American Spinal Injury Association’s impairment scale (ASIA). The mechanism of injury (MOI) may play a significant role in the primary injury and should be considered for greater precision in care. Methods: We isolated ASIA A cervical tSCI patients from three multicenter prospective randomized controlled trials (NACTN, STASCIS, Sygen). Chi-square test with pairwise comparisons with Bonferroni corrections was performed to compare the proportion of ASIA A patients that converted to a higher ASIA grade between different MOI. Results: We identified 486 complete cervical tSCI patients. For patients who developed tSCI as a result of a fall, a significant proportion converted to a higher ASIA grade by 52 weeks (p = 0.009). For patients who developed tSCI as a result of a sports injury, a significantly smaller proportion did not convert to a higher ASIA grade compared to those that converted (p = 0.034). Conclusions: Due to the difference in outcomes, tSCI patients should be treated differently depending on their mechanism of injury.

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Neurological recovery following traumatic spinal cord injury: a systematic review and meta-analysis

Journal of Neurosurgery Spine ◽

10.3171/2018.10.spine18802 ◽

2019 ◽

Vol 30 (5) ◽

pp. 683-699 ◽

Cited By ~ 15

Author(s):

MirHojjat Khorasanizadeh ◽

Mahmoud Yousefifard ◽

Mahsa Eskian ◽

Yi Lu ◽

Maryam Chalangari ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Recovery Rate ◽

Meta Analysis ◽

Neurological Recovery ◽

Traumatic Spinal Cord Injury ◽

Mechanism Of Injury ◽

Cord Injury ◽

Lower Recovery

OBJECTIVEPredicting neurological recovery following traumatic spinal cord injury (TSCI) is a complex task considering the heterogeneous nature of injury and the inconsistency of individual studies. This study aims to summarize the current evidence on neurological recovery following TSCI by use of a meta-analytical approach, and to identify injury, treatment, and study variables with prognostic significance.METHODSA literature search in MEDLINE and EMBASE was performed, and studies reporting follow-up changes in American Spinal Injury Association (ASIA) Impairment Scale (AIS) or Frankel or ASIA motor score (AMS) scales were included in the meta-analysis. The proportion of patients with at least 1 grade of AIS/Frankel improvement, and point changes in AMS were calculated using random pooled effect analysis. The potential effect of severity, level and mechanism of injury, type of treatment, time and country of study, and follow-up duration were evaluated using meta-regression analysis.RESULTSA total of 114 studies were included, reporting AIS/Frankel changes in 19,913 patients and AMS changes in 6920 patients. Overall, the quality of evidence was poor. The AIS/Frankel conversion rate was 19.3% (95% CI 16.2–22.6) for patients with grade A, 73.8% (95% CI 69.0–78.4) for those with grade B, 87.3% (95% CI 77.9–94.8) for those with grade C, and 46.5% (95% CI 38.2–54.9) for those with grade D. Neurological recovery was significantly different between all grades of SCI severity in the following order: C > B > D > A. Level of injury was a significant predictor of recovery; recovery rates followed this pattern: lumbar > cervical and thoracolumbar > thoracic. Thoracic SCI and penetrating SCI were significantly more likely to result in complete injury. Penetrating TSCI had a significantly lower recovery rate compared to blunt injury (OR 0.76, 95% CI 0.62–0.92; p = 0.006). Recovery rate was positively correlated with longer follow-up duration (p = 0.001). Studies with follow-up durations of approximately 6 months or less reported significantly lower recovery rates for incomplete SCI compared to studies with long-term (3–5 years) follow-ups.CONCLUSIONSThe authors’ meta-analysis provides an overall quantitative description of neurological outcomes associated with TSCI. Moreover, they demonstrated how neurological recovery after TSCI is significantly dependent on injury factors (i.e., severity, level, and mechanism of injury), but is not associated with type of treatment or country of origin. Based on these results, a minimum follow-up of 12 months is recommended for TSCI studies that include patients with neurologically incomplete injury.

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Effects of age on survival and neurological recovery of individuals following acute traumatic spinal cord injury

Spinal Cord ◽

10.1038/s41393-021-00719-0 ◽

2021 ◽

Author(s):

Julio C. Furlan

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neurological Recovery ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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Influence of severity and level of injury on the occurrence of complications during the subacute and chronic stage of traumatic spinal cord injury: a systematic review

Journal of Neurosurgery Spine ◽

10.3171/2021.7.spine21537 ◽

2021 ◽

pp. 1-21

Author(s):

Charlotte Y. Adegeest ◽

Jort A. N. van Gent ◽

Janneke M. Stolwijk-Swüste ◽

Marcel W. M. Post ◽

William P. Vandertop ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Chronic Phase ◽

Autonomic Dysreflexia ◽

Traumatic Spinal Cord Injury ◽

Chronic Stage ◽

Increased Risk ◽

Cord Injury ◽

Meta Analyses

OBJECTIVE Secondary health conditions (SHCs) are long-term complications that frequently occur due to traumatic spinal cord injury (tSCI) and can negatively affect quality of life in this patient population. This study provides an overview of the associations between the severity and level of injury and the occurrence of SHCs in tSCI. METHODS A systematic search was conducted in PubMed and Embase that retrieved 44 studies on the influence of severity and/or level of injury on the occurrence of SHCs in the subacute and chronic phase of tSCI (from 3 months after trauma). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS In the majority of studies, patients with motor-complete tSCI (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade A or B) had a significantly increased occurrence of SHCs in comparison to patients with motor-incomplete tSCI (AIS grade C or D), such as respiratory and urogenital complications, musculoskeletal disorders, pressure ulcers, and autonomic dysreflexia. In contrast, an increased prevalence of pain was seen in patients with motor-incomplete injuries. In addition, higher rates of pulmonary infections, spasticity, and autonomic dysreflexia were observed in patients with tetraplegia. Patients with paraplegia more commonly suffered from hypertension, venous thromboembolism, and pain. CONCLUSIONS This review suggests that patients with a motor-complete tSCI have an increased risk of developing SHCs during the subacute and chronic stage of tSCI in comparison with patients with motor-incomplete tSCI. Future studies should examine whether systematic monitoring during rehabilitation and the subacute and chronic phase in patients with motor-complete tSCI could lead to early detection and potential prevention of SHCs in this population.

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Neurological Recovery Is Impaired by Concurrent but Not by Asymptomatic Pre-existing Spinal Cord Compression After Traumatic Spinal Cord Injury

Spine ◽

10.1097/brs.0b013e31824ffda5 ◽

2012 ◽

Vol 37 (17) ◽

pp. 1448-1455 ◽

Cited By ~ 11

Author(s):

Kensuke Kubota ◽

Hirokazu Saiwai ◽

Hiromi Kumamaru ◽

Kazu Kobayakawa ◽

Takeshi Maeda ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Compression ◽

Cord Compression ◽

Neurological Recovery ◽

Traumatic Spinal Cord Injury ◽

Cord Injury

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The serum SIRT1 protein is associated with the severity of injury and neurological recovery in mice with traumatic spinal cord injury

Neuroscience ◽

10.1016/j.neuroscience.2021.06.025 ◽

2021 ◽

Author(s):

Guibin Zhong ◽

Yanqiu Yang ◽

Xiaodong Huang ◽

Junling Chen ◽

Daming Feng ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neurological Recovery ◽

Traumatic Spinal Cord Injury ◽

Severity Of Injury ◽

Cord Injury

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Failure of Mean Arterial Pressure Goals to Improve Outcomes Following Penetrating Spinal Cord Injury

Neurosurgery ◽

10.1227/neu.0000000000001249 ◽

2016 ◽

Vol 79 (5) ◽

pp. 708-714 ◽

Cited By ~ 16

Author(s):

William J. Readdy ◽

Rajiv Saigal ◽

William D. Whetstone ◽

Anthony N. Mefford ◽

Adam R. Ferguson ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Patient Population ◽

Spinal Injury ◽

Neurological Recovery ◽

American Spinal Injury Association ◽

Neurological Improvement ◽

Cord Injury

Abstract BACKGROUND: Increased spinal cord perfusion and blood pressure goals have been recommended for spinal cord injury (SCI). Penetrating SCI is associated with poor prognosis, but there is a paucity of literature examining the role of vasopressor administration for the maintenance of mean arterial pressure (MAP) goals in this patient population. OBJECTIVE: To elucidate this topic and to determine the efficacy of vasopressor administration in penetrating SCI by examining a case series of consecutive penetrating SCIs. METHODS: We reviewed consecutive patients with complete penetrating SCI who met inclusion and exclusion criteria, including the administration of vasopressors to maintain MAP goals. We identified 14 patients with complete penetrating SCIs with an admission American Spinal Injury Association grade of A from 2005 to 2011. The neurological recovery, complications, interventions, and vasopressor administration strategies were reviewed and compared with those of a cohort with complete blunt SCI. RESULTS: In our patient population, only 1 patient with penetrating SCI (7.1%) experienced neurological recovery, as determined by improvement in the American Spinal Injury Association grade, despite the administration of vasopressors for supraphysiological MAP goals for an average of 101.07 ± 34.96 hours. Furthermore, 71.43% of patients with penetrating SCI treated with vasopressors experienced associated cardiogenic complications. CONCLUSION: Given the decreased likelihood of neurological improvement in penetrating injuries, it may be important to re-examine intervention strategies in this population. Specifically, the use of vasopressors, in particular dopamine, with their associated complications is more likely to cause complications than to result in neurological improvement. Our experience shows that patients with acute penetrating SCI are unlikely to recover, despite aggressive cardiopulmonary management.

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Selenium-Binding Protein 1 (SELENBP1) as Biomarker for Adverse Clinical Outcome After Traumatic Spinal Cord Injury

Frontiers in Neuroscience ◽

10.3389/fnins.2021.680240 ◽

2021 ◽

Vol 15 ◽

Author(s):

Julian Seelig ◽

Raban Arved Heller ◽

Patrick Haubruck ◽

Qian Sun ◽

Jochen Georg Klingenberg ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Injury ◽

Cell Damage ◽

Cell Activity ◽

Mechanical Trauma ◽

Specific Cell ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

Sensory Functions

Graphical AbstractThe pathophysiology of traumatic spinal cord injury (TSCI) can be divided into two major phases. (A) The mechanical trauma is followed within minutes by a secondary phase consisting of local complex and intertwined acute responses, intercellular signaling and cell activity regulating pathways. Inflammatory processes, oxidative stress and hypoxia, leading to cell damage and death, and specific cell contents are released into the circulation (B). The motor and sensory deficits upon TSCI are assessed by using the American Spinal Injury Association (ASIA) impairment scale (AIS), ranging from AIS A as a complete absence of any motor and sensory functions under the lesion site, to AIS E with complete preservation of motor and sensory functions. (C) The concentrations of serum SELENBP1 were elevated in patients classified as AIS A as compared to less severely affected patients classified as AIS B, C or D. A cut-off was deduced [(SELENBP1) > 30.2 μg/L], reliably predicting whether a patient belongs to the group showing neurological recovery (G1) or not (G0) within 3 months after the trauma. The figure was created by using https://biorender.com.

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Early Surgery for Traumatic Spinal Cord Injury: Where Are We Now?

Global Spine Journal ◽

10.1177/2192568219877860 ◽

2020 ◽

Vol 10 (1_suppl) ◽

pp. 84S-91S ◽

Cited By ~ 6

Author(s):

Jefferson R. Wilson ◽

Christopher D. Witiw ◽

Jetan Badhiwala ◽

Brian K. Kwon ◽

Michael G. Fehlings ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Injury Severity ◽

Significant Proportion ◽

Evidence Base ◽

Narrative Review ◽

Early Surgery ◽

Traumatic Spinal Cord Injury ◽

Cord Injury ◽

Central Cord Syndrome

Study Design: Narrative review. Objective: There is a strong biological rationale to perform early decompression after traumatic spinal cord injury (SCI). With an enlarging clinical evidence base, most spine surgeons internationally now favor early decompression for the majority of SCI patients; however, a number of pertinent questions remain surrounding this therapy. Methods: A narrative review evaluating the status of early surgery for SCI. In particular, we addressed the following questions: (1) Which patients stand to benefit most from early surgery? 2) What is the most appropriate time threshold defining early surgery? Results: Although heterogeneity exists, the evidence generally seems to support early surgery. While the best evidence exists for cervical SCI, there is insufficient data to support a differential effect for early surgery depending on neurological level or injury severity. When comparing thresholds to define early versus late surgery—including a later threshold (48-72 hours), an earlier threshold (24 hours), and an ultra-early threshold (8-12 hours)—the 2 earlier time points seem to be associated with the greatest potential for improved outcomes. However, existing prehospital and hospital logistics pose barriers to early surgery in a significant proportion of patients. An overview of recommendations from the recent AOSpine guidelines is provided. Conclusion: In spite of increasing acceptance of early surgery post SCI, further research is needed to (1) identify subgroups of patients who stand to derive particular benefit—in particular to develop more evidence-based approaches for central cord syndrome and (2) investigate the efficacy and feasibility of ultra-early surgery targeting more aggressive timelines.

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