The natural history of complete spinal cord injury: a pooled analysis of 1162 patients and a meta-analysis of modern data

OBJECTIVEThe natural history of complete spinal cord injury (SCI) is poorly studied. The classically quoted rate of improvement or conversion for patients with American Spinal Injury Association (ASIA) grade A (ASIA A) injuries is 15%–20%; however, data supporting this rate are very limited. In this paper, the authors conducted a meta-analysis of modern data reporting on ASIA A patients and evaluated factors affecting the natural history of the disease.METHODSThe authors conducted a systematic literature review of all randomized clinical trials (RCTs) and observational studies of patients with traumatic SCI. The Embase, MEDLINE, PubMed, Scopus, CINAHL, and Cochrane databases were reviewed for all studies reporting on SCI and published after 1992. A meta-analysis was conducted using the DerSimonian and Laird (random-effects) model with a summary odds ratio analysis.RESULTSEleven RCTs and 9 observational studies were included in the final analysis. Overall, the 20 included studies reported on 1162 patients with ASIA A injuries. The overall conversion rate was 28.1%, with 327 of 1162 patients improving to at least ASIA B. The overall rate of conversion noted in cervical spine injuries was 33.3%, whereas that in thoracic injuries was 30.6%. Patients undergoing early surgery had a higher rate of conversion (46.1%) than patients undergoing late surgery (25%) (OR 2.31, 95% CI 1.08–4.96, p = 0.03).CONCLUSIONSThe overall rate of conversion of ASIA A SCIs from pooled data of prospective trials and observational series is 28.1%. This rate of conversion is higher than what is reported in the literature. Early surgery is predictive of a higher conversion rate. However, there are not enough data to provide conclusions pertaining to the efficacy of biological and medical therapies.

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Neuro-Spinal Scaffold"! Implantation in Patients with Acute Traumatic Thoracic Complete Spinal Cord Injury: 24 Month Results From the INSPIRE Study

Neurosurgery ◽

10.1093/neuros/nyz310_334 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Kee D Kim ◽

K Stuart Lee ◽

Jason J Chang ◽

Richard M Toselli

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Natural History ◽

Primary Endpoint ◽

Conversion Rate ◽

Clinical Investigation ◽

Open Label ◽

Cord Injury ◽

Complete Spinal Cord Injury

Abstract INTRODUCTION The Neuro-Spinal Scaffold"! (NSS) is an investigational biodegradable device developed to facilitate spinal cord repair following intraparenchymal implantation within the injured spinal cord. An open-label, single-arm, multicenter clinical study was conducted to evaluate the safety and efficacy of the device in acute thoracic complete spinal cord injury (SCI). Here, we report on available 24-mo follow-up data. METHODS The INSPIRE Study (NCT02138110) enrolled patients with nonpenetrating, thoracic (T2-T12/L1) AIS A SCI within 96 h of injury. Safety and neurological outcomes were assessed. The primary endpoint was AIS conversion rate at 6 mo. The study included an Objective Performance Criterion (OPC) defined as at least 25% of patients demonstrating an AIS grade improvement at 6 mo, which was derived from a 16% natural history AIS conversion rate in the studied patient population.[1] RESULTS A total of 19 patients were implanted with the NSS. There were 3 deaths determined by investigators to be unrelated to the NSS or its implantation. A total of 8 patients have completed the 24-mo assessment visit, with additional follow-up ongoing. Seven of the sixteen patients who reached the 6-mo primary endpoint visit experienced an AIS grade improvement (43.8%; AIS B, n = 5; AIS C, n = 2). Three of the five patients who converted to AIS B experienced further improvement to AIS C at 12 (n = 2) and 24 mo (n = 1) postinjury. At last follow-up, none of the patients with AIS conversion had deteriorated and there were no unanticipated or serious adverse device effects related to the NSS or its implantation as determined by investigators. CONCLUSION The INSPIRE study is the first to clinically evaluate implantation of a scaffold as a treatment for acute SCI. This study describes the safety of the NSS and feasibility of implantation. The AIS conversion rate exceeds published natural history rates and the OPC. Available results at twenty-four months continue to support further clinical investigation.

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The Natural History of Degenerative Cervical Myelopathy and the Rate of Hospitalization Following Spinal Cord Injury: An Updated Systematic Review

Global Spine Journal ◽

10.1177/2192568217700396 ◽

2017 ◽

Vol 7 (3_suppl) ◽

pp. 28S-34S ◽

Cited By ~ 23

Author(s):

Lindsay A. Tetreault ◽

Spyridon Karadimas ◽

Jefferson R. Wilson ◽

Paul M. Arnold ◽

Shekar Kurpad ◽

...

Keyword(s):

Systematic Review ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Natural History ◽

Cervical Myelopathy ◽

Cochrane Collaboration ◽

Level Of Evidence ◽

Cord Injury ◽

History Of ◽

Degenerative Cervical Myelopathy

Study Method: Systematic review (update). Objective: Degenerative cervical myelopathy (DCM) is a degenerative spine disease and the most common cause of spinal cord dysfunction in adults worldwide. The objective of this study is to determine the natural history of DCM by updating the systematic review by Karadimas et al. The specific aims of this review were (1) to describe the natural history of DCM and (2) to determine potential risk factors of disease progression. Method: An updated search based on a previous protocol was conducted in PubMed and the Cochrane Collaboration library for studies published between November 2012 and February 15, 2015. Results: The updated search yielded 3 additional citations that met inclusion criteria and reported the incidence of spinal cord injury and severe disability in patients with DCM. Based on 2 retrospective cohort studies, the incidence rate of hospitalization for spinal cord injury is 13.9 per 1000 person-years in patients with cervical spondylotic myelopathy and 4.8 per 1000 person-years in patients with myelopathy secondary to ossification of the posterior longitudinal ligament (OPLL). In a third small prospective study, the risk of being wheelchair bound or bedridden was 66.7% in DCM patients with OPLL. Conclusion: The overall level of evidence for these estimated rates of hospitalization following spinal cord injury was rated as low.

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Early Versus Late Surgical Decompression for Acute Spinal Cord Injury: An Individual Patient Data Meta-Analysis of 1548 Patients

Neurosurgery ◽

10.1093/neuros/nyz310_121 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Jetan H Badhiwala ◽

Christopher D Witiw ◽

Jefferson R Wilson ◽

Michael G Fehlings

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Individual Patient Data ◽

Meta Analysis ◽

Surgical Decompression ◽

Early Surgery ◽

Light Touch ◽

Surgery Group ◽

Cord Injury ◽

Sensorimotor Recovery

Abstract INTRODUCTION We sought to leverage the statistical power derived from pooling 4 high-quality prospective datasets to compare sensorimotor recovery with early (< 24 hr) vs late (≥ 24 hr) surgical decompression for acute traumatic spinal cord injury (SCI). METHODS Patients with acute SCI who underwent surgical decompression were identified from 4 prospective, multi-center SCI datasets (NACTN, STASCIS, Sygen, and NASCIS III). Patients were dichotomized into early (< 24 hr) and late (≥ 24 hr) surgery groups. The primary end point was change in ASIA motor score (AMS) at 1-yr. Secondary outcomes included AIS grade and change in ASIA light touch and pin prick scores at 1-yr. One-stage meta-analyses for each outcome were performed by hierarchical mixed-effects regression using a stratified intercept to account for clustering of patients within studies. Fixed-effect covariates were specified for baseline score, age, injury mechanism, AIS grade, neurological level, and steroids. The treatment (early vs late surgery) was specified as a random-effect. RESULTS A total of 1548 patients were eligible. The early surgery group experienced greater improvement than the late surgery group at 1-yr for AMS (MD 4.0, 95% CI 1.7-6.2, P = .001), light touch score (MD 4.6, 95% CI 1.9-7.2, P = .001), and pin prick score (MD 4.2, 95% CI 1.5-6.9, P = .003). Further, on ‘shift analysis’, the early surgery group achieved a more favorable distribution of AIS grades at 1-yr compared to the late surgery group (cOR 1.46, 95% CI 1.14-1.87, P = .003). The effect of early surgery was strongest for cervical SCI (P = .003); however, we observed a trend toward improved recovery with early versus late surgery for thoracic SCI as well (MD 5.2, 95% CI -0.8-11.2, P = .088). CONCLUSION In an individual patient data meta-analysis adjusting for potential confounders, we found early surgery, within 24 hr of injury, to be associated with superior sensorimotor recovery at 1-yr following acute SCI, as compared to late surgery.

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The Natural History of Spinal Cord Injury

Neurosurgery Clinics of North America ◽

10.1016/j.nec.2021.03.003 ◽

2021 ◽

Vol 32 (3) ◽

pp. 315-321

Author(s):

Alexander F. Haddad ◽

John F. Burke ◽

Sanjay S. Dhall

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Natural History ◽

Cord Injury ◽

History Of

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Natural History of Isolated Below-Knee Vein Thrombosis in Patients with Spinal Cord Injury

Healthcare ◽

10.3390/healthcare9070861 ◽

2021 ◽

Vol 9 (7) ◽

pp. 861

Author(s):

Jang-Hyuk Cho ◽

Dong-Gyu Lee

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Deep Vein Thrombosis ◽

Natural History ◽

Vein Thrombosis ◽

Asian Patients ◽

Cord Injury ◽

History Of ◽

Deep Vein

In the general population, serial imaging is recommended over anticoagulant therapy for below-knee deep vein thrombosis (BKDVT). However, no clinical trial in Asian patients with spinal cord injury and BKDVT has been performed. Therefore, we evaluated the natural course of BKDVT in patients with acute spinal cord injury. We retrospectively analyzed inpatients with spinal cord injury with BKDVT between 2016 and 2020. All patients underwent inpatient rehabilitation treatment and duplex ultrasonographic examination of both the lower extremities at follow-up. After screening 172 patients with acute spinal cord injury for deep vein thrombosis using duplex ultrasound, 27 patients with below-the-knee deep vein thrombosis were included in this study. The mean lower-extremity motor score (median, interquartile range) was 66.0, 54.0–74.5. Sixteen patients received a non-vitamin K antagonist oral anticoagulant (NOAC) for anticoagulation. None of the patients had proximal propagation according to the follow-up duplex ultrasonography. BKDVT disappearance was not significantly different between the NOAC treatment and non-treatment groups. Asian patients with spinal cord injury have a low incidence of venous thromboembolism and favorable natural history of BKDVT. We recommend serial imaging over anticoagulant therapy for BKDVT in these patients.

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Spinal obstruction-related versus craniocervical junction related syringomyelia: a comparative study of spinal cord injury

10.21203/rs.3.rs-1073541/v1 ◽

2021 ◽

Author(s):

yuan chenghua ◽

jian guan ◽

yueqi du ◽

zeyu fang ◽

xinyu wang ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Natural History ◽

Scoring Systems ◽

Craniocervical Junction ◽

Initial Symptoms ◽

Cord Injury ◽

History Of ◽

The Difference ◽

Blood Spinal Cord Barrier

Abstract Background No prior reports have focused on spinal cord injury (SCI) characteristics or inflammation after destruction of the blood-spinal cord barrier by syringomyelia. To compare the difference of syringomyelia-related central SCI between craniocervical junction (CCJ) and post-traumatic syringomyelia (PTS) before and after decompression. Methods Between 2015 and 2019, 106 CCJ, 26 CCJ revision and 15 PTS patients (mean history of symptoms 71.5 ± 94.3, 88.9 ± 85.5 and 32.3 ± 48.9 months). The symptom courses were analysed with the ASIA, Klekamp and Samii scoring systems and Kaplan-Meier statistics for neurological changes. The mean follow-up was 20.7 ± 6.2, 21.7 ± 8.8 and 34.8 ± 19.4 months. Results Compared with the other group, the interval time after PTS was longer, but the natural history of syringomyelia was shorter (P=0.0004, 0.0173, respectively). The initial symptoms were usually paraesthesia (P=0.258), and the symptoms were mainly hypoesthesia (P=0.006), abnormal muscle strength (P=0.004), gait (P<0.0001) and abnormal urination (P<0.0001). SCI associated with PTS was more severe than that CCJ related (P=0.003). The cavities in the PTS group were primarily located at the thoracolumbar level, which was different from those in the cervical-thoracic segment at the CCJ. The rate of syrinx/cord was more than 75% (P=0.009), and the intradural adhesions tended to be more severe (P<0.0001). However, there were no significant differences in peripheral blood inflammation markers (PBIM) or long-term clinical efficacy except for the RBC (P=0.042). Conclusion The natural history of PTS tends to progress faster and is more severe than CCJ related. PBIM had no distinguishing effect on the difference in inflammation of syringomyelia except for the RBC. The predictive value of NLR for syringomyelia-related inflammation except in the acute phase was negative.

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