Spinal cord injury: prognostic indicators

doi:10.1016/0020-1383(89)90148-4

Injury

Volume 20, Issue 2, March 1989, Pages 92-93

https://doi.org/10.1016/0020-1383(89)90148-4 Get rights and content

Abstract

A retrospective analysis of 70 patients with closed traumatic incomplete injuries of the spinal cord was performed. Of those presenting with motor sparing, as minimal as muscle flicker, 86 per cent recovered useful motor function. Of those presenting with spinothalamic sensory sparing, as minimal as unilateral sacral sparing, 71 per cent recovered to a similar functional level. While the patients presenting with preservation of only posterior column sensory sparing had the worst prognosis, some still showed important improvement. Meticulous neurological assessment within 72 h of the injury can localize the tract spared and can help with the prognosis in those patients with incomplete lesions.

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Cited by (38)

Traumatic spinal cord injuries
2017, Journal of Clinical Orthopaedics and Trauma
Citation Excerpt :
The authors have none to declare.1–4,6,9–16,18,20,22,23,34–38,44–47
Influence of Age Alone, and Age Combined With Pinprick, on Recovery of Walking Function in Motor Complete, Sensory Incomplete Spinal Cord Injury
2016, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
Supporting the earlier conclusion by Crozier et al,7 Waters et al12 observed that subjects with Frankel grade B with bilateral sacral pin sensation had greater recovery than subjects with Frankel grade A and cautioned that Frankel grades A and B should not be grouped in clinical trials. If the Frankel grade D used in previous studies9,10,12 is equated with household ambulation (50ft [15.2m]), then several of the other studies8,13 listed in table 1, including the current study, need to interpret the outcome measure of walking function as household ambulation. This interpretation enables comparison of the current study with earlier literature and facilitates better appreciation of the relation of pinprick to household ambulation in individuals with AIS grade B SCI.
To determine if age, pinprick scores in the lower extremities, and neurologic severity of injury influence recovery of ambulation in persons with motor complete, sensory incomplete (American Spinal Injury Association Impairment Scale [AIS] grade B) spinal cord injury (SCI) 1 year after initial injury.
This retrospective analysis examined subjects with AIS grade B from the Spinal Cord Injury Model System (SCIMS) database from 2006 to 2015. The baseline neurologic examination at rehabilitation admission (2–4wk postinjury) was used for comparison with 1-year outcome measures of locomotion.
Fifteen acute inpatient rehabilitation centers (participants in the SCIMS database).
Participants with AIS grade B SCI (N=249) were enrolled in the SCIMS database in 2 cycles (2006–2010 and 2011–2015).
Not applicable.
Household ambulation at 1 year by FONE-FIM and by direct interview, as part of the annual neurologic exam; change in American Spinal Injury Association score 1 year postinjury.
Findings demonstrate a statistically nonsignificant increase in likelihood of walking for those age <50 years compared with those age ≥50 years (relative risk [RR]=1.99; 95% confidence interval, 0.80–3.04). Presence of pinprick in at least one half of the lower-extremity dermatomes L2-S1 was associated with higher likelihood of walking (RR=5.57, P=.0023). Pinprick was significant for patients age <50 years (RR=4.58, P=.0090) but not for those age ≥50 years (P=.15).
Compared with younger individuals, participants age ≥50 years with AIS grade B SCI are less likely to achieve walking function 1 year postinjury. Likewise, preservation of pinprick sensation postinjury in the majority of lower-extremity dermatomes L2-S1 increases the chances of walking in individuals age <50 years.
Traumatic Spinal Cord Injury: Acute Spinal Cord Injury and Prognosis
2014, Quantitative MRI of the Spinal Cord
Prior to the widespread use of magnetic resonance imaging (MRI), the diagnosis of acute traumatic spinal cord injury (SCI) was largely based on clinical history, physical examination, plain film X-ray, CT scan, and CT myelography. Prognosis was loosely based on the severity of injury whereby individuals presenting with severe injuries were deemed unlikely to recover, and those with mild injuries were thought to recover to a greater extent. The implementation of clinical MRI units from the 1980s to present has offered clinicians an opportunity to view the damaged spinal cord. In this chapter we will (1) describe the meaning of different MRI signal characteristics relative to the pathobiology of SCI as elucidated in animal imaging models, (2) describe how quantitative measurements of spinal cord compression can be used as a tool to determine the degree of spinal cord damage in a patient, and (3) describe how intramedullary MRI signal characteristics can been used as a diagnostic and prognostic tool.
Effects of functional electrical stimulation on peak torque and body composition in patients with incomplete spinal cord injury
2007, Kaohsiung Journal of Medical Sciences
The aim of this study was to investigate the change in body composition, leg girths, and muscle strength of patients with incomplete spinal cord injury (SCI) after functional electrical stimulation cycling exercises (FESCE). Eighteen subjects with incomplete SCI were recruited. Each patient received FESCE three times per week for 8 weeks. Body composition, thigh and calf girths of bilateral legs, muscle strength of bilateral knee flexors and extensors were measured before and after 4 and 8 weeks of FESCE. A significant increase in bilateral thigh girth after 4 weeks of FESCE and significant increase in muscular peak torque of knee flexion and extension were found after 8 weeks of training. Besides, lean body mass increased significantly after complete treatment. FESCE can increase the thigh girth and muscular peak torque of patients with incomplete spinal cord injury.
Restoring Function After Spinal Cord Injury: Promoting Spontaneous Regeneration with Stem Cells and Activity-Based Therapies
2007, Neurosurgery Clinics of North America
Olfactory ensheathing cells: ripples of an incoming tide?
2006, Lancet Neurology
Until now, brain and spinal cord injuries that sever nerve fibres have resulted in a degree of incurable functional loss. An incoming tide of research is now beginning to challenge this as yet unbreached sea wall. One of the most promising approaches involves a recently discovered type of cell, the olfactory ensheathing cell, which can be obtained from the adult nasal lining. In animal models transplantation of cultured olfactory ensheathing cells into an injured spinal cord induces regeneration, remyelination of severed spinal nerve fibres, and functional recovery. Although several clinical centres worldwide have shown an interest in applying this approach to patients with spinal cord injury, there is no agreement on cell technology, and claims of beneficial results lack independent confirmation. Important aspects still need to be worked out at the laboratory level. Overall, the outlook is optimistic, but there is still some way to go.

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PaperSpinal cord injury: prognostic indicators

Abstract

Recovery of spinal cord function

Paraplegia

A review of cervical spine injuries with neurological dysfunction

Paraplegia

Acute fractures and dislocations of the cervical spine

J. Bone Joint Surg.

The results of treatment of acute injuries of the upper thoracic spine with paralysis

J. Bone Joint Surg.

A review and update of experimental and clinical studies of spinal cord injury

Paraplegia

Clinical review of the early stability of spine injuries

Spine

Paper
Spinal cord injury: prognostic indicators