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Superiority of Brain and Spinal Injury Center Score for Assessing Injury Severity and Predicting Prognosis in Patients with Acute Traumatic Spinal Cord Injury

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Abstract

Purpose

The goal of this study was to evaluate the interrelationship between different magnetic resonance (MR) imaging measures and their validity in assessing the severity of acute traumatic spinal cord injury (tSCI) and predicting neurological outcomes.

Methods

We performed a preoperative multicenter cohort study of 89 patients with acute tSCI and preoperative MR imaging within 24 h after injury. We assessed several MR imaging measures of injury, including axial grade (Brain and Spinal Injury Center [BASIC] score), sagittal grade, length of injury, maximum canal compromise (MCC), and maximum spinal cord compression (MSCC). Principal component analysis (PCA) was applied to evaluate the interrelationship between different MR imaging measures. Spearman correlation and regression analyses were applied to assess injury severity and predict neurological impairment. The severity was assessed by the American Spinal Injury Association Impairment Scale (AIS) at admission, while neurological outcome was defined by AIS grade change at 6 weeks, AIS grade and SCIM score at 1 year after surgery.

Results

The PCA identified 2 clusters of MR imaging variables related to 1) measures of intrinsic cord signal abnormality (BASIC score, sagittal grade and length of injury) and 2) measures of extrinsic cord compression (MCC and MSCC). Neurological outcome and injury severity were best accounted for by MR imaging measures of intrinsic cord signal abnormalities, with the BASIC score representing the most accurate predictor of short-term and long-term neurological outcomes.

Conclusion

We determined the superior significance of the BASIC score in assessing injury severity, predicting early AIS improvement, AIS grade and SCIM score at 1 year compared with other MR imaging measures.

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Abbreviations

AIS:

AISA Impairment Scale

ASIA:

American Spinal Injury Association

BASIC:

Brain and Spinal Injury Center

ISS:

Injury Severity Score

MCC:

Maximum canal compromise

MR:

Magnetic resonance

MSCC:

Maximum spinal cord compression

PCA:

Principal component analysis

SCI:

Spinal cord injury

SCIM:

Spinal Cord Independence Measure

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Funding

This study was funded by Ministry of Education Key Laboratory of Trauma Treatment and Nerve Regeneration and the Beijing Science and Technology Plan Project in China, No. D161100002816001.

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Authors and Affiliations

  1. Department of Orthopedics, Peking University People’s Hospital, No.11 Xizhimen South Street, Xicheng District, 100044, Beijing, China

    Sizheng Zhan, Wenyong Xie, Feng Xue, Dianying Zhang & Baoguo Jiang

  2. Ministry of Education Key Laboratory of trauma treatment and nerve regeneration, Peking University People’s Hospital, 100044, Beijing, China

    Sizheng Zhan, Wenyong Xie, Feng Xue & Baoguo Jiang

  3. Department of Orthopedics, Peking University Binhai Hospital, 300450, Tianjin, China

    Dianying Zhang

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  1. Sizheng Zhan
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Contributions

F X, DY Z and BG J were responsible for the study design. SZ Z and WY X contributed to the interpretation and analysis of data. SZ Z was responsible for drafting the article. WY X and F X were responsible for revising it critically for important intellectual content. DY Z and BG J have approved the version to be published and all subsequent versions. SZ Z and WY X were major contributors and should be listed as to first coauthors.

Corresponding author

Correspondence to Feng Xue.

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Conflict of interest

S. Zhan, W. Xie, F. Xue, D. Zhang and B. Jiang declare that they have no competing interests.

Ethical standards

The study was approved by the ethics committee of Peking University People’s Hospital, approval number: 2016PHB136-01. Consent to participate: all patients had the contents of the study fully explained and signed the informed consent form before enrolment. Consent for publication: not applicable.

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Availability of Data and Material

The datasets generated and analyzed during the current study are not publicly available due to the data also forming part of an ongoing study but are available from the corresponding author on reasonable request.

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Not Applicable.

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Zhan, S., Xie, W., Xue, F. et al. Superiority of Brain and Spinal Injury Center Score for Assessing Injury Severity and Predicting Prognosis in Patients with Acute Traumatic Spinal Cord Injury. Clin Neuroradiol 32, 1117–1125 (2022). https://doi.org/10.1007/s00062-022-01154-1

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  • DOI: https://doi.org/10.1007/s00062-022-01154-1

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