Skip to main content
SpringerLink
Log in

Early clinical predictors of functional recovery following traumatic spinal cord injury: a population-based study of 143 patients

  • Original Article - Spine trauma
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Traumatic spinal cord injuries (TSCI) are associated with uncertainty regarding the prognosis of functional recovery. The aim of the present study was to evaluate the potential of early clinical variables to predict the degree of functional independence assessed by Spinal Cord Independence Measure III (SCIM-III) up to 1 year after injury.

Methods

Prospectively collected data from 143 SCI patients treated in Western Denmark during 2012–2019 were retrospectively analysed. Data analysis involved univariate methods and multivariable linear regression modelling total SCIM-III scores against age, gender, body mass index (BMI), comorbidity, American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades A–B and C–D, ASIA Motor Score (AMS), timing of surgical treatment and occurrence of medical complications. Statistical significance was set at p < .05.

Results

Univariate analyses indicated that variables significantly associated with decreased functional independence included increased age (p = .023), increased BMI (p = .012), pre-existing comorbidity (p = .001), AIS grades A–B (p < .001), decreased AMS (p < .001) and occurrence of medical complications (p < .001). However, in the multivariable regression model were pre-existing comorbidity (p = .010), AIS grades A–B (p < .001), low AMS (p < .001) and late surgical treatment (p = .018) significant predictors of decreased functional independence 1 year after injury.

Conclusion

TSCI patients with greatest potential for functional recovery up to 1 year after injury seem to be patients that immediately after trauma present with few or no comorbidities, who sustain motor-incomplete injuries and undergo early decompressive surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

ADL:

Activities of daily living

ASIA:

American Spinal Injury Association

AIS:

American Spinal Injury Association Impairment Scale

AMS:

American Spinal Injury Association Motor Score

ALT:

American Spinal Injury Association Sensory Score for Light Touch

BMI:

Body mass index

CI:

Confidence intervals

Coef:

Coefficient

ISNCSCI:

International Standards for Neurological Classification of Spinal Cord Injury

IQR:

Interquartile range

R 2 :

Adjusted R-square

SCIM-III:

Spinal Cord Independence Measure III

TSCI:

Traumatic spinal cord injury

References

  1. Aarabi B, Sansur CA, Ibrahimi DM, Simard JM, Hersh DS, Le E, Diaz C, Massetti J, Akhtar-Danesh N (2017) Intramedullary lesion length on postoperative magnetic resonance imaging is a strong predictor of ASIA impairment scale grade conversion following decompressive surgery in cervical spinal cord injury. Clin Neurosurg 80(4):610–620

    Article  Google Scholar 

  2. Anderson KIMD (2004) Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 21(10):1371–1383

    Article  Google Scholar 

  3. Brienza D, Krishnan S, Karg P, Sowa G, Allegretti AL (2018) Predictors of pressure ulcer incidence following traumatic spinal cord injury: a secondary analysis of a prospective longitudinal study. Spinal Cord 56(1):28–34

    Article  CAS  Google Scholar 

  4. Denis AR, Feldman D, Thompson C, Mac-Thiong JM (2018) Prediction of functional recovery six months following traumatic spinal cord injury during acute care hospitalization. J Spinal Cord Med 41(3):309–317

    Article  Google Scholar 

  5. Dickson HG, Catz A, Tamir A, Itzkovich M (1998) SCIM - Spinal Cord Independence Measure: a new disability scale for patients with spinal cord lesions (multiple letters) [1]. Spinal Cord 36(10):734–735

    Article  CAS  Google Scholar 

  6. Facchinello Y, Beauséjour M, Richard-Denis A, Thompson C, Mac-Thiong J-M (2017) The use of regression tree analysis for predicting the functional outcome following traumatic spinal cord injury. J Neurotrauma. https://doi.org/10.1089/neu.2017.5321

  7. Farhadi HF, Kukreja S, Minnema A, Vatti L, Gopinath M, Prevedello L, Chen C, Xiang H, Schwab JM (2018) Impact of admission imaging findings on neurological outcomes in acute cervical traumatic spinal cord injury. J Neurotrauma 35(12):1398–1406

    Article  Google Scholar 

  8. Fehlings MG, Vaccaro A, Wilson JR et al (2012) Early versus delayed decompression for traumatic cervical spinal cord injury: results of the surgical timing in acute spinal cord injury study (STASCIS). PLoS One. https://doi.org/10.1371/journal.pone.0032037

  9. Franceschini M, Bonavita J, Cecconi L, Ferro S, Pagliacci MC (2020) Traumatic spinal cord injury in Italy 20 years later: current epidemiological trend and early predictors of rehabilitation outcome. Spinal Cord. https://doi.org/10.1038/s41393-020-0421-y

  10. Geuther M, Grassner L, Mach O et al (2019) Functional outcome after traumatic cervical spinal cord injury is superior in adolescents compared to adults. Eur J Paediatr Neurol 23(2):248–253

    Article  Google Scholar 

  11. Grant SW, Hickey GL, Head SJ (2019) Statistical primer: multivariable regression considerations and pitfalls. Eur J Cardiothorac Surg 55(2):179–185

    Article  Google Scholar 

  12. Grassner L, Wutte C, Klein B et al (2016) Early decompression (< 8 h) after traumatic cervical spinal cord injury improves functional outcome as assessed by spinal cord independence measure after one year. J Neurotrauma 33(18):1658–1666

    Article  Google Scholar 

  13. Haldrup M, Dyrskog S, Thygesen MM, Kirkegaard H, Kasch H, Rasmussen MM (2020) Initial blood pressure is important for long-term outcome after traumatic spinal cord injury. J Neurosurg Spine:1–5

  14. Haldrup M, Schwartz OS, Kasch H, Rasmussen MM (2019) Early decompressive surgery in patients with traumatic spinal cord injury improves neurological outcome. Acta Neurochir 161(10):2223–2228

    Article  Google Scholar 

  15. Heinze G, Dunkler D (2017) Five myths about variable selection. Transpl Int 30(1):6–10

    Article  Google Scholar 

  16. Horn SD, Smout RJ, Dejong G, Dijkers MP, Hsieh CH, Lammertse D, Whiteneck GG (2013) Association of various comorbidity measures with spinal cord injury rehabilitation outcomes. Arch Phys Med Rehabil 94(4 SUPPL):S75–S86

    Article  Google Scholar 

  17. Itzkovich M, Gelernter I, Biering-Sorensen F et al (2007) The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil 29(24):1926–1933

    Article  CAS  Google Scholar 

  18. Jaja BNR, Jiang F, Badhiwala JH et al (2019) Association of pneumonia, wound infection, and sepsis with clinical outcomes after acute traumatic spinal cord injury. J Neurotrauma 36(21):3044–3050

    Article  Google Scholar 

  19. Jiang F, Jaja BNR, Kurpad SN et al (2019) Acute adverse events after spinal cord injury and their relationship to long-term neurologic and functional outcomes: analysis from the North American Clinical Trials Network for Spinal Cord Injury. Crit Care Med 47(11):e854–e862

    Article  Google Scholar 

  20. Kaminski L, Cordemans V, Cernat E, M’Bra KI, Mac-Thiong JM (2017) Functional outcome prediction after traumatic spinal cord injury based on acute clinical factors. J Neurotrauma 34(12):2027–2033

    Article  Google Scholar 

  21. Kramer JLK, Geisler F, Ramer L, Plunet W, Cragg JJ (2017) Open access platforms in spinal cord injury: existing clinical trial data to predict and improve outcomes. Neurorehabil Neural Repair 31(5):399–401

    Article  Google Scholar 

  22. Kwon BK, Streijger F, Fallah N et al (2017) Cerebrospinal fluid biomarkers to stratify injury severity and predict outcome in human traumatic spinal cord injury. J Neurotrauma 34(3):567–580

    Article  Google Scholar 

  23. Ozelie R, Gassaway J, Buchman E et al (2012) Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab Project. J Spinal Cord Med 35(6):527–546

    Article  Google Scholar 

  24. Pouw MH, Hosman AJF, Van Kampen A, Hirschfeld S, Thietje R, Van De Meent H (2011) Is the outcome in acute spinal cord ischaemia different from that in traumatic spinal cord injury? A cross-sectional analysis of the neurological and functional outcome in a cohort of 93 paraplegics. Spinal Cord 49(2):307–312

    Article  CAS  Google Scholar 

  25. Rabinstein AA (2018) Traumatic spinal cord injury. Continuum (Minneap Minn) 24(2):551–566

    Google Scholar 

  26. Richard-Denis A, Beauséjour M, Thompson C, Nguyen BH, Mac-Thiong JM (2018) Early predictors of global functional outcome after traumatic spinal cord injury: a systematic review. J Neurotrauma 35(15):1705–1725

    Article  Google Scholar 

  27. Richard Denis A, Thompson C, Mac Thiong J-M (2017) Determining complete functional independence in patients with a traumatic cervical spinal cord injury: proposal of a two-level scale based on the Spinal Cord Independence Measure. Int J Phys Med Rehabil 05(04):5–9

    Article  Google Scholar 

  28. Roberts TT, Leonard GR, Cepela DJ (2017) Classifications in brief: American Spinal Injury Association (ASIA) Impairment Scale. Clin Orthop Relat Res 475(5):1499–1504

    Article  Google Scholar 

  29. Teeter L, Gassaway J, Taylor S et al (2012) Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab Project. J Spinal Cord Med 35(6):503–526

    Article  Google Scholar 

  30. Warner FM, Tong B, Jutzeler CR, Cragg JJ, Scheuren PS, Kramer JLK (2017) Long-term functional outcome in patients with acquired infections after acute spinal cord injury. Neurology 89(7):e76–e78

    Article  Google Scholar 

  31. Wartenberg KE, Hwang DY, Haeusler KG et al (2019) Gap analysis regarding prognostication in neurocritical care: a joint statement from the German Neurocritical Care Society and the Neurocritical Care Society. Neurocrit Care 31(2):231–244

    Article  CAS  Google Scholar 

  32. Whiteneck G, Gassaway J, Dijkers MP, Heinemann AW, Kreider SED (2012) Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: the SCIRehab Project. J Spinal Cord Med 35(6):484–502

    Article  Google Scholar 

  33. Wilson JR, Davis AM, Kulkarni AV, Kiss A, Frankowski RF, Grossman RG, Fehlings MG (2014) Defining age-related differences in outcome after traumatic spinal cord injury: analysis of a combined, multicenter dataset. Spine J 14(7):1192–1198

    Article  Google Scholar 

  34. Wilson JR, Grossman RG, Frankowski RF et al (2012) A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors. J Neurotrauma 29(13):2263–2271

    Article  Google Scholar 

  35. Wilson JR, Singh A, Craven C, Verrier MC, Drew B, Ahn H, Ford M, Fehlings MG (2012) Early versus late surgery for traumatic spinal cord injury: the results of a prospective Canadian cohort study. Spinal Cord 50(11):840–843

    Article  CAS  Google Scholar 

  36. Witiw CD, Fehlings MG (2015) Acute spinal cord injury. J Spinal Discord Tech 28(6):202–210

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark

    Thea Overgaard Wichmann, Mette Haldrup Jensen & Mikkel Mylius Rasmussen

  2. Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg Regional Hospital, Viborg, Denmark

    Helge Kasch

  3. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Helge Kasch

Authors
  1. Thea Overgaard Wichmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mette Haldrup Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Helge Kasch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mikkel Mylius Rasmussen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thea Overgaard Wichmann.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For this type of study, formal consent is not required.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Spine trauma

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wichmann, T.O., Jensen, M.H., Kasch, H. et al. Early clinical predictors of functional recovery following traumatic spinal cord injury: a population-based study of 143 patients. Acta Neurochir 163, 2289–2296 (2021). https://doi.org/10.1007/s00701-020-04701-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-020-04701-2

Keywords

Search

Navigation