scholarly journals Adult Spinal Cord Injury without Major Bone Injury: Effects of Surgical Decompression and Predictors of Neurological Outcomes in American Spinal Injury Association Impairment Scale A, B, or C

2021 ◽  
Vol 10 (5) ◽  
pp. 1106
Author(s):  
Bo-Ram Na ◽  
Hyoung-Yeon Seo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Surgical Decompression ◽  
Lesion Length ◽  
Compression Rate ◽  
American Spinal Injury Association ◽  
Bone Injury ◽  
Cord Injury ◽  
Adult Spinal Cord

The cervical spine can be injured even in the absence of radiographic abnormality, and the best surgical treatment for adult spinal cord injury without bone injury is debated. The aim of this study was to retrospectively investigate the effect of surgical decompression for severe adult spinal cord injury without major bone injury and to establish predictors of good neurological outcome. We analyzed 11 patients who underwent surgical decompression in severe adult spinal cord injury without major bone injury patients classified as American Spinal Injury Association Impairment Scale (AIS) grade A, B, or C. Neurological assessments were performed using AIS at preoperative and postoperative 1-year follow-up. Radiological evaluations were performed using cervical magnetic resonance imaging (MRI) at preoperative. Seven cases were classified as AIS grade A; two cases as AIS grade B; and two cases as AIS grade C. Five of 11 (45.5%) patients showed improved neurological grade 1-year postoperatively. Intramedullary lesion length (IMLL) (p = 0.047) and compression rate (p = 0.045) had the most powerful effect on AIS grade conversion. This study shows that the fate of the injured spinal cord is determined at the time of the injury, but adequate decompression may have limited contribution to the recovery of neurological function. Compression rate and IMLL on MRI can be used as a predictor of neurological recovery.

scholarly journals 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

Neurosurgery ◽  
2016 ◽  
Vol 80 (4) ◽  
pp. 610-620 ◽  
Author(s):  
Bizhan Aarabi ◽  
Charles A. Sansur ◽  
David M. Ibrahimi ◽  
J. Marc Simard ◽  
David S. Hersh ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Spinal Injury ◽  
Surgical Decompression ◽  
Lesion Length ◽  
American Spinal Injury Association ◽  
Resonance Imaging ◽  
Motor Score ◽  
Intramedullary Lesion ◽  
Cord Injury

Abstract BACKGROUND: Evidence indicates that, over time, patients with spinal cord injury (SCI) improve neurologically in various degrees. We sought to further investigate indicators of grade conversion in cervical SCI. OBJECTIVE: To detect predictors of ASIA impairment scale (AIS) grade conversion in SCI following surgical decompression. METHODS: In a retrospective study, demographics, clinical, imaging, and surgical data from 100 consecutive patients were assessed for predictors of AIS grade conversion. RESULTS: American Spinal Injury Association motor score was 17.1. AIS grade was A in 52%, B in 29%, and C in 19% of patients. Surgical decompression took place on an average of 17.6 h following trauma (≤12 h in 51 and >12 h in 49). Complete decompression was verified by magnetic resonance imaging (MRI) in 73 patients. Intramedullary lesion length (IMLL) on postoperative MRI measured 72.8 mm, and hemorrhage at the injury epicenter was noted in 71 patients. Grade conversion took place in 26.9% of AIS grade A patients, 65.5% of AIS grade B, and 78.9% of AIS grade C. AIS grade conversion had statistical relationship with injury severity score, admission AIS grade, extent of decompression, presence of intramedullary hemorrhage, American Spinal Injury Association motor score, and IMLL. A stepwise multiple logistic regression analysis indicated IMLL was the sole and strongest indicator of AIS grade conversion (odds ratio 0.950, 95% CI 0.931-0.969). For 1- and 10-mm increases in IMLL, the model indicates 4% and 40% decreases, respectively, in the odds of AIS grade conversion. CONCLUSION: Compared with other surrogates, IMLL remained as the only predictor of AIS grade conversion.

scholarly journals Ultra-Early (<12 Hours) Surgery Correlates With Higher Rate of American Spinal Injury Association Impairment Scale Conversion After Cervical Spinal Cord Injury

Neurosurgery ◽  
2018 ◽  
Vol 85 (2) ◽  
pp. 199-203 ◽  
Author(s):  
John F Burke ◽  
John K Yue ◽  
Laura B Ngwenya ◽  
Ethan A Winkler ◽  
Jason F Talbott ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Optimal Time ◽  
American Spinal Injury Association ◽  
Early Group ◽  
Cord Injury

Abstract BACKGROUND Cervical spinal cord injury (SCI) is a devastating condition with very few treatment options. It remains unclear if early surgery correlated with conversion of American Spinal Injury Association Impairment Scale (AIS) grade A injuries to higher grades. OBJECTIVE To determine the optimal time to surgery after cervical SCI through retrospective analysis. METHODS We collected data from 48 patients with cervical SCI. Based on the time from Emergency Department (ED) presentation to surgical decompression, we grouped patients into ultra-early (decompression within 12 h of presentation), early (within 12-24 h), and late groups (&gt;24 h). We compared the improvement in AIS grade from admission to discharge, controlling for confounding factors such as AIS grade on admission, injury severity, and age. The mean time from injury to ED for this group of patients was 17 min. RESULTS Patients who received surgery within 12 h after presentation had a relative improvement in AIS grade from admission to discharge: the ultra-early group improved on average 1.3. AIS grades compared to 0.5 in the early group (P = .02). In addition, 88.8% of patients with an AIS grade A converted to a higher grade (AIS B or better) in the ultra-early group, compared to 38.4% in the early and late groups (P = .054). CONCLUSION These data suggest that surgical decompression after SCI that takes place within 12 h may lead to a relative improved neurological recovery compared to surgery that takes place after 12 h.

Long-Term Follow-up of Patients with Spinal Cord Injury

2005 ◽  
Vol 19 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Figen Yilmaz ◽  
Fusun Sahin ◽  
Semra Aktug ◽  
Banu Kuran ◽  
Adem Yilmaz
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Functional Independence Measure ◽  
Functional Independence ◽  
American Spinal Injury Association ◽  
Cord Injury ◽  
Long Term Follow Up

Objective. The aim of this study was to evaluate the motor, sensory, and functional recovery in patients with spinal cord injury (SCI). Methods. Forty-one patients with SCI participated in this study. Twenty patients were evaluated after discharge. Each patient was evaluated by the American Spinal Injury Association (ASIA) impairment scale and the Functional Independence Measure (FIM) at admission, before discharge, and at least at 6 months after discharge. Friedman, Dunn, and Mann-Whitney U tests were used for statistical analysis. Results. There were 17 male and 3 female patients. Seven patients had complete SCI, and 13 patients had incomplete SCI. The evaluation of motor, sensory, and FIM scores at admission showed significant improvement in all of the patients during the follow-up period (P < 0.0001). Five incompletely injured cases improved with regard to ASIA staging. Motor and FIM scores significantly increased at follow-up for converted and unconverted patients. All parameters increased at follow-up in patients who were complete and incomplete. Motor scores significantly increased at discharge and at follow-up. FIM scores also increased significantly at follow-up in incomplete patients. Conclusion. Motor, sensory, and FIM scores increased in patients with SCI after a follow-up period of 18 months. Improvement to a higher ASIA stage could be accomplished by 25% of the patients. Although both complete and incomplete patients recovered significantly at the follow-up period, only incompletely injured cases could convert to a higher ASIA stage.

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

Neurosurgery ◽  
2016 ◽  
Vol 79 (5) ◽  
pp. 708-714 ◽  
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.

scholarly journals A Functional Outcome Prediction Model of Acute Traumatic Spinal Cord Injury Based on Extreme Gradient Boost

2021 ◽  
Author(s):  
Sizheng Zhan ◽  
Boxuan Huang ◽  
Wenyong Xie ◽  
Feng Xue ◽  
Dianying Zhang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Prediction Model ◽  
Functional Outcome ◽  
Nonlinear Regression ◽  
Spinal Injury ◽  
Surgical Decompression ◽  
Cord Injury ◽  
The Difference ◽  
Outcome Index

Abstract Purpose: We aimed to construct a nonlinear regression model through Extreme Gradient Boost (XGBoost) to predict functional outcome 1 year after surgical decompression for patients with acute spinal cord injury (SCI).Methods: We prospectively enrolled 249 patients with acute SCI from 5 primary orthopedic centers from June 1, 2016, to June 1, 2020. We identified a total of 6 predictors with three aspects: 1) clinical characteristics, including age, American Spinal Injury Association (ASIA) Impairment Scale (AIS) at admission, level of injury and baseline ASIA motor score (AMS); 2) MR imaging, mainly including Brain and Spinal Injury Center (BASIC) score; 3) surgical timing, specifically comparing whether surgical decompression was received within 24 hours or not. We assessed the SCIM score at 1 year after the operation as the functional outcome index. XGBoost was used to build a nonlinear regression prediction model through the method of boosting integrated learning.Results: We successfully constructed a nonlinear regression prediction model through XGBoost and verified the credibility. The average absolute value of the difference between the predicted value and the actual value is 3.72 (t=1.29, P=0.203), ranging from 0 to 8.44. AMS and age ranked first and second in predicting the functional outcome.Conclusion: We verified the feasibility of using XGBoost to construct a nonlinear regression prediction model for the functional outcome of patients with acute SCI, and we found that age and AMS play the most important role in predicting the functional outcome.Trial registration: ClinicalTrials.gov identifier: NCT03103516.

scholarly journals Multivariate Analysis of Acute Magnetic Resonance Imaging Predicts Neurological Improvements in Patients With Cervical Spinal Cord Injury After Early Surgical Decompression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tomoo Inoue ◽  
Toshiki Endo ◽  
Shinsuke Suzuki ◽  
Hiroshi Uenohara ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Principal Component ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury

Abstract INTRODUCTION Patients with cervical spinal cord injury (SCI) show different clinical outcomes. There is a significant association between the acute magnetic resonance (MR) imaging of cervical SCI and neurological recovery of cervical SCI. We speculated that principal component analysis (PCA), a dimension reduction procedure, would detect clinically predictive patterns in complex MR imaging and predict neurological improvements assessed by the American Spinal Injury Association Impairment Scale (AIS) and Japanese Orthopaedic Association (JOA) score. METHODS We performed a retrospective analysis of 50 patients with cervical SCI who underwent early surgical decompression less than 48 h after the trauma. We analyzed 7 types of MR imaging assessments: axial grade assessed by the Brain and Spinal Injury Center score (BASIC), longitudinal intramedurallry lesion length, spinal cord signal intensity on T1 and T2 weighted image, maximum canal compromise, maximum spinal cord compression, Subaxial Cervical Spine Injury Classification System. PCA was applied on these multivariate data to identify factors that contribute to recovery after cervical SCI following surgery. AIS conversion was evaluated at 6 mo. RESULTS Nonlinear principal component (PC) evaluation detected 2 features of MR imaging. PCA revealed PC 1 (40.6%) explaining the intramedullary signal abnormalities that were negatively associated with postoperative AIS conversion. PC2 (18.5%) suggested extrinsic morphological variables, but did not predict outcomes. The BASIC score revealed the significant overall predictive value for AIS conversion at six months (AUC 0.86). This result suggested that the intramedullary signal abnormalities reflect delayed neurological improvements even after early surgical decompressions in patients with cervical SCI. CONCLUSION PCA could be a useful data-mining tool to show the complex relationships between acute MR imaging findings in cervical SCI. This study emphasized the importance of multivariable intramedullary MR imaging as clinical outcome predictors.

scholarly journals Spinal cord injury as a trigger to develop periodic leg movements during sleep: an evolutionary perspective

2012 ◽  
Vol 70 (11) ◽  
pp. 880-884 ◽  
Author(s):  
Susana Cristina Lerosa Telles ◽  
Rosana S. Cardoso Alves ◽  
Gerson Chadi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Pattern Generator ◽  
Periodic Limb Movement ◽  
American Spinal Injury Association ◽  
Evolutionary Perspective ◽  
Periodic Leg Movements ◽  
Cord Injury ◽  
Leg Movements

The primary trigger to periodic limb movement (PLM) during sleep is still unknown. Its association with the restless legs syndrome (RLS) is established in humans and was reported in spinal cord injury (SCI) patients classified by the American Spinal Injury Association (ASIA) as A. Its pathogenesis has not been completely unraveled, though recent advances might enhance our knowledge about those malfunctions. PLM association with central pattern generator (CPG) is one of the possible pathologic mechanisms involved. This article reviewed the advances in PLM and RLS genetics, the evolution of CPG functioning, and the neurotransmitters involved in CPG, PLM and RLS. We have proposed that SCI might be a trigger to develop PLM.

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