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Multicenter Study
. 2020 Sep;58(9):980-987.
doi: 10.1038/s41393-020-0463-1. Epub 2020 May 5.

Recovery after traumatic thoracic- and lumbar spinal cord injury: the neurological level of injury matters

Eveline M J R Brouwers  1 , Henk van de Meent  2 , Armin Curt  3 , Doris D Maier  4 , Rainer F Abel  5 , Norbert Weidner  6 , Rüdiger Rupp  6 , Jiri Kriz  7 , Anton F J de Haan  8 , John K Kramer  9 , Allard J F Hosman  10 , Ronald H M A Bartels  11 ; EMSCI participants and investigators
Collaborators, Affiliations
Multicenter Study

Recovery after traumatic thoracic- and lumbar spinal cord injury: the neurological level of injury matters

Eveline M J R Brouwers et al. Spinal Cord. 2020 Sep.

Abstract

Study design: Multicenter prospective cohort.

Objective: To discern neurological- and functional recovery in patients with a traumatic thoracic spinal cord injury (TSCI), conus medullaris syndrome (CMS), and cauda equina syndrome (CES).

Setting: Specialized spinal cord injury centers in Europe.

Method: Lower extremity motor score (LEMS) and spinal cord independent measure (SCIM) scores from patients with traumatic TSCI, CMS, and CES were extracted from the EMSCI database. Scores from admittance and during rehabilitation at 1, 3, 6, and 12 months were compared. Linear mixed models were used to statistically analyse differences in outcome, which were corrected for the ASIA Impairment Scale (AIS) in the acute phase.

Results: Data from 1573 individuals were analysed. Except for the LEMS in patients with a CES AIS A, LEMS, and SCIM significantly improved over time for patients with a TSCI, CMS, and CES. Irrespectively of the AIS score, recovery in 12 months after trauma as measured by the LEMS showed a statistically significant difference between patients with a TSCI, CMS, and CES. Analysis of SCIM score showed no difference between patients with TSCI, CMS, or CES.

Conclusion: Difference in recovery between patients with a traumatic paraplegia is based on neurological (motor) recovery. Regardless the ceiling effect in CES patients, patients with a mixed upper and lower motor neuron syndrome (CMS) showed a better recovery compared with patients with a upper motor neuron syndrome (TSCI). These findings enable stratifications of patients with paraplegia according to the level and severity of SCI.

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References

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    1. Brouwers E, van de Meent H, Curt A, Starremans B, Hosman A, Bartels R. Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review. Spinal Cord. 2017. https://doi.org/10.1038/sc.2017.54 .
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    1. Mauffrey C, Randhawa K, Lewis C, Brewster M, Dabke H. Cauda equina syndrome: an anatomically driven review. Br J Hosp Med. 2008;69:344–7. - DOI

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