Predictors of neurological recovery after traumatic thoracolumbar spinal cord injury.

Abstract

Background: Traumatic thoracolumbar spinal cord injury (SCI) can result in significant neurological disability, but has been shown to have a wide spectrum of recovery in patients who have seemingly similar injuries. A clinical, imaging, and treatment based prediction could enhance the prognosis and surgical planning and contribute to personalizing rehabilitation. Aim: To identify factors associated with neurological recovery after traumatic thoracolumbar spinal cord injury and to obtain independent predictors of neurological recovery at 6-months follow up. Methods: A retrospective observational cohort study of adult patients with traumatic thoracolumbar SCI treated at a tertiary-care hospital. Demographic data, mechanism and degree of injury, American Spinal Injury Association Impairment Scale (AIS) grade, MRI results, timing of surgical decompression, associated injuries, and neurological status at follow-up were assessed. The primary outcome of neurological recovery was improvement in at least one AIS grade at 6 months. Univariate analysis was carried out, and the independent predictors of recovery were identified using multivariable logistic regression. Results: A total of 112 patients were included, with a mean age of 38.4 ± 13.7 years; 82 (73.2%) were male. 51 patients (45.5%) showed an improvement of one or more AIS grade at 6 months. Neurological recovery was more prevalent in patients with incomplete baseline injury (AIS B–D), early decompression (≤24 hours) and no intramedullary hemorrhage, or in the patients with the shorter duration of spinal cord edema on initial MRI. Neurological improvement was independently predicted by incomplete baseline AIS grade (adjusted odds ratio [aOR] 4.62), decompression within 24 hours (aOR 2.48), and when the IH was absent (aOR 2.71), while increasing age had a negative association with probability of neurological improvement. Conclusion: Neurologic completeness at time of injury, time for decompression, MRI characteristics, and age seem to be significant factors in neurologic recovery for traumatic thoracolumbar SCI. A multimodal assessment, therefore, could contribute to the accuracy of prognosis and individual treatment and rehabilitation planning, especially at an early stage.