A multi-analyte blood test for acute spinal cord injury.

Functional outcome following spinal cord injury: Significance of motor-evoked potentials and ASIA scores

Retrospective observational cohort study. We explored the relationship between diffusion tensor imaging (DTI) parameters and prognosis in patients with acute traumatic cervical spinal cord injury (ATCSCI). DTI has been used to diagnose spinal cord injury; nevertheless, its role remains controversial. We analyzed retrospectively 24 patients with ATCSCI who were examined using conventional T2-weighted imaging and DTI. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were recorded at the injured site. Diffusion tensor tractography (DTT) was used to measure the spinal cord white matter fiber volume (MWFV). American Spinal Injury Association (ASIA) grades were recorded. Correlations between DTI parameters and ASIA scores were evaluated using Spearman correlation coefficients. FA values at injured sites were significantly lower than those of the control group, whereas ADC values in injured and control groups were not significantly different. DTT revealed that ATCSCI could be divided into four types: Type A1-complete rupture of spinal cord white matter fiber (MWF); Type A2-partial rupture of MWF; Type B-most MWF retained with severe compression or abnormal fiber conduction direction; and Type C-MWF basically complete with slight compression. Preoperative physical examinations revealed complete injury (ASIA A) in patients with A1 (n = 4) and A2 (n = 4). The ASIA grades or scores of A2 were improved to varying degrees, whereas there was no significant improvement in A1. FA values and MWFV of ASIA B, C, and D were significantly higher than those of ASIA A. FA and MWFV were correlated with ASIA motor score preoperatively and at final follow-up. We propose a classification for the severity of ATCSCI based on DTI and DTT that may explain why some patients with ASIA A recover, whereas others do not.Level of Evidence: 4.

The strong correlation between evoked potentials (EPs) and American Spinal Injury Association (ASIA) scores in individuals with spinal cord injury (SCI) suggests that EPs may serve as reliable predictive markers for rehabilitation progress. Numerous studies have confirmed a relationship between variations in somatosensory evoked potentials (SSEPs) and ASIA scores, especially in the early stages of SCI. Machine learning’s (ML’s) increasing importance in medicine is driven by the growing availability of health data and improved algorithms. It enables the creation of predictive models for disease diagnosis, progression prediction, personalized treatment, and improved healthcare efficiency. Data-driven approaches can significantly improve patient care, reduce costs, and facilitate personalized medicine. The meticulous analysis of medical data is crucial for timely disease identification, leading to effective symptom management and appropriate treatment. This study applies artificial intelligence to identify predictors of SCI progression, as measured by the disability index, ASIA impairment scale (AIS), and final motor recovery. We aim to clarify the prognostic role of electrophysiological testing (SSEPs, MEPs, and nerve conduction studies (NCSs)) in SCI. We analyzed data from a medical database of 123 records. We developed an ML-based intelligent system, utilizing ensemble algorithms combining decision trees and neural network approaches, to predict SCI recovery. Our evaluation showed SEP accuracies of 90% for motor recovery prediction and 80% for AIS scale determination, comparable to full electrophysiology evaluation accuracies of 93% and 89%, respectively, and generally superior results compared to MEP and NCS results. EPs emerged as the best predictors, comparable to a comprehensive electrophysiology assessment, significantly improving accuracy compared to clinical findings alone. An electrophysiological assessment, when available, increased overall accuracy for final motor recovery prediction to 93% (from a maximum of 75%) and, for ASIA score determination, to 89% (from a maximum of 66%). Further validation is needed with a larger dataset. Future research should validate that sensory electrophysiology assessment is a less expensive, portable, and simpler alternative to other prognostic tests and more effective than clinical assessments, like the AIS, biomarker for SCI, and personalized rehabilitation planning.

In prior analyses of the effectiveness of methylprednisolone for the treatment of patients with acute traumatic spinal cord injuries (TSCIs), the prognostic importance of patients' neurological levels of injury and their baseline severity of impairment has not been considered. Our objective was to determine whether methylprednisolone improved motor recovery among participants in the Rick Hansen Spinal Cord Injury Registry (RHSCIR).We identified RHSCIR participants who received methylprednisolone according to the Second National Spinal Cord Injury Study (NASCIS-II) protocol and used propensity score matching to account for age, sex, time of neurological exam, varying neurological level of injury, and baseline severity of neurological impairment. We compared changes in total, upper extremity, and lower extremity motor scores using the Wilcoxon signed-rank test and performed sensitivity analyses using negative binomial regression.Forty-six patients received methylprednisolone and 1555 received no steroid treatment. There were no significant differences between matched participants for each of total (13.7 vs. 14.1, respectively; p=0.43), upper extremity (7.3 vs. 6.4; p=0.38), and lower extremity (6.5 vs. 7.7; p=0.40) motor recovery. This result was confirmed using a multivariate model and, as predicted, only cervical (C1–T1) rather than thoracolumbar (T2–L3) injury levels (p<0.01) and reduced baseline injury severity (American Spinal Injury Association [ASIA] Impairment Scale grades; p<0.01) were associated with greater motor score recovery. There was no in-hospital mortality in either group; however, the NASCIS-II methylprednisolone group had a significantly higher rate of total complications (61% vs. 36%; p=0.02)NASCIS-II methylprednisolone did not improve motor score recovery in RHSCIR patients with acute TSCIs in either the cervical or thoracic spine when the influence of anatomical level and severity of injury were included in the analysis. There was a significantly higher rate of total complications in the NASCIS-II methylprednisolone group. These findings support guideline recommendations against routine administration of methylprednisolone in acute TSCI.

In this study the motor scores of 62 consecutive acute spinal cord-injured patients were retrospectively reviewed. The reliability of the American Spinal Injury Association and National Acute Spinal Cord Injury Study motor scores, compared with the conventional motor scores, was retrospectively assessed. The reliability of the American Spinal Injury Association and National Acute Spinal Cord Injury Study scores has not as yet been confirmed. Sixty-two consecutive adult patients admitted within 7 days of acute spinal cord injury between April, 1983, and September, 1992, were evaluated. The motor deficit percentage and the motor recovery percentage of each of the American Spinal Injury Association and the National Acute Spinal Cord Injury Study motor scores were compared with those of the conventional motor score. From the initial and final motor score, the motor deficit percentage and motor recovery percentage were calculated. There were 38 patients with cervical and thoracic lesions, 12 patients with dorso-lumbar lesions, and 12 patients with lower lumbar lesions. The average follow-up period was 41 months. Both the American Spinal Injury Association motor score and the National Acute Spinal Cord Injury Study motor score were representative of the conventional motor score for the evaluation of the motor deficit percentage and the motor recovery percentage in all levels (P < 0.0001). The differences in all correlation coefficients between the American Spinal Injury Association motor score and the National Acute Spinal Cord Injury Study motor score were not statistically significant in all levels and in every group. The American Spinal Injury Association and National Acute Spinal Cord Injury Study motor scores can both be used for the neurological quantification of motor deficit and motor recovery.

Aim: With only limited treatment options in acute spinal cord injury (SCI) currently available, we aimed to investigate the effect of progesterone on neurological recovery after acute SCI. Material and Methods: Randomised double-blind placebo-controlled single-centre trial on 128 patients of acute SCI (within 24 hours of injury) was conducted at our institute with the approval of the ethics committee. Eligible patients were allocated to the progesterone or placebo arm. Of 133 eligible patients, one from the placebo arm expired in the acute phase while 4 were lost to follow-up, leaving 128 patients in the study.68 patients remained in the progesterone arm and 60 in placebo. Patients in the progesterone arm received intramuscular progesterone while those in the placebo received intramuscular isotonic saline twice daily for five consecutive days. Neurological assessment was done at baseline, day six, first and sixth months using the American Spinal Injury Association (ASIA) score and motor and sensory actual neural recovery (ANR) scores. Results: Baseline characteristics were comparable between the groups. At the end of six months, significant improvement occurred in motor and sensory ASIA scores in the progesterone arm (p=&lt;0.01). Compared with the placebo, motor scores were significantly higher in the progesterone arm at 6 months while sensory scores were not (p= &lt;0.01 and p= 0.59 respectively). Additionally, at 6 months, motor ANR was significantly higher in the progesterone arm vs placebo (p=&lt;0.01 vs 0.65). Early progesterone administration (within six hours of injury) was associated with significantly higher motor and sensory ASIA scores at 6 months (p= &lt;0.01vs0.04 respectively). Conclusion: Administration of intramuscular progesterone within 24 hours in acute SCI was associated with better neurological recovery. Further multicentric studies are required to shed more light on the strength and consistency of this improved outcome.

Retrospective. With approximately 10,000 new spinal cord injury (SCI) patients in the United States each year, predicting public health outcomes is an important public health concern. Combining all regions of the spine in SCI trials may be misleading if the lumbar and sacral regions (conus) have a neurologic improvement at different rates than the thoracic or thoracolumbar spinal cord. Over a 10-year period between January 1995 to 2005, 1746 consecutive spinal injured patients were seen, evaluated, and treated through a level 1 trauma referral center. A retrospective analysis was performed on 150 patients meeting the criteria of T4 to S5 injury, excluding gunshot wounds. One-year follow-up data were available on 95 of these patients. Contingency table analyses (chi-squared statistics) and multivariate logistic regression. Variables of interest included level of injury, initial American Spinal Injury Association (ASIA), age, race, and etiology. A total of 92.9% of lumbar (conus) patients neurologically improved one ASIA level or more compared with 22.4% of thoracic or thoracolumbar spinal cord-injured patients. Only 7.7% of ASIA A patients showed neurologic improvement, compared with 95.2% of ASIA D patients; ASIA B patients demonstrated a 66.7% improvement rate, whereas ASIA C had a 84.6% improvement rate. When the two effects were considered jointly in a multivariate analysis, ASIA A and thoracic/thoracolumbar patients had only a 4.1% rate of improvement, compared with 96% for lumbar (conus) and incomplete patients (ASIA B-D) and 66.7% to 72.2% for the rest of the patients. All of these relationships were significant to P < 0.001 (chi-square test). There was no link to age or gender, and race and etiology were secondary to region and severity of injury. Thoracic (T4-T9) SCIs have the least potential for neurologic improvement. Thoracolumbar (T10-T12) and lumbar (conus) spinal cord have a greater neurologic improvement rate, which might be related to a greater proportion of lower motor neurons. Thus, defining the exact region of injury and potential for neurologic improvement should be considered in future clinical trial design. Combining all anatomic regions of the spine in SCI trials may be misleading if different regions have neurologic improvement at different rates. Over a ten-year period, 95 complete thoracic/thoracolumbar SCI patients had only a 4.1% rate of neurologic improvement, compared with 96.0% for incomplete lumbar (conus) patients and 66.7% to 72.2% for all others.

The optimal management of acute spinal cord injuries remains to be defined. The authors prospectively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury. According to the Intensive Care Unit protocol, all patients were managed by using Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated. Intravenous fluids, colloid, and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg. Surgery was performed for decompression and stabilization, and fusion in selected cases. Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessments and functional ability evaluations. Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association (ASIA) grade at the last follow-up review. Thirty percent regained the ability to walk and 20% had return of bladder function 1 year postinjury. Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade. Approximately 10% of the patients regained the ability to walk and had return of bladder function. As of the 12-month follow-up review, 92% of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status. Ninety-two percent regained the ability to walk and 88% regained bladder function. Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury. Eighty-eight percent were able to walk and 63% had return of bladder function. The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to, and/or distinct from, any potential benefit provided by surgery. Early and aggressive medical management (volume resuscitation and blood pressure augmentation) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma.

Predicting the risk and severity of acute spinal cord injury after a minor trauma to the cervical spine

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Acute spinal cord injury (SCI) after a minor trauma to the cervical spine has been reported in patients without preceding neurologic symptoms. Spinal canal stenosis may be the reason for the discrepancy between the severity of the injury and that of the trauma. The objective of this study was to investigate MRI parameters of the cervical spine in patients suffering from acute SCI and to investigate the use of these parameters for predicting the risk and severity of acute cervical SCI after a minor trauma to the cervical spine. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Retrospective radiological study was conducted in Meenakshi Medical College and Research Institute Kanchipuram with fifty patients suffering from acute cervical SCI and 130 patients showing no neurologic deficits after a minor trauma to the cervical spine. The following calculations were performed using measurements from MR images the spinal canal to vertebral body ratio, the space available for the cord, and the canal-to-cord ratio. SPSS version 21 was used for analysis.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All investigated MR image parameters in the SCI group were significantly (p&amp;lt;001) smaller compared with the control group. However, there was no significant difference in any parameter among the different American spinal injury association impairment score groups. A cut-off value of 8.0 mm for the minimal sagittal disc-level canal diameter yielded the largest positive predictive value and likelihood ratio for predicting SCI.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Patients at risk of acute SCI after a minor trauma to the cervical spine can be identified by applying a disc-level canal diameter cut-off value measured on MR images. Supplementary factors to the radiological characteristics of the spinal canal affect the severity of acute SCI after trauma.&lt;/p&gt;

Objective To investigate the therapeutic effects of electromyography biofeedback (EMGBF) on motor and psychological function in patients with spinal cord injury (SCI).Methods Seventy SCI patients were randomly divided into research and control groups with 35 patients in each.In addition to conventional rehabilitation,the patients in the research group received EMGBF training while those in the control group were treated with medium frequency electrotherapy.To evaluate the patients' self confidence and motor function of their paralyzed limbs,Rosenberg's self-esteem scale (RSES) and American Spinal Injury Association (ASIA) locomotor function scoring were performed before and six weeks after the interventions in both groups of patients.The changes of EMG of the quadriceps,hamstring and anterior tibial muscles of both groups in maximum contraction were also observed before and six weeks after the interventions.Results There were no significant differences in the RSES scores or ASIA locomotor function results between the groups before the interventions.ASIA locomotor function evaluation scores increased significantly in both groups after the interventions,with significantly better results in the research group.The RSES scores in the research group also improved significantly after the interventions,and RSES scoring and ASIA scoring were positively correlated in those patients.But no significant improvement in average RSES scores was found in the control group.The muscle contraction EMG amplitudes also increased significantly in patients of the research group after the interventions.Conclusions EMGBF training can enhance patients' self-confidence,which helps patients with SCI improve their motor functions. Key words: Spinal cord injury; Electromyographic biofeedback training; Rosenberg self-esteem scale; Medium frequency electrotherapy

BackgroundThe proper timing for surgery in patients with acute spinal cord injury is controversial. This study was conducted to detect if there is an advantage in early (within the first 4 hours after trauma) compared to late (between 4 and 24 hours after trauma) surgery on neurological outcome.MethodsIn this single institution prospective cohort study, data were analyzed from 51 spinal cord injured patients with an average age of 43.4 (±19.2) years. The influence of early (29 patients within the first 4 hours) as opposed to late (22 patients between 4 and 24 hours) decompression was evaluated by comparing data for neurological outcome. Patients of the study collectively suffered acute spinal fractures from C2 to L3 (cervical 39.2%, thoracic 29.4%, and lumbal 21.6%) or nonosseous lesions (9.8%). American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades were assessed at time of admission and 6 months after trauma or longer depending on the time of release. Surgical treatment included early stabilization and decompression within 24 hours.ResultsNo significant difference between improved neurological function, measured with the AIS, and an early or late surgery time can be seen (P=0.402). Furthermore, binary logistic regression shows no significant difference between sex or age, and AIS improvement as possible confounders.ConclusionIn our study, all patients with spinal cord injury were treated with spine stabilization and decompression within the first 24 hours after trauma. Surgical decompression within the first 4 hours after trauma was not associated with improved neurological outcome compared to treatment between 4 and 24 hours. In a clinical context, this indicates that there is a time frame of at least 1 day in which optimal care is possible.

Objective To observe the clinical efficacy of screwing via the paraspinal muscle approach plus single-segment laminectomy decompression via the dorsomedian approach for thoracolumbar fractures complicated with spinal cord injury. Methods From February 2013 to September 2015, 21 patients with thoracolumbar fracture plus spinal cord injury were treated at our department. They were 15 men and 6 women, aged from 20 to 54 years (average, 33.2 years). The injury was located at T11 in 2 cases, at T12 in 6, at T12 and L1 in one, at L1 in 7 and at L2 in 5; the injury was rated as grade A in one case, grade B in 3 cases, grade C in 8 and grade D in 9 according to the American Spinal Injury Association (ASIA) grading system. Al the patients were treated by screwing via the paraspinal muscle approach followed by single-segment laminectomy decompression via the dorsomedian approach. Results The operation time averaged 116.1+24.5 minutes and the amount of bleeding 580.7+80.8 mL. At 3 days after surgery and the final follow-up, their visual analogue scale (VAS) score, anterior vertebral height and cobb angle were significantly improved in comparison with the preoperative values(P< 0.05). At the final follow-up, their Japanese Orthopaedic Association (JOA) the score were also significantly better than the preoperative one (P< 0.05), giving 12 excellent cases, 6 good ones and 3 fair ones. Their ASIA grading at the final follow-up showed one case of grade B, 2 cases of grade C, 6 cases of grade D and 12 cases of grade E. Conclusion Treatment of thoracolumbar fractures complicated with spinal cord injury by crewing via the paraspinal muscle approach plus single-segment laminectomy decompression via the dorsomedian approach is a good way due to limited invasion, less bleeding, simple operation, excellent reduction, reliable fixation and rapid recovery. Key words: Spinal fractures; Fracture fixation, internal; Bone nails; Paraspinal muscle approach; Median approach

Diagnostic and Predictive Value of Novel Inflammatory Markers of the Severity of Acute Traumatic Spinal Cord Injury: A Retrospective Study

To determine the clinical efficacy of monosialotetrahexosylganglioside (GM1) combined with methylprednisolone in the treatment of spinal cord injury (SCI). An observational study. Place and Duration of the Study: Department of Orthopaedics, Baoding No.1 Central Hospital, Baoding, Hebei, China, from January 2018 to June 2021. A total of 80 patients with SCI were divided into control and observation groups according to treatment methods, the control group receiving methylprednisolone treatment and the observation group receiving methylprednisolone combined with GM1. The effective rate of treatment, time of normal muscle strength recovery, walk on the ground, and hospital stay were compared. The changes in the American Spinal Injury Association (ASIA) score, activity of daily living (ADL), serum inflammatory factors, oxidative stress factor levels, and adverse reactions were recorded. The effective rate of clinical efficacy of the observation group was 92.50%, surpassing the control group's which was 75.00% (χ2= 4.501, p = 0.034). The observation group had a shorter recovery time for muscle strength, walking time, and hospital stay compared to the control group (p <0.05). After treatment, the ADL scores of both groups were higher than before treatment, and the degree of increase in the observation group was higher than the control group (p <0.05). The levels of serum tumour necrosis factor-α (TNF-α) and interleukin-8 (IL-8) for all patients were significantly reduced, with the observation group showing a more significant decrease (p <0.05). There was a notable increase in glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) levels in both groups, while the levels of malondialdehyde (MDA) decreased significantly. GSH-Px, SOD, and MDA levels were significantly greater in the observation group (p <0.05). The combination of methylprednisolone and MG1 treatment of SCI can significantly reduce the inflammatory response and improve clinical efficacy. Spinal cord injury, Ganglioside, Methylprednisolone, Inflammatory indicators, Oxidative stress.