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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Data availability
The data that supports the findings of this study are available from EMSCI but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publically available. Data are however available from the authors upon reasonable request and with permission of EMSCI.
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EB was responsible for designing the study, screening literature, extracting and analyzing data, interpreting results, creating tables, and writing the paper. HvdM was responsible for the data collection (Radboud University Medical Center), designing the study, and writing the paper. AC is Principal Investigator for the EMSCI study (data collection) and provided feedback on the paper. DM was responsible for the data collection (BG Unfallklinik Murnau) and provided feedback on the paper. RA was responsible for the data collection (Krankenhaus Hohe Warte Bayreuth) and provided feedback on the paper. NW was responsible for the data collection (Spinal Cord Injury Center, Heidelberg University Hospital) and provided feedback on the paper. RR was responsible for the data collection (Spinal Cord Injury Center, Heidelberg University Hospital) and provided feedback on the paper. JK was responsible for the data collection (Motol Hospital, Prague) and provided feedback on the paper. AdH was responsible for the statistical part of this study, designing the figures and writing the statistical part in the methodology section of the paper. JK is expert in analyzing EMSCI data, gave statistical advice, and gave feedback on the paper. AH was responsible for the data collection (Radboud University Medical Center), designing the study, and provided feedback on the paper. RB was responsible for the study design, contributed to writing the paper, analyzing data, and provided feedback on the paper.
EMSCI participants and investigators
Yorck-Bernhard Kalke11, Jesus Benito12, Joan Vidal12, Klaus Rohl13, Carl Fürstenberg14, Djamel Bensmail15, Marion Saur16, Thomas Meiners17, Michael Baumberger18, Angel Gil-Agudo19, Renate Meindl20, Giorgio Scivoletto21, Herbert Resch22, Stephanie Aschauer-Wallner22, Oswald Marcus23, Mariel Purcell24, Andreas Badke25, Xavier Jordan26, Roland Thietje27, Kerstin Anders28, H.S. Chhabra29
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Brouwers, E.M.J.R., Meent, H.v.d., Curt, A. et al. Recovery after traumatic thoracic- and lumbar spinal cord injury: the neurological level of injury matters. Spinal Cord 58, 980–987 (2020). https://doi.org/10.1038/s41393-020-0463-1
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DOI: https://doi.org/10.1038/s41393-020-0463-1
