Uraz rdzenia kręgowego – Rokowania, prognozy i postęp choroby

Uraz rdzenia kręgowego
Rokowania, prognozy i postęp choroby

Dokładne przewidywanie wyników funkcjonalnych po urazie rdzenia kręgowego (URK) opiera się przede wszystkim na początkowym stanie neurologicznym ocenianym według skali AIS (American Spinal Injury Association Impairment Scale), który jest najsilniejszym predyktorem zarówno poprawy neurologicznej, jak i funkcjonalnej. Inne istotne czynniki prognostyczne to początkowy wynik motoryczny ASIA (AMS ≥50 wskazuje na lepsze rokowanie), wiek pacjenta (starszy wiek koreluje z gorszymi wynikami), charakterystyka obrazu MRI (obrzęk i krwotok rdzenia predysponują do gorszych rezultatów), obecność i zakres strefy częściowego zachowania czucia (ZPP), poziom urazu oraz amplituda CMAP nerwu łokciowego w urazach szyjnych. Wczesna dekompresja chirurgiczna (≤6 godzin od urazu) oraz utrzymanie średniego ciśnienia tętniczego (MAP) ≥85 mmHg przez 7 dni poprawiają rokowanie neurologiczne. Modele predykcyjne, w tym regresja liniowa, logistyczna oraz algorytmy uczenia maszynowego (np. XGBoost), wykazują wysoką dokładność (np. AUC ~0,93, dokładność testowa 73,6%) w przewidywaniu wyników funkcjonalnych i neurologicznych.

Prognoza urazu rdzenia kręgowego (uraz rdzenia kręgowego)

Czynniki prognostyczne neurologicznego powrotu do zdrowia
Konwersja stopnia AIS jako wskaźnik prognostyczny
Modele predykcyjne w urazie rdzenia kręgowego
Rokowanie dotyczące odzyskania funkcji chodzenia
Czynniki wpływające na przeżycie po urazie rdzenia kręgowego
Wpływ czynników funkcjonalnych na powrót do zdrowia
Rokowanie w zakresie funkcji pęcherza i jelita
Nowoczesne podejścia do prognozowania wyników

Podsumowanie czynników prognostycznych

Kolejne rozdziały

Prognoza urazu rdzenia kręgowego (uraz rdzenia kręgowego)

Dokładne przewidywanie wyników funkcjonalnych po urazie rdzenia kręgowego (URK) jest kluczowym elementem opieki klinicznej, który pozwala na właściwe poradnictwo dla pacjentów i ich rodzin, planowanie rehabilitacji oraz stratyfikację ryzyka w badaniach klinicznych. Prognozy oparte na czynnikach klinicznych i obrazowych umożliwiają lekarzom dostarczanie realistycznych oczekiwań dotyczących powrotu do zdrowia neurologicznego i funkcjonalnego.¹² Zdolność przewidywania wyników ma fundamentalne znaczenie dla oceny wartości nowych terapii i prowadzenia badań klinicznych.³ Rosnąca wiedza na temat nowych i pojawiających się czynników prognostycznych może pomóc w ukierunkowaniu wysiłków na ukierunkowane interwencje terapeutyczne, które mogą przynieść obiecujące rezultaty.

Czynniki prognostyczne neurologicznego powrotu do zdrowia

Początkowy stan neurologiczny po urazie, zgodnie ze standardami Międzynarodowej Klasyfikacji Neurologicznej Urazu Rdzenia Kręgowego (ISNCSCI), jest najlepszym wskaźnikiem prognostycznym funkcjonalnego powrotu do zdrowia po URK.⁴ Początkowe badanie neurologiczne determinuje rokowanie w URK, a szansa na chodzenie po URK może być dokładnie przewidziana na podstawie danych demograficznych i badania klinicznego.⁵

Do głównych czynników prognostycznych powrotu do zdrowia neurologicznego należą:

Początkowy stopień uszkodzenia według skali AIS (American Spinal Injury Association Impairment Scale) – silny predyktor zarówno poprawy neurologicznej, jak i funkcjonalnej⁶⁷
Początkowy wynik motoryczny ASIA (AMS) – pacjenci z wynikiem ≥50 mają lepsze rokowanie funkcjonalne⁸⁹
Wiek – starszy wiek wiąże się z gorszymi wynikami funkcjonalnymi¹⁰¹¹
Charakterystyka sygnału w rezonansie magnetycznym (MRI) wskazująca na obrzęk lub krwotok rdzenia kręgowego – predyktor gorszego wyniku funkcjonalnego¹²
Obecność i zakres strefy częściowego zachowania czucia (ZPP)¹³
Poziom urazu – wyższy poziom urazu (C0-C3) może być związany z lepszą poprawą w skali AIS¹⁴
Amplituda złożonego potencjału czynnościowego (CMAP) nerwu łokciowego – niezależny predyktor dobrego wyniku po roku w urazach rdzenia kręgowego w odcinku szyjnym¹⁵

Konwersja stopnia AIS jako wskaźnik prognostyczny

Konwersja stopnia AIS jest ważnym wskaźnikiem prognostycznym powrotu do zdrowia neurologicznego. Ogólnie rzecz biorąc, około 50% pacjentów z urazowym URK wykazuje konwersję stopnia AIS.¹⁶ Według literatury, konwersja z całkowitego do niecałkowitego URK szacowana jest na zakres od 4 do 25%.¹⁷

Badanie przeprowadzone przez grupę badawczą Spine Trauma Study Group wykazało, że 6 miesięcy po urazie, wczesna dekompresja chirurgiczna była związana z 2,8-krotnie większą szansą na poprawę o 2 stopnie w skali AIS.¹⁸ Badanie STASCIS udokumentowało, że dekompresja chirurgiczna w ciągu 6 godzin od urazu prowadzi do poprawy o 1 stopień w skali ASIA u około 70% pacjentów.¹⁹

Istnieją dowody na poziomie III, że utrzymywanie średniego ciśnienia tętniczego (MAP) ≥85 mmHg przez 7 dni u pacjentów z urazem rdzenia kręgowego poprawia wynik neurologiczny.²⁰

Modele predykcyjne w urazie rdzenia kręgowego

Opracowano różne modele predykcyjne do prognozowania wyników po urazie rdzenia kręgowego:

Model liniowy przewidujący wynik motoryczny FIM wykazał współczynnik R-kwadrat wynoszący 0,52 w oryginalnym zbiorze danych i 0,52 (95% CI 0,52, 0,53) w 200 próbach bootstrap²¹
Model logistyczny wykazał pole pod krzywą wynoszące 0,93 w oryginalnym zbiorze danych i 0,92 (95% CI 0,92, 0,93) w próbach bootstrap, wskazując na doskonałą dyskryminację predykcyjną²²
Modele nieliniowe oparte na algorytmie XGBoost (Extreme Gradient Boost) okazały się lepsze niż tradycyjne modele regresji liniowej w przewidywaniu wyników funkcjonalnych²³²⁴
Modele uczenia maszynowego wykazały 73,6% dokładność testową w przewidywaniu poprawy AIS²⁵

Rokowanie dotyczące odzyskania funkcji chodzenia

Stopień AIS przy początkowym badaniu jest uważany za podstawę do przewidywania powrotu funkcji chodzenia.²⁶ Ogólny wskaźnik powrotu do chodzenia u pacjentów z początkowym stopniem B wynosi około 33%.²⁷ Pacjenci z początkowym stopniem C mają lepsze rokowanie dotyczące powrotu do chodzenia niż pacjenci z niecałkowitym czuciowo, ale całkowitym ruchowo urazem, z ogólnym wskaźnikiem powrotu wynoszącym około 75%.²⁸

W jednym z badań 51% pacjentów było chodzących podczas obserwacji kontrolnej, przy czym 22% korzystało z pomocy do chodzenia.²⁹ Aktualny stan wiedzy w tej dziedzinie stanowi model regresji logistycznej opracowany przez van Middendorp i wsp., który zapewnia przewidywanie zdolności chodzenia danej osoby.³⁰

Czynniki wpływające na przeżycie po urazie rdzenia kręgowego

Czynniki niezależnie przewidujące zmniejszone przeżycie po URK obejmują:

Zwiększony wiek (+10 lat; współczynnik ryzyka (HR (95% CI)), 1,6 (1,4-1,7))³¹
Płeć męska (1,3 (1,0-1,6))³²
Niższy wynik FIM przy wypisie (10 punktów; 1,3 (1,2-1,3))³³
Wszystkie nieurazowe przyczyny URK³⁴

Przeżycie po URK różni się w zależności od przyczyny, przy czym przeżycie jest lepsze po urazowym URK niż po nieurazowym URK.³⁵

Wpływ czynników funkcjonalnych na powrót do zdrowia

Początkowy wynik motoryczny (MS), początkowy indeks Barthel (BI), początkowy wynik w skali SCIM (Spinal Cord Independence Measure), wiek i poziom URK okazały się statystycznie istotnymi predyktorami poprawy klinicznej podczas wczesnej rehabilitacji neurologicznej (ENR), wyrażonej przez osiąganie przez pacjentów wyższych wartości w skalach funkcjonalnych.³⁶

Wyższy początkowy wynik motoryczny może zwiększyć szanse na większą i szybszą poprawę funkcjonalną podczas wczesnej rehabilitacji neurologicznej.³⁷ Parametry funkcjonalne oceniane u pacjentów z URK są jednymi z licznych możliwych predyktorów poprawy klinicznej.³⁸

Rokowanie w zakresie funkcji pęcherza i jelita

Ważnym następstwem URK jest utrata kontroli nad pęcherzem i jelitem.³⁹ Głównym czynnikiem predykcyjnym powrotu funkcji pęcherza (normalne oddawanie moczu) wydaje się być stan neurologiczny w momencie pierwszego badania, szczególnie w odniesieniu do stopnia AIS: żaden z pacjentów ze stopniem AIS A przy przyjęciu nie odzyskuje wolicjonalnego oddawania moczu.⁴⁰

Nowoczesne podejścia do prognozowania wyników

Rozwój modeli predykcyjnych opartych na danych dotyczących szczegółowego segmentarnego powrotu do zdrowia motorycznego dla wszystkich segmentów rdzeniowych od poziomu uszkodzenia w kierunku najniższych segmentów motorycznych poprawi projektowanie programów rehabilitacyjnych i czułość badań klinicznych.⁴¹

Nowe podejścia wykorzystujące nienadzorowane uczenie maszynowe oferują szczegółowe przewidywania powrotu do zdrowia neurologicznego i funkcjonalnego oparte na wysoce interpretowalnej koncepcji uczenia maszynowego.⁴² Te podejścia dostarczają pacjentom i lekarzom spersonalizowanej perspektywy dotyczącej powrotu do zdrowia neurologicznego i funkcjonalnego, w tym kwantyfikacji pewności przewidywania wynikającej z rozkładu w kohorcie referencyjnej.⁴³

Podsumowanie czynników prognostycznych

Kategoria czynników	Specyficzne czynniki	Wpływ na rokowanie
Kliniczne	Początkowy stopień AIS	Najsilniejszy predyktor poprawy neurologicznej i funkcjonalnej
	Początkowy wynik motoryczny ASIA (AMS)	Wynik ≥50 wiąże się z lepszym rokowaniem funkcjonalnym
	Strefa częściowego zachowania czucia (ZPP)	Większa ZPP wiąże się z lepszym rokowaniem
	Amplituda CMAP nerwu łokciowego	Niezależny predyktor dobrego wyniku po roku w urazach szyjnych
	Czas pobytu na OIT	Dłuższy pobyt wiąże się z mniejszym prawdopodobieństwem poprawy AIS
Demograficzne	Wiek	Starszy wiek wiąże się z gorszymi wynikami funkcjonalnymi
Demograficzne	Płeć	Płeć męska wiąże się z niższym wskaźnikiem przeżycia
Obrazowe	Obrzęk rdzenia kręgowego w MRI	Predyktor gorszego wyniku funkcjonalnego
Obrazowe	Krwotok rdzenia kręgowego w MRI	Predyktor gorszego wyniku funkcjonalnego
Terapeutyczne	Wczesna dekompresja chirurgiczna (≤6h)	Związana z lepszym wynikiem neurologicznym
Terapeutyczne	MAP ≥85 mmHg przez 7 dni	Poprawia wynik neurologiczny
Funkcjonalne	Początkowy indeks Barthel (BI)	Predyktor poprawy klinicznej podczas ENR
	Początkowy SCIM	Predyktor poprawy klinicznej podczas ENR
	Wynik FIM przy wypisie	Niższy wynik wiąże się ze zmniejszonym przeżyciem

Podsumowując, powrót do zdrowia neurologicznego i funkcjonalnego pacjentów z urazem rdzenia kręgowego może być wiarygodnie przewidziany na podstawie poziomu i ciężkości urazu.⁴⁴ Początkowe badanie neurologiczne jest najsilniejszym predyktorem, ale nowoczesne podejścia wykorzystujące uczenie maszynowe i szczegółowe wzorce funkcji motorycznych mogą dodatkowo poprawić dokładność prognozowania. Dokładna prognoza ma kluczowe znaczenie dla pacjentów, ich rodzin i pracowników służby zdrowia w planowaniu rehabilitacji i stawianiu realistycznych celów terapeutycznych.⁴⁵⁴⁶

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Materiały źródłowe

#1 An unsupervised machine learning approach to predict recovery from traumatic spinal cord injury | medRxiv
https://www.medrxiv.org/content/10.1101/2023.09.26.23295361.full
Neurological and functional recovery after traumatic spinal cord injury (SCI) is highly heterogeneous, challenging outcome predictions in rehabilitation and clinical trials. […] Patients and their families have critical questions regarding their prognosis of recovery and probable long-term disability to plan for their health-related, financial, and social future. Personalised outcome predictions could provide a more specific perspective and help guide physicians in their rehabilitation planning. […] The current state-of-the-art in the field is a logistic regression model by van Middendrop et al. that provided a prediction of an individuals walking ability. […] Our approach provides detailed predictions of neurological and functional recovery based on a highly interpretable unsupervised machine learning concept.
#2 Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury | Neurological Research and Practice | Full Text
https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-019-0017-1
In cervical spinal cord injury, the consideration of early ulnar nerve CMAP improves prognostic accuracy, which is of particular importance in patients with clinical grading uncertainties. […] Early and accurate prediction of neurological recovery is a major goal in the care of traumatic cervical spinal cord injury (SCI) for (1) providing patients with a realistic prognosis, (2) an effective and tailored rehabilitation plan and (3) the correct risk stratification in clinical trials. […] Within 4-week ulnar nerve axonal integrity is an independent predictor of good 1-year outcome. […] The prediction model consisting of baseline AIS and ulnar nerve CMAP amplitude is robust and inferable to other cervical SCI cohorts. […] The consideration of early ulnar nerve CMAP amplitudes improves prognostic accuracy of 1-year neurologic outcomes in cervical SCI patients. This could be of particular importance in patients who are difficult to grade clinically. Moreover, improved accuracy could prove significant for proper risk stratification in clinical trials.
#3 Outcome Prediction in Spinal Cord Injury: Myth or Reality – PubMed
https://pubmed.ncbi.nlm.nih.gov/32437998/
Objective: To identify the prognostic factors affecting the outcome of acute traumatic spinal cord injury (tSCI) and to provide updated recommendations on improving outcomes. […] The initial neurologic examination determines the prognosis in SCI. The chance of walking after SCI can be accurately predicted on the basis of demographic data and clinical examination. […] There is level III evidence that keeping mean arterial pressure (MAP) 85 for 7 days in patients with spinal cord injury improves neurologic outcome. […] The Spine Trauma Study Group showed that at 6 months after injury, early surgical decompression was associated with 2.8-fold increased odds of a 2-grade American Spinal Injury Association Impairment Scale improvement. […] The STASCIS trial documented that surgical decompression within 6 hours of injury leads to an improvement in about 70% of patients by 1 American Spinal Injury Association grade. […] Prognostic data in tSCI are fundamental to assess the value of new therapies and to undertake clinical trials. The increasing knowledge of new and emerging prognostic factors may assist us to direct our efforts toward focused therapeutic interventions, which may present a promising result.
#4
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
The initial neurological status following injury, as standardized in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) seems to be the best prognostic indicator of SCI functional recovery. […] Neurologic recovery is particularly important to patients, as the completeness or incompleteness of a lesion is one of the most relevant determinants of functional outcome. […] Several studies have assessed AIS grade conversion. Overall, approximately 50% of patients with traumatic SCI show a conversion of the AIS grade. […] An important prognostic factor for recovery is the presence and extent of a sensory zone of partial preservation (ZPP). […] The motor score improvement varied based on the initial AIS grade being greater for AIS B and C subjects than for AIS A and D subjects.
#5 Outcome Prediction in Spinal Cord Injury: Myth or Reality – PubMed
https://pubmed.ncbi.nlm.nih.gov/32437998/
Objective: To identify the prognostic factors affecting the outcome of acute traumatic spinal cord injury (tSCI) and to provide updated recommendations on improving outcomes. […] The initial neurologic examination determines the prognosis in SCI. The chance of walking after SCI can be accurately predicted on the basis of demographic data and clinical examination. […] There is level III evidence that keeping mean arterial pressure (MAP) 85 for 7 days in patients with spinal cord injury improves neurologic outcome. […] The Spine Trauma Study Group showed that at 6 months after injury, early surgical decompression was associated with 2.8-fold increased odds of a 2-grade American Spinal Injury Association Impairment Scale improvement. […] The STASCIS trial documented that surgical decompression within 6 hours of injury leads to an improvement in about 70% of patients by 1 American Spinal Injury Association grade. […] Prognostic data in tSCI are fundamental to assess the value of new therapies and to undertake clinical trials. The increasing knowledge of new and emerging prognostic factors may assist us to direct our efforts toward focused therapeutic interventions, which may present a promising result.
#6 Long-term outcome and predictors of neurological recovery in cervical spinal cord injury: a population-based cohort study | Scientific Reports
https://www.nature.com/articles/s41598-024-71983-2
The multivariable analysis predicting at least a one-step improvement in AIS revealed several significant predictors. […] Our analysis indicated that a longer stay in the ICU was associated with a decreased likelihood of AIS improvement. […] An association between a higher level of injury (C0C3) and improved AIS was seen. […] In summary, patients with less severe status at admission, particularly those with central cord syndrome, showed a higher likelihood for improvement in AIS scores, while extended ICU stays correlated with less favorable outcomes, potentially due to more severe injuries or complications arising from prolonged intensive care. […] Fifty-one percent of the patients were ambulatory at follow-up, with 22% using walking aids. […] The finding that old age was a negative prognostic factor may reflect a reduced recovery potential relating to senescence itself as well as to a greater degree of pre-existing comorbidities. […] This study highlights the importance of the initial injury severity for the long-term prognosis in cervical SCI, while it simultaneously reveals the recovery potential that exists even in severe cases.
#7 Spinal Cord Injury AIS Predictions Using Machine Learning | eNeuro
https://www.eneuro.org/content/10/1/ENEURO.0149-22.2022
The study used machine learning to predict The American Spinal Injury Association Impairment Scale (AIS) scores for newly injured spinal cord injury patients at hospital discharge time from hospital admission data. […] AIS scores and neurologic category at the time of admission were the best predictors of recovery. […] AIS scores on admission are highly predictive of patient outcomes when combined with patient demographic data. […] One key question among SCI patients is how the severity of their injury, as measured by the AIS, will improve or deteriorate during the course of SCI recovery. […] The analysis of feature importance serves two purposes. One is to verify the importance of AIS classification at the time of hospital admission as a critical feature, using a data-driven approach. The other purpose is to identify demographic features that also play a crucial role in determining recovery.
#8 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors – PubMed
https://pubmed.ncbi.nlm.nih.gov/22709268/
To improve clinicians’ ability to predict outcome after spinal cord injury (SCI) and to help classify patients within clinical trials, we have created a novel prediction model relating acute clinical and imaging information to functional outcome at 1 year. […] Better functional status was predicted by less severe initial American Spinal Injury Association (ASIA) Impairment Scale grade, and by an ASIA motor score 50 at admission. In contrast, older age and magnetic resonance imaging (MRI) signal characteristics consistent with spinal cord edema or hemorrhage predicted worse functional outcome. […] The linear model predicting FIM motor score demonstrated an R-square of 0.52 in the original dataset, and 0.52 (95% CI 0.52,0.53) across the 200 bootstraps. […] For the logistic model, the area under the curve was 0.93 in the original dataset, and 0.92 (95% CI 0.92,0.93) across the bootstraps, indicating excellent predictive discrimination. These models will have important clinical impact to guide decision making and to counsel patients and families.
#9 A functional outcome prediction model of acute traumatic spinal cord injury based on extreme gradient boost | Journal of Orthopaedic Surgery and Research | Full Text
https://josr-online.biomedcentral.com/articles/10.1186/s13018-022-03343-7
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) and explored the importance of predictors in predicting the functional outcome. […] We verified the feasibility of using XGBoost to construct a nonlinear regression prediction model for the functional outcome of patients with acute SCI, and proved that the predictive performance of the nonlinear model is better than the traditional linear regression prediction model. Age and baseline AMS play the most important role in predicting the functional outcome. We also found a significant correlation between AIS at admission, baseline AMS and BASIC score. […] Prognosticating functional outcome after acute SCI is important to guide management strategies and to give the patients and their families a realistic idea of long-term expectations.
#10 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors – PubMed
https://pubmed.ncbi.nlm.nih.gov/22709268/
To improve clinicians’ ability to predict outcome after spinal cord injury (SCI) and to help classify patients within clinical trials, we have created a novel prediction model relating acute clinical and imaging information to functional outcome at 1 year. […] Better functional status was predicted by less severe initial American Spinal Injury Association (ASIA) Impairment Scale grade, and by an ASIA motor score 50 at admission. In contrast, older age and magnetic resonance imaging (MRI) signal characteristics consistent with spinal cord edema or hemorrhage predicted worse functional outcome. […] The linear model predicting FIM motor score demonstrated an R-square of 0.52 in the original dataset, and 0.52 (95% CI 0.52,0.53) across the 200 bootstraps. […] For the logistic model, the area under the curve was 0.93 in the original dataset, and 0.92 (95% CI 0.92,0.93) across the bootstraps, indicating excellent predictive discrimination. These models will have important clinical impact to guide decision making and to counsel patients and families.
#11 Long-term outcome and predictors of neurological recovery in cervical spinal cord injury: a population-based cohort study | Scientific Reports
https://www.nature.com/articles/s41598-024-71983-2
The multivariable analysis predicting at least a one-step improvement in AIS revealed several significant predictors. […] Our analysis indicated that a longer stay in the ICU was associated with a decreased likelihood of AIS improvement. […] An association between a higher level of injury (C0C3) and improved AIS was seen. […] In summary, patients with less severe status at admission, particularly those with central cord syndrome, showed a higher likelihood for improvement in AIS scores, while extended ICU stays correlated with less favorable outcomes, potentially due to more severe injuries or complications arising from prolonged intensive care. […] Fifty-one percent of the patients were ambulatory at follow-up, with 22% using walking aids. […] The finding that old age was a negative prognostic factor may reflect a reduced recovery potential relating to senescence itself as well as to a greater degree of pre-existing comorbidities. […] This study highlights the importance of the initial injury severity for the long-term prognosis in cervical SCI, while it simultaneously reveals the recovery potential that exists even in severe cases.
#12 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors – PubMed
https://pubmed.ncbi.nlm.nih.gov/22709268/
To improve clinicians’ ability to predict outcome after spinal cord injury (SCI) and to help classify patients within clinical trials, we have created a novel prediction model relating acute clinical and imaging information to functional outcome at 1 year. […] Better functional status was predicted by less severe initial American Spinal Injury Association (ASIA) Impairment Scale grade, and by an ASIA motor score 50 at admission. In contrast, older age and magnetic resonance imaging (MRI) signal characteristics consistent with spinal cord edema or hemorrhage predicted worse functional outcome. […] The linear model predicting FIM motor score demonstrated an R-square of 0.52 in the original dataset, and 0.52 (95% CI 0.52,0.53) across the 200 bootstraps. […] For the logistic model, the area under the curve was 0.93 in the original dataset, and 0.92 (95% CI 0.92,0.93) across the bootstraps, indicating excellent predictive discrimination. These models will have important clinical impact to guide decision making and to counsel patients and families.
#13
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
The initial neurological status following injury, as standardized in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) seems to be the best prognostic indicator of SCI functional recovery. […] Neurologic recovery is particularly important to patients, as the completeness or incompleteness of a lesion is one of the most relevant determinants of functional outcome. […] Several studies have assessed AIS grade conversion. Overall, approximately 50% of patients with traumatic SCI show a conversion of the AIS grade. […] An important prognostic factor for recovery is the presence and extent of a sensory zone of partial preservation (ZPP). […] The motor score improvement varied based on the initial AIS grade being greater for AIS B and C subjects than for AIS A and D subjects.
#14 Long-term outcome and predictors of neurological recovery in cervical spinal cord injury: a population-based cohort study | Scientific Reports
https://www.nature.com/articles/s41598-024-71983-2
The multivariable analysis predicting at least a one-step improvement in AIS revealed several significant predictors. […] Our analysis indicated that a longer stay in the ICU was associated with a decreased likelihood of AIS improvement. […] An association between a higher level of injury (C0C3) and improved AIS was seen. […] In summary, patients with less severe status at admission, particularly those with central cord syndrome, showed a higher likelihood for improvement in AIS scores, while extended ICU stays correlated with less favorable outcomes, potentially due to more severe injuries or complications arising from prolonged intensive care. […] Fifty-one percent of the patients were ambulatory at follow-up, with 22% using walking aids. […] The finding that old age was a negative prognostic factor may reflect a reduced recovery potential relating to senescence itself as well as to a greater degree of pre-existing comorbidities. […] This study highlights the importance of the initial injury severity for the long-term prognosis in cervical SCI, while it simultaneously reveals the recovery potential that exists even in severe cases.
#15 Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury | Neurological Research and Practice | Full Text
https://neurolrespract.biomedcentral.com/articles/10.1186/s42466-019-0017-1
In cervical spinal cord injury, the consideration of early ulnar nerve CMAP improves prognostic accuracy, which is of particular importance in patients with clinical grading uncertainties. […] Early and accurate prediction of neurological recovery is a major goal in the care of traumatic cervical spinal cord injury (SCI) for (1) providing patients with a realistic prognosis, (2) an effective and tailored rehabilitation plan and (3) the correct risk stratification in clinical trials. […] Within 4-week ulnar nerve axonal integrity is an independent predictor of good 1-year outcome. […] The prediction model consisting of baseline AIS and ulnar nerve CMAP amplitude is robust and inferable to other cervical SCI cohorts. […] The consideration of early ulnar nerve CMAP amplitudes improves prognostic accuracy of 1-year neurologic outcomes in cervical SCI patients. This could be of particular importance in patients who are difficult to grade clinically. Moreover, improved accuracy could prove significant for proper risk stratification in clinical trials.
#16
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
The initial neurological status following injury, as standardized in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) seems to be the best prognostic indicator of SCI functional recovery. […] Neurologic recovery is particularly important to patients, as the completeness or incompleteness of a lesion is one of the most relevant determinants of functional outcome. […] Several studies have assessed AIS grade conversion. Overall, approximately 50% of patients with traumatic SCI show a conversion of the AIS grade. […] An important prognostic factor for recovery is the presence and extent of a sensory zone of partial preservation (ZPP). […] The motor score improvement varied based on the initial AIS grade being greater for AIS B and C subjects than for AIS A and D subjects.
#17 Can the Initial Parameters of Functional Scales Predict Recovery in Patients with Complete Spinal Cord Injury? A Retrospective Cohort Study
https://www.mdpi.com/2075-4418/14/2/129
Can the Initial Parameters of Functional Scales Predict Recovery in Patients with Complete Spinal Cord Injury? A Retrospective Cohort Study […] The natural course and the prognosis for SCIs depend on the level of SCI, and the extent and severity of the injury. […] According to the literature, complete to incomplete SCI conversion is estimated to range from 4 to 25%. […] However, it should be remembered that the experience of the clinician (avoiding misdiagnoses) and the time from the SCI to the initial SCI patient examination are important in the functional assessment. […] The ability to predict recovery after SCI is an important role of the medical rehabilitation physician, who is provided with the tools to navigate difficult conversations with patients about their chances of clinical improvement or regaining independence.
#18 Outcome Prediction in Spinal Cord Injury: Myth or Reality – PubMed
https://pubmed.ncbi.nlm.nih.gov/32437998/
Objective: To identify the prognostic factors affecting the outcome of acute traumatic spinal cord injury (tSCI) and to provide updated recommendations on improving outcomes. […] The initial neurologic examination determines the prognosis in SCI. The chance of walking after SCI can be accurately predicted on the basis of demographic data and clinical examination. […] There is level III evidence that keeping mean arterial pressure (MAP) 85 for 7 days in patients with spinal cord injury improves neurologic outcome. […] The Spine Trauma Study Group showed that at 6 months after injury, early surgical decompression was associated with 2.8-fold increased odds of a 2-grade American Spinal Injury Association Impairment Scale improvement. […] The STASCIS trial documented that surgical decompression within 6 hours of injury leads to an improvement in about 70% of patients by 1 American Spinal Injury Association grade. […] Prognostic data in tSCI are fundamental to assess the value of new therapies and to undertake clinical trials. The increasing knowledge of new and emerging prognostic factors may assist us to direct our efforts toward focused therapeutic interventions, which may present a promising result.
#19 Outcome Prediction in Spinal Cord Injury: Myth or Reality – PubMed
https://pubmed.ncbi.nlm.nih.gov/32437998/
Objective: To identify the prognostic factors affecting the outcome of acute traumatic spinal cord injury (tSCI) and to provide updated recommendations on improving outcomes. […] The initial neurologic examination determines the prognosis in SCI. The chance of walking after SCI can be accurately predicted on the basis of demographic data and clinical examination. […] There is level III evidence that keeping mean arterial pressure (MAP) 85 for 7 days in patients with spinal cord injury improves neurologic outcome. […] The Spine Trauma Study Group showed that at 6 months after injury, early surgical decompression was associated with 2.8-fold increased odds of a 2-grade American Spinal Injury Association Impairment Scale improvement. […] The STASCIS trial documented that surgical decompression within 6 hours of injury leads to an improvement in about 70% of patients by 1 American Spinal Injury Association grade. […] Prognostic data in tSCI are fundamental to assess the value of new therapies and to undertake clinical trials. The increasing knowledge of new and emerging prognostic factors may assist us to direct our efforts toward focused therapeutic interventions, which may present a promising result.
#20 Outcome Prediction in Spinal Cord Injury: Myth or Reality – PubMed
https://pubmed.ncbi.nlm.nih.gov/32437998/
Objective: To identify the prognostic factors affecting the outcome of acute traumatic spinal cord injury (tSCI) and to provide updated recommendations on improving outcomes. […] The initial neurologic examination determines the prognosis in SCI. The chance of walking after SCI can be accurately predicted on the basis of demographic data and clinical examination. […] There is level III evidence that keeping mean arterial pressure (MAP) 85 for 7 days in patients with spinal cord injury improves neurologic outcome. […] The Spine Trauma Study Group showed that at 6 months after injury, early surgical decompression was associated with 2.8-fold increased odds of a 2-grade American Spinal Injury Association Impairment Scale improvement. […] The STASCIS trial documented that surgical decompression within 6 hours of injury leads to an improvement in about 70% of patients by 1 American Spinal Injury Association grade. […] Prognostic data in tSCI are fundamental to assess the value of new therapies and to undertake clinical trials. The increasing knowledge of new and emerging prognostic factors may assist us to direct our efforts toward focused therapeutic interventions, which may present a promising result.
#21 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors – PubMed
https://pubmed.ncbi.nlm.nih.gov/22709268/
To improve clinicians’ ability to predict outcome after spinal cord injury (SCI) and to help classify patients within clinical trials, we have created a novel prediction model relating acute clinical and imaging information to functional outcome at 1 year. […] Better functional status was predicted by less severe initial American Spinal Injury Association (ASIA) Impairment Scale grade, and by an ASIA motor score 50 at admission. In contrast, older age and magnetic resonance imaging (MRI) signal characteristics consistent with spinal cord edema or hemorrhage predicted worse functional outcome. […] The linear model predicting FIM motor score demonstrated an R-square of 0.52 in the original dataset, and 0.52 (95% CI 0.52,0.53) across the 200 bootstraps. […] For the logistic model, the area under the curve was 0.93 in the original dataset, and 0.92 (95% CI 0.92,0.93) across the bootstraps, indicating excellent predictive discrimination. These models will have important clinical impact to guide decision making and to counsel patients and families.
#22 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors – PubMed
https://pubmed.ncbi.nlm.nih.gov/22709268/
To improve clinicians’ ability to predict outcome after spinal cord injury (SCI) and to help classify patients within clinical trials, we have created a novel prediction model relating acute clinical and imaging information to functional outcome at 1 year. […] Better functional status was predicted by less severe initial American Spinal Injury Association (ASIA) Impairment Scale grade, and by an ASIA motor score 50 at admission. In contrast, older age and magnetic resonance imaging (MRI) signal characteristics consistent with spinal cord edema or hemorrhage predicted worse functional outcome. […] The linear model predicting FIM motor score demonstrated an R-square of 0.52 in the original dataset, and 0.52 (95% CI 0.52,0.53) across the 200 bootstraps. […] For the logistic model, the area under the curve was 0.93 in the original dataset, and 0.92 (95% CI 0.92,0.93) across the bootstraps, indicating excellent predictive discrimination. These models will have important clinical impact to guide decision making and to counsel patients and families.
#23 A functional outcome prediction model of acute traumatic spinal cord injury based on extreme gradient boost | Journal of Orthopaedic Surgery and Research | Full Text
https://josr-online.biomedcentral.com/articles/10.1186/s13018-022-03343-7
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) and explored the importance of predictors in predicting the functional outcome. […] We verified the feasibility of using XGBoost to construct a nonlinear regression prediction model for the functional outcome of patients with acute SCI, and proved that the predictive performance of the nonlinear model is better than the traditional linear regression prediction model. Age and baseline AMS play the most important role in predicting the functional outcome. We also found a significant correlation between AIS at admission, baseline AMS and BASIC score. […] Prognosticating functional outcome after acute SCI is important to guide management strategies and to give the patients and their families a realistic idea of long-term expectations.
#24 A functional outcome prediction model of acute traumatic spinal cord injury based on extreme gradient boost | Journal of Orthopaedic Surgery and Research | Full Text
https://josr-online.biomedcentral.com/articles/10.1186/s13018-022-03343-7
We successfully constructed a nonlinear regression prediction model through XGBoost and verified the credibility. […] The nonlinear model is superior to the traditional linear model. […] AMS and age played the most important roles in constructing predictive models. There is an obvious correlation between AIS, AMS and BASIC score.
#25 Spinal Cord Injury AIS Predictions Using Machine Learning | eNeuro
https://www.eneuro.org/content/10/1/ENEURO.0149-22.2022
The results showed promising results in predicting AIS improvement. A 73.6% test accuracy can be considered a benchmark for improvement. […] Feature strength gave a better understanding of which areas most affected recovery, both when it came to validating the importance of the hospital admission AIS score and with regard to understanding the role that demographics play. […] The surprising result of marital status exceeding the importance of age was an important outcome of the study.
#26
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
With regard to lower extremity recovery, patients with complete tetraplegia have a very low probability of motor recovery in the lower extremities (5%), especially if they remain clinically complete for more than 1-month post-injury. […] The descent in the level of lesions in complete tetraplegic patients is of fundamental importance, particularly for those with complete lesions, as lesions at lower levels correspond with higher levels of function. […] Functional outcome prognosis is an important part of helping patients with SCI, relatives, and professionals to understand functional capacity at the time of discharge from rehabilitation. […] AIS grade at initial examination is considered the basis for predicting functional walking recovery. […] The overall walking recovery of patients with grade B at the initial examination is approximately 33%.
#27
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
With regard to lower extremity recovery, patients with complete tetraplegia have a very low probability of motor recovery in the lower extremities (5%), especially if they remain clinically complete for more than 1-month post-injury. […] The descent in the level of lesions in complete tetraplegic patients is of fundamental importance, particularly for those with complete lesions, as lesions at lower levels correspond with higher levels of function. […] Functional outcome prognosis is an important part of helping patients with SCI, relatives, and professionals to understand functional capacity at the time of discharge from rehabilitation. […] AIS grade at initial examination is considered the basis for predicting functional walking recovery. […] The overall walking recovery of patients with grade B at the initial examination is approximately 33%.
#28
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
AIS grade C patients have a better prognosis for walking recovery than sensory incomplete, motor complete patients, with an overall recovery rate of approximately 75%. […] An important sequela of SCI is the loss of bladder and bowel control. […] The main predictive factor for bladder recovery (normal voiding) seems to be the neurological status at the moment of the first examination, particularly with regard to AIS grade: none of the patients with AIS grade A at admission recover volitional micturition. […] The neurological and functional recovery of subjects with cervical SCI could be reliably predicted based on the level and severity of the injury.
#29 Long-term outcome and predictors of neurological recovery in cervical spinal cord injury: a population-based cohort study | Scientific Reports
https://www.nature.com/articles/s41598-024-71983-2
The multivariable analysis predicting at least a one-step improvement in AIS revealed several significant predictors. […] Our analysis indicated that a longer stay in the ICU was associated with a decreased likelihood of AIS improvement. […] An association between a higher level of injury (C0C3) and improved AIS was seen. […] In summary, patients with less severe status at admission, particularly those with central cord syndrome, showed a higher likelihood for improvement in AIS scores, while extended ICU stays correlated with less favorable outcomes, potentially due to more severe injuries or complications arising from prolonged intensive care. […] Fifty-one percent of the patients were ambulatory at follow-up, with 22% using walking aids. […] The finding that old age was a negative prognostic factor may reflect a reduced recovery potential relating to senescence itself as well as to a greater degree of pre-existing comorbidities. […] This study highlights the importance of the initial injury severity for the long-term prognosis in cervical SCI, while it simultaneously reveals the recovery potential that exists even in severe cases.
#30 An unsupervised machine learning approach to predict recovery from traumatic spinal cord injury | medRxiv
https://www.medrxiv.org/content/10.1101/2023.09.26.23295361.full
Neurological and functional recovery after traumatic spinal cord injury (SCI) is highly heterogeneous, challenging outcome predictions in rehabilitation and clinical trials. […] Patients and their families have critical questions regarding their prognosis of recovery and probable long-term disability to plan for their health-related, financial, and social future. Personalised outcome predictions could provide a more specific perspective and help guide physicians in their rehabilitation planning. […] The current state-of-the-art in the field is a logistic regression model by van Middendrop et al. that provided a prediction of an individuals walking ability. […] Our approach provides detailed predictions of neurological and functional recovery based on a highly interpretable unsupervised machine learning concept.
#31 Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury | Spinal Cord
https://www.nature.com/articles/sc2016182
To identify factors predictive of survival after spinal cord injury (SCI). […] Factors independently predictive of decreased survival were increased age (+10 years; hazard ratio (HR (95% CI)), 1.6 (1.41.7)), male sex (1.3 (1.01.6)), lower dismissal FIM score (10 points; 1.3 (1.21.3)) and all nontraumatic causes. […] Age, male sex and lower dismissal FIM score were associated with decreased survival, but neither injury severity nor level was associated with it. […] Survival after SCI varies depending on SCI cause, with survival better after traumatic SCI than after nontraumatic SCI. […] The primary goals of this study were to identify factors predictive of survival after SCI of various etiologic causes and to compare expected survival in the 10 years after injury. […] The final multiple-variable Cox model identified four independent factors as significantly predictive of decreased survival: increased age, male sex, lower dismissal FIM score, and all subgroups of NTSCI (that is, metastatic cancer, primary tumors, musculoskeletal disease or spinal stenosis, vascular and other NTSCI) vs TSCI. […] Factors that independently predicted decreased survival after SCI included increased age, male sex and lower dismissal FIM scores.
#32 Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury | Spinal Cord
https://www.nature.com/articles/sc2016182
To identify factors predictive of survival after spinal cord injury (SCI). […] Factors independently predictive of decreased survival were increased age (+10 years; hazard ratio (HR (95% CI)), 1.6 (1.41.7)), male sex (1.3 (1.01.6)), lower dismissal FIM score (10 points; 1.3 (1.21.3)) and all nontraumatic causes. […] Age, male sex and lower dismissal FIM score were associated with decreased survival, but neither injury severity nor level was associated with it. […] Survival after SCI varies depending on SCI cause, with survival better after traumatic SCI than after nontraumatic SCI. […] The primary goals of this study were to identify factors predictive of survival after SCI of various etiologic causes and to compare expected survival in the 10 years after injury. […] The final multiple-variable Cox model identified four independent factors as significantly predictive of decreased survival: increased age, male sex, lower dismissal FIM score, and all subgroups of NTSCI (that is, metastatic cancer, primary tumors, musculoskeletal disease or spinal stenosis, vascular and other NTSCI) vs TSCI. […] Factors that independently predicted decreased survival after SCI included increased age, male sex and lower dismissal FIM scores.
#33 Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury | Spinal Cord
https://www.nature.com/articles/sc2016182
To identify factors predictive of survival after spinal cord injury (SCI). […] Factors independently predictive of decreased survival were increased age (+10 years; hazard ratio (HR (95% CI)), 1.6 (1.41.7)), male sex (1.3 (1.01.6)), lower dismissal FIM score (10 points; 1.3 (1.21.3)) and all nontraumatic causes. […] Age, male sex and lower dismissal FIM score were associated with decreased survival, but neither injury severity nor level was associated with it. […] Survival after SCI varies depending on SCI cause, with survival better after traumatic SCI than after nontraumatic SCI. […] The primary goals of this study were to identify factors predictive of survival after SCI of various etiologic causes and to compare expected survival in the 10 years after injury. […] The final multiple-variable Cox model identified four independent factors as significantly predictive of decreased survival: increased age, male sex, lower dismissal FIM score, and all subgroups of NTSCI (that is, metastatic cancer, primary tumors, musculoskeletal disease or spinal stenosis, vascular and other NTSCI) vs TSCI. […] Factors that independently predicted decreased survival after SCI included increased age, male sex and lower dismissal FIM scores.
#34 Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury | Spinal Cord
https://www.nature.com/articles/sc2016182
To identify factors predictive of survival after spinal cord injury (SCI). […] Factors independently predictive of decreased survival were increased age (+10 years; hazard ratio (HR (95% CI)), 1.6 (1.41.7)), male sex (1.3 (1.01.6)), lower dismissal FIM score (10 points; 1.3 (1.21.3)) and all nontraumatic causes. […] Age, male sex and lower dismissal FIM score were associated with decreased survival, but neither injury severity nor level was associated with it. […] Survival after SCI varies depending on SCI cause, with survival better after traumatic SCI than after nontraumatic SCI. […] The primary goals of this study were to identify factors predictive of survival after SCI of various etiologic causes and to compare expected survival in the 10 years after injury. […] The final multiple-variable Cox model identified four independent factors as significantly predictive of decreased survival: increased age, male sex, lower dismissal FIM score, and all subgroups of NTSCI (that is, metastatic cancer, primary tumors, musculoskeletal disease or spinal stenosis, vascular and other NTSCI) vs TSCI. […] Factors that independently predicted decreased survival after SCI included increased age, male sex and lower dismissal FIM scores.
#35 Factors predictive of survival and estimated years of life lost in the decade following nontraumatic and traumatic spinal cord injury | Spinal Cord
https://www.nature.com/articles/sc2016182
To identify factors predictive of survival after spinal cord injury (SCI). […] Factors independently predictive of decreased survival were increased age (+10 years; hazard ratio (HR (95% CI)), 1.6 (1.41.7)), male sex (1.3 (1.01.6)), lower dismissal FIM score (10 points; 1.3 (1.21.3)) and all nontraumatic causes. […] Age, male sex and lower dismissal FIM score were associated with decreased survival, but neither injury severity nor level was associated with it. […] Survival after SCI varies depending on SCI cause, with survival better after traumatic SCI than after nontraumatic SCI. […] The primary goals of this study were to identify factors predictive of survival after SCI of various etiologic causes and to compare expected survival in the 10 years after injury. […] The final multiple-variable Cox model identified four independent factors as significantly predictive of decreased survival: increased age, male sex, lower dismissal FIM score, and all subgroups of NTSCI (that is, metastatic cancer, primary tumors, musculoskeletal disease or spinal stenosis, vascular and other NTSCI) vs TSCI. […] Factors that independently predicted decreased survival after SCI included increased age, male sex and lower dismissal FIM scores.
#36 Can the Initial Parameters of Functional Scales Predict Recovery in Patients with Complete Spinal Cord Injury? A Retrospective Cohort Study
https://www.mdpi.com/2075-4418/14/2/129
According to the literature, a number of clinical, imaging and therapeutic factors may have an impact on clinical improvement in patients with SCIs. […] The aim of this study was to analyze the impact of functional factors on the clinical improvement in patients with AIS-A during early neurological rehabilitation (ENR), with particular emphasis on the motor score of AIS (MS). […] Higher initial MS may increase the chances of a greater and faster functional improvement during ENR. […] Initial MS, initial BI, initial SCIM, age and level of SCI were found to be statistically significant predictors of clinical improvement during ENR, as expressed by patients achieving higher values on functional scales. […] The improvement in the functional parameters of patients after ENR which we observed in our study constitutes a kind of confirmation of the effectiveness of the treatment and therapeutic procedure, and confirmation of what is known and proven by previous studies, i.e., that the clinical and functional condition after a SCI improves during ENR. […] Our study also confirmed the importance of this parameter in the process of predicting clinical improvement. […] The functional parameters assessed in SCI patients are among numerous possible predictors of clinical improvement.
#37 Can the Initial Parameters of Functional Scales Predict Recovery in Patients with Complete Spinal Cord Injury? A Retrospective Cohort Study
https://www.mdpi.com/2075-4418/14/2/129
According to the literature, a number of clinical, imaging and therapeutic factors may have an impact on clinical improvement in patients with SCIs. […] The aim of this study was to analyze the impact of functional factors on the clinical improvement in patients with AIS-A during early neurological rehabilitation (ENR), with particular emphasis on the motor score of AIS (MS). […] Higher initial MS may increase the chances of a greater and faster functional improvement during ENR. […] Initial MS, initial BI, initial SCIM, age and level of SCI were found to be statistically significant predictors of clinical improvement during ENR, as expressed by patients achieving higher values on functional scales. […] The improvement in the functional parameters of patients after ENR which we observed in our study constitutes a kind of confirmation of the effectiveness of the treatment and therapeutic procedure, and confirmation of what is known and proven by previous studies, i.e., that the clinical and functional condition after a SCI improves during ENR. […] Our study also confirmed the importance of this parameter in the process of predicting clinical improvement. […] The functional parameters assessed in SCI patients are among numerous possible predictors of clinical improvement.
#38 Can the Initial Parameters of Functional Scales Predict Recovery in Patients with Complete Spinal Cord Injury? A Retrospective Cohort Study
https://www.mdpi.com/2075-4418/14/2/129
According to the literature, a number of clinical, imaging and therapeutic factors may have an impact on clinical improvement in patients with SCIs. […] The aim of this study was to analyze the impact of functional factors on the clinical improvement in patients with AIS-A during early neurological rehabilitation (ENR), with particular emphasis on the motor score of AIS (MS). […] Higher initial MS may increase the chances of a greater and faster functional improvement during ENR. […] Initial MS, initial BI, initial SCIM, age and level of SCI were found to be statistically significant predictors of clinical improvement during ENR, as expressed by patients achieving higher values on functional scales. […] The improvement in the functional parameters of patients after ENR which we observed in our study constitutes a kind of confirmation of the effectiveness of the treatment and therapeutic procedure, and confirmation of what is known and proven by previous studies, i.e., that the clinical and functional condition after a SCI improves during ENR. […] Our study also confirmed the importance of this parameter in the process of predicting clinical improvement. […] The functional parameters assessed in SCI patients are among numerous possible predictors of clinical improvement.
#39
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
AIS grade C patients have a better prognosis for walking recovery than sensory incomplete, motor complete patients, with an overall recovery rate of approximately 75%. […] An important sequela of SCI is the loss of bladder and bowel control. […] The main predictive factor for bladder recovery (normal voiding) seems to be the neurological status at the moment of the first examination, particularly with regard to AIS grade: none of the patients with AIS grade A at admission recover volitional micturition. […] The neurological and functional recovery of subjects with cervical SCI could be reliably predicted based on the level and severity of the injury.
#40
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
AIS grade C patients have a better prognosis for walking recovery than sensory incomplete, motor complete patients, with an overall recovery rate of approximately 75%. […] An important sequela of SCI is the loss of bladder and bowel control. […] The main predictive factor for bladder recovery (normal voiding) seems to be the neurological status at the moment of the first examination, particularly with regard to AIS grade: none of the patients with AIS grade A at admission recover volitional micturition. […] The neurological and functional recovery of subjects with cervical SCI could be reliably predicted based on the level and severity of the injury.
#41 Prediction of segmental motor outcomes in traumatic spinal cord injury: Advances beyond sum scores
https://www.zora.uzh.ch/id/eprint/262925/
BACKGROUND AND OBJECTIVES Neurological and functional recovery after traumatic spinal cord injury (SCI) is highly challenged by the level of the lesion and the high heterogeneity in severity (different degrees of in/complete SCI) and spinal cord syndromes (hemi-, ant-, central-, and posterior cord). […] The development of data-driven prediction models of detailed segmental motor recovery for all spinal segments from the level of lesion towards the lowest motor segments will improve the design of rehabilitation programs and the sensitivity of clinical trials. […] Our approach is the first to provide predictions across all motor segments independent of the level and severity of SCI. […] We provide a machine learning concept that is highly interpretable, i.e. the prediction formation process is transparent, that has been validated across European and American data sets, and provides reliable and validated algorithms to incorporate external control data to increase sensitivity and feasibility of multinational clinical trials.
#42 An unsupervised machine learning approach to predict recovery from traumatic spinal cord injury | medRxiv
https://www.medrxiv.org/content/10.1101/2023.09.26.23295361.full
Neurological and functional recovery after traumatic spinal cord injury (SCI) is highly heterogeneous, challenging outcome predictions in rehabilitation and clinical trials. […] Patients and their families have critical questions regarding their prognosis of recovery and probable long-term disability to plan for their health-related, financial, and social future. Personalised outcome predictions could provide a more specific perspective and help guide physicians in their rehabilitation planning. […] The current state-of-the-art in the field is a logistic regression model by van Middendrop et al. that provided a prediction of an individuals walking ability. […] Our approach provides detailed predictions of neurological and functional recovery based on a highly interpretable unsupervised machine learning concept.
#43 An unsupervised machine learning approach to predict recovery from traumatic spinal cord injury | medRxiv
https://www.medrxiv.org/content/10.1101/2023.09.26.23295361.full
The objective of this study was to benchmark different ways to match patients with SCI to historic cohorts (i.e. the nearest neighbours) and quantify the degree to which these models provide detailed, personalised recovery predictions. […] The mechanistic rationale for this is that several features of the retained motor and sensory function influence recovery implying that the full motor function pattern needs to be accounted for upon neighbour matching. […] Our study presents quantitative results for these metrics that serve as a baseline for future prediction models. The clinical impact of this study is twofold. Firstly, the presented concept provides patients and physicians with a personalised perspective regarding neurological and functional recovery, including quantification of prediction confidence stemming from the distribution in the reference cohort. […] The proposed analysis hence represents predictions based on an expected normal/optimal recovery trajectory.
#44
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
AIS grade C patients have a better prognosis for walking recovery than sensory incomplete, motor complete patients, with an overall recovery rate of approximately 75%. […] An important sequela of SCI is the loss of bladder and bowel control. […] The main predictive factor for bladder recovery (normal voiding) seems to be the neurological status at the moment of the first examination, particularly with regard to AIS grade: none of the patients with AIS grade A at admission recover volitional micturition. […] The neurological and functional recovery of subjects with cervical SCI could be reliably predicted based on the level and severity of the injury.
#45
https://journals.lww.com/isoj/fulltext/2022/05010/predicting_outcomes_following_cervical_spine.7.aspx
Outcome prediction is fundamental for patients with spinal cord injury (SCI) to allow correct counselling of patients and their families and to determine resource allocation during and after rehabilitation immediately after the lesion. […] Both neurological and functional recovery could be prognosticated by the severity of the lesion as assessed by radiological findings and the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). […] Therefore, a correct outcome prognosis is mandatory for both patients and professionals. […] A precise prognosis may allow clinicians to address questions more accurately regarding a patients functional outcomes. […] Finally, to enhance neurological recovery following SCI, we require better knowledge of its course, as well as a better understanding of its mechanisms, to develop effective treatment options.
#46 Long-term outcome and predictors of neurological recovery in cervical spinal cord injury: a population-based cohort study | Scientific Reports
https://www.nature.com/articles/s41598-024-71983-2
This retrospective study analyzed prognostic factors for neurological improvement and ambulation in 194 adult patients (15 years) with traumatic cervical spinal cord injuries treated at the neurological SCI unit (SCIU) at the Karolinska University Hospital Stockholm, Sweden, between 2010 and 2020. […] In conclusion, initial injury severity significantly predicted neurological improvement and ambulation. Recovery was observed even in severe cases, emphasizing the importance of tailored rehabilitation for improved outcomes. […] A critical aspect of early SCI management involves predicting the patients potential for neurological recovery. […] The identification of predictors of neurological recovery would enable clinicians to help patients make well-founded decisions regarding rehabilitation strategies, financial considerations, and the establishment of achievable goals.