The incidence rate appeared to remain stable in Stockholm, Sweden. However, significant changes in injury aetiology and impairment-level post injury were found, compared with the previous study. There remains a need for developing fall-related prevention strategies in rehabilitation settings as well as in population-based programmes.

Background and Objectives:Spinal cord infarction (SCInf) is a rare condition where consensus regarding diagnostic criteria is lacking and mis- or delayed diagnosis can be detrimental. The aim of this study was to describe baseline findings and predictors of long-term functional outcome in a population-based cohort of patients with SCInf.Methods:All adult patients (≥18 years) treated at the Spinal Cord Injury Unit of the study center, between 2006–2019, and discharged with a G95 diagnosis(“other and unspecified disease of the spinal cord”) were screened for inclusion. The diagnostic criteria proposed by Zalewski et al. were retrospectively applied to evaluate the certainty of the SCInf diagnosis.Results:270 patients were screened and 57 were included in the study, of whom 30 had a spontaneous and 27 had a periprocedural SCInf. The median American Spinal Cord Injury Association Impairment Scale (AIS) on admission was C, which at median follow-up of 2.1 years had improved to D (p=0.002). Compared to periprocedural cases, spontaneous SCInf showed significantly better admission-AIS (median AIS D vs. B, p<0.001), fewer multilevel SCInf (27% vs. 59%, p=0.029), shorter hospital stay (median 22 vs. 44 days, p<0.001), as well as better AIS (median AIS D vs. C, p<0.001) and ambulatory status on long-term follow-up (66% vs. 1%, p<0.001). Regression analyses revealed that spontaneous SCInfs (OR=5.91 [1.92–18.1], p=0.002) and more favorable admission-AIS (OR=33.6 [7.72–146], p<0.001) were significant predictors of more favorable AIS at follow-up, with admission-AIS demonstrating independent predictive ability (OR=35.9 [8.05–160], p<0.001).Discussion:SCInf is a rare neurological emergency lacking specific management guidelines. While the presumptive diagnosis is based on the typical presentation and clinical findings, T2-weighted and diffusion-weighted MRI were the most useful diagnostic tools in establishing a definitive diagnosis. Our data shows that spontaneous SCInf mostly affected a single spinal cord segment while periprocedural cases were more extensive, had poorer AIS on admission, poorer ambulatory function, and longer hospital stays. Regardless of the etiology, significant neurological improvements were seen at long-term follow-up, highlighting the importance of active rehabilitation.

Study design Retrospective population-based cohort study. Objective To investigate the long-term outcome following surgery for posttraumatic spinal cord tethering (PSCT). Setting Publicly funded tertiary care center. Methods Patients surgically treated for PSCT between 2005–2020 were identified and included. No patients were excluded or lost to follow-up. Medical records and imaging data were retrospectively reviewed. Results Seventeen patients were included. Median age was 52 (23–69) years and 7 (41%) were female. PSCT was diagnosed at a median of 5.0 (0.6–27) years after the initial trauma. Motor deficit was the most common neurological manifestation (71%), followed by sensory deficit (53%), spasticity (53%), pain (41%) and gait disturbance (24%). Median follow-up time was 5.1 (0.7–13) years. Fifteen patients (88%) showed satisfactory results following untethering, defined as improvement or halted progression of one or more of the presenting symptoms. Treatment goals were met for motor symptoms in 92%, sensory loss in 100%, spasticity in 100%, gait disturbance in 100% and pain in 86%. Statistically, a significant improvement in motor deficit (p = 0.031) and syrinx decrease (p = 0.004) was also seen. A postoperative complication occurred in four patients: three cases of cerebrospinal fluid leakage and one postoperative hematoma. Two patients showed a negative surgical outcome: 1 with increased neck pain and 1 with left arm weakness following the postoperative hematoma. Conclusion Surgical treatment of PSCT results in improved neurological function or halted neurological deterioration in the vast majority of patients.