Early prognostic factors for walking in spinal cord injuries

Abstract

SutntnaryThe authors present a prospective analysis with 1 year follow-up of about 157 consecutive spinal cord injured patients admitted to the Bordeaux CHU, over a 3 year period (1982)(1983)(1984)(1985). They present a method of analysing the walking status recovery in patients with spinal cord injuries from the early factors recorded on initial clinical examination. Twenty eight per cent of all patients are 'functional walkers', 1 year after injury. Three early factors were selected: age; the level of injury; and the initial Yale Scale Score. Only the age and the initial Yale Scale Score are independant predictive factors, according to the Cox model.The authors present a model of walking status recovery, 1 year after the injury, predicted from age and the initial Yale Scale Score.Key words: Spinal cord injury; Walking status; Prognosis.The prediction of the evolution of a spinal cord injury is necessary for the physician to develop a therapeutic strategy for the patient for functional activity and for any economic repercussions. When the initial emergency is resolved, the question is to know to what level a spinal injured patient will recover a functional autonomy in his daily life. We chose as functional criteria the walking status recovery, for this is the most commonly studied in the literature. We have to acknowledge that the physician does not give a prognosis of the possibilities of late recovery, according to the severity of the initial spinal shock. Our team operates very early in the evaluation of these injured patients and collaborates with the emergency team. As we are involved in the earliest care of the patients, we are confronted with the question of the prognosis from the very day of the injury.The purpose of this work is to establish a prediction for walking recovery in those with spinal cord injuries, from the early factors recorded on the initial clinical examination. Patients and tnethodsThe crucial point is to obtain a population as representative as possible of the 'theoretical' population of the spinal injured patients. If some selection bias exist, due to a defective protocol or simply to chance, the results may be totally wrong. To try to overcome the risk we consider the prognosis very early on on

Spinal cord injury: prognosis for ambulation based on quadriceps recovery

“…Also, we found no rela tionship between the initial level injury and recovery of ambulation. This finding is consistent with Deverat et al 4 Previous studies by Crozier et al noted a statistically significant improvement in prognosis for ambulation in Frankel B patients who had sparing of pin sensation below the zone of injury within 72 hours post SCI. 1 2 However in the present study no subjects (FA or NA) had the complete absence of pin sensation and therefore this factor could not be analyzed in relation to ambulation.…”

Neurological and functional recovery after thoracic spinal cord injury

“…22 Kay et al found that being older than 50 had a significant negative effect on walking for AIS D subjects, while it was not a factor for AIS C subjects. 21 Although we expected those in higher age groups to be less likely to walk, we did not find an effect of age on walking after controlling for level and completeness of injury.…”

Clinical Algorithm for Improved Prediction of Ambulation and Patient Stratification after Incomplete Spinal Cord Injury

“…A broad range of different factors such as neurological deficit, age, gender, and electrophysiological measurements have been shown in previous studies to be closely related to functional outcome and, in particular, to walking ability after SCI (Burns et al, 1997;Crozier et al, 1991;Curt and Dietz, 1999;Daverat et al, 1988;Jacobs et al, 1995;Kay et al, 2007;Scivoletto et al, 2003;Sipski et al, 2004;Waters, 1996). The general characteristics of our patients, such as neurological level of injury, type of injury, or gender (predominantly men), were similar to these studies, although the mean age of 47.3 years in this study was slightly higher.…”