Functional outcome after traumatic cervical spinal cord injury is superior in adolescents compared to adults

Geuther, Martina; Grassner, Lukas; Mach, Orpheus; Klein, Barbara; Högel, Florian; Voth, M.; Bühren, V.; Maier, Doris; Abel, Rainer; Weidner, Norbert; Rupp, Rüdiger; Fürstenberg, Carl Hans; Schneidmueller, Dorien

doi:10.1016/j.ejpn.2018.12.001

Cited by 7 publications

(3 citation statements)

References 20 publications

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“…The limited number of individuals with SCI currently included in EMSCI did not allow to add both age and gender as matching criteria in the present study. The age in the HO cohort, although not significantly higher, may nevertheless have contributed to the observed differences in functional outcomes (Jakob et al, 2009 ; Kaminski et al, 2017 ; Geuther et al, 2019 ; Kirshblum et al, 2021b ; Wichmann et al, 2021 ). Gender, which was not equally distributed in both groups, has not been identified as a confounder in this context.…”

Section: Discussionmentioning

confidence: 97%

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury

Franz

Rust

Heutehaus

et al. 2022

Front. Cell. Neurosci.

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Objective: In spinal cord injury (SCI), heterotopic ossification is a frequent secondary complication, commonly associated with limited range of motion of affected joints, which could lead to secondary disability in activities of daily living. Additionally, heterotopic ossifications might challenge the effect of regeneration-promoting therapies on neurological and functional recovery. This study evaluated the impact of heterotopic ossification on clinical recovery within the first year after SCI.Methods: The study was conducted as a monocentric longitudinal paired cohort study. Recruitment was based on consecutive sampling in the framework of the European Multicenter about Spinal Cord Injury (EMSCI). Recovery profiles were determined using standardized neurological and functional clinical assessments within the 1st year following SCI. All study participants underwent at least two comprehensive standardized neurological and functional clinical examinations according to the International Standards for Neurological Classification of SCI and the Spinal Cord Independence Measure, respectively. Data regarding the diagnosis and treatment of heterotopic ossification were obtained by reviewing the patient medical records. The most similar “digital twin” from the entire EMSCI database were matched in terms of age, acute neurological and functional status to each individual with SCI, and heterotopic ossification.Results: Out of 25 participants diagnosed with heterotopic ossification, 13 individuals were enrolled and matched to control individuals. Most individuals presented with motor complete injury (75%). Ossifications were most frequently located at the hip joints (92%) and mainly occurred within the first 3 months after SCI. Individuals with heterotopic ossification achieved around 40% less functional improvement over time compared to their matched counterparts, whereas neurological recovery was not altered in individuals with SCI and heterotopic ossification.Conclusion: Heterotopic ossification—a common complication of SCI—unfavorably affects functional recovery, which in the end is most relevant for the best possible degree of independence in activities of daily living. Upon presentation with heterotopic ossification, neurological improvement achieved through potential restorative therapies might not translate into clinically meaningful functional improvement. Diagnostic algorithms and effective early prevention/treatment options for heterotopic ossification need to be established to ensure the best possible functional outcome.Clinical Trial Registration: NCT01571531 (https://clinicaltrials.gov).

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Section: Discussionmentioning

confidence: 97%

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury

Franz

Rust

Heutehaus

et al. 2022

Front. Cell. Neurosci.

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“…More objective measurements (such as motor evoked poten-tial, MEP, and SEP) are warranted. If spinal cord function can only be subjectively assessed, multiple scales, such as the spinal cord independence measure 6 (SCIM-6), 12 SCIM-7, total motor score, 13 and lower extremity motor score, 14 should be utilized to ensure the credibility of the results.…”

Section: Summary Of Findingsmentioning

confidence: 99%

Early Surgery (Within 24 Hours) Benefits Patients Suffering from Acute Thoracolumbar Spinal Cord Injury

Wang

et al. 2022

Clinical Spine Surgery: A Spine Publication

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A meta-analysis of early surgery for acute thoracolumbar spinal cord injury.Objective: To evaluate whether early surgery increases the American Spinal Injury Association (ASIA) grade of patients confronted with acute thoracolumbar spinal cord injury. Summary of Background Data:The idea that early surgery aids the recovery of spinal cord function in patients confronted with acute thoracolumbar spinal cord injury is controversial.Methods: All articles were retrieved from the PubMed, Embase, Web of Science and Scopus databases, which were searched from onset until 1 May 2021. All data are presented as odds ratios (ORs) and mean deviations (MDs) with 95% confidential intervals (CIs).Results: Ten studies, including 6 prospective studies, 3 retrospective studies, and 1 randomized controlled trial, containing 952 patients, were included in the analysis. The results showed that early surgery significantly reduced the number of patients with ASIA grade A (OR 0.27, 95% CI: 0.13-0.58, P < 0.01) and B (OR 0.56, 95% CI: 0.39-0.82, P < 0.01) status but greatly increased the number of patients with grade E status (OR 1.44, 95% CI: 1.06-1.96, P < 0.01). Generally, the patients receiving early surgery achieved > 1 ASIA grade improvement (OR 1.70, 95% CI: 1.31-2.21, P < 0.01) or > 2 ASIA grade (OR 3.55, 95% CI: 2.20-5.70, P < 0.01) improvements. Although early surgery did not reduce the incidence of operative complications (OR 0.72, 95% CI: 0.45-1.16, P < 0.01), the duration of hospitalization was greatly shortened (MD−3.48, 95% CI: −0.45 to −2.91, P < 0.01). Conclusions:The spinal cord function of acute thoracolumbar spinal cord injury patients can benefit from early decompression. This conclusion should be further verified with randomized controlled trials.

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“…Follow-up rehabilitation has to be a life-long process, flexible, and adapted to functional improvements, complications and changing demands. Nevertheless, juvenile age appears to be an independent predictor for better functional outcome after SCI [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Pediatric spinal cord injury rehabilitation: A protocol for an international multicenter project (SINpedSCI)

Roaldsen

Jrgensen

Höfers

et al. 2022

PRM

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PURPOSE: Children and adolescents (<18 years old) who sustain a spinal cord injury (SCI) should ideally be managed in specialized rehabilitation services. This project aims to describe the organization of pediatric SCI in ten rehabilitation units in seven countries and to qualitatively explore psychosocial aspects of adolescents living with SCI. METHODS: A multicenter cross-sectional project is planned, using quantitative (web survey) and qualitative (interview) methods in ten rehabilitation units from Norway, Sweden, United States, Israel, PR China, Russia and Palestine. Individual interviews will be conducted with ≥20 adolescents aged 13–17 years at least 6 months’ post rehabilitation. RESULTS: Units involved will be described and compared, according to funding, attachment to an acute SCI unit, catchment area, number of beds, admittance and discharge procedures, availability of services, staff/patient ratio, content and intensity of rehabilitation programs, length of stay, measurement methods, follow-up services, health promotion services, and pediatric SCI prevention acts. The semi-structured interview guide will include experiences from acute care and primary rehabilitation, daily life, school, contact with friends, leisure time activities, peers, physical and psychological health, and the adolescents’ plans for the future. CONCLUSION: Based on the present protocol, this project is likely to provide new insight and knowledge on pediatric SCI rehabilitation and increase the understanding of pediatric SCI in adolescents and their families internationally.

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Functional outcome after traumatic cervical spinal cord injury is superior in adolescents compared to adults

Cited by 7 publications

References 20 publications

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury

Impact of Heterotopic Ossification on Functional Recovery in Acute Spinal Cord Injury

Early Surgery (Within 24 Hours) Benefits Patients Suffering from Acute Thoracolumbar Spinal Cord Injury

Pediatric spinal cord injury rehabilitation: A protocol for an international multicenter project (SINpedSCI)

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