Late neurologic recovery after traumatic spinal cord injury1☆
Abstract
Kirshblum S, Millis S, McKinley W, Tulsky D. Late neurologic recovery after traumatic spinal cord injury. Arch Phys Med Rehabil 2004;85:1811–7.
Objective
To present Model Spinal Cord Injury System (MSCIS) data on late neurologic recovery after 1 year after spinal cord injury (SCI).
Design
Longitudinal study of neurologic status as determined by annual evaluations at 1 and 5 years postinjury.
Setting
MSCIS centers contributing data on people with traumatic SCI to the National Spinal Cord Injury Statistical Center database.
Participants
People with traumatic SCI (N=987) admitted to an MSCIS between 1988 and 1997 with 1- and 5-year follow-up examinations.
Interventions
Not applicable.
Main outcome measures
American Spinal Injury Association (ASIA) Impairment Scale (AIS) classification, motor index scores (MIS), motor level, and neurologic level of injury (NLI), measured and compared for changes over time.
Results
The majority of subjects (94.4%) who had a neurologically complete injury at 1 year remained complete at 5 years postinjury, with 3.5% improving to AIS grade B, and up to 1.05% each improving to AIS grades C and D. There was a statistically significant change noted for MIS. There were no significant changes for the motor level and NLI over 4 years; however, approximately 20% of subjects improved their motor level and NLI. People with complete and incomplete injuries had similar improvements in motor level, but subjects with an incomplete injury had a greater chance of improvement in NLI and MIS.
Conclusions
There was a small degree of neurologic recovery (between 1 and 5y postinjury) after a traumatic SCI. Late conversion, between 1 and 5 years, from a neurologically complete to an incomplete injury occurred in 5.6% of cases, but in only up to 2.1% was there a conversion from motor complete to motor incomplete status. Limitations of this study included changes in the ASIA classification during the study and in the intra- and interrater reliability typically seen in longitudinal studies of the ASIA standards. Functional changes were not studied. Knowledge of the degree of late recovery may help in analyzing newer interventions to enhance recovery.
aKessler Institute for Rehabilitation, West Orange, NJ, USA
bKessler Medical Rehabilitation Research and Education Corp, West Orange, NJ, USA
cDepartment of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
dDepartment of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA
Reprint requests to Steven Kirshblum, MD, Kessler Institute for Rehabilitation, 1199 Pleasant Valley Way, West Orange, NJ 07052 USA
☆ Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitation Services, US Department of Education (grant no. H133N000022), and the Eastern Paralyzed Veterans Association.
1 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.
ABSTRACT