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Characterizing Natural Recovery of People With Initial Motor Complete Tetraplegia

Published:November 16, 2021DOI:https://doi.org/10.1016/j.apmr.2021.09.018

      Abstract

      Objective

      To determine the differences in neurologic recovery in persons with initial cervical American Spinal Cord Injury Association Impairment Scale (AIS) grades A and B over time.

      Design

      Retrospective analysis of data from people with traumatic cervical spinal cord injury (SCI) enrolled in the National Spinal Cord Injury Model Systems (SCIMS) database from 2011-2019.

      Setting

      SCIMS centers.

      Participants

      Individuals (N=187) with traumatic cervical (C1-C7 motor level) SCI admitted with initial AIS grade A and B injuries within 30 days of injury, age 16 years or older, upper extremity motor score (UEMS) ≤20 on both sides, and complete neurologic data at admission and follow-up between 6 months and 2 years.

      Interventions

      Not applicable.

      Main Outcome Measures

      Conversion in AIS grades, UEMS and lower extremity motor scores (LEMS), and sensory scores.

      Results

      Mean time to initial and follow-up examinations were 16.1±7.3 days and 377.5±93.4 days, respectively. Conversion from an initial cervical AIS grades A and B to motor incomplete status was 13.4% and 50.0%, respectively. The mean UEMS change for people with initial AIS grades A and B did not differ (7.8±6.5 and 8.8±6.1; P=.307), but people with AIS grade B experienced significantly higher means of LEMS change (2.3±7.4 and 8.8±13.9 (P≤.001). The increased rate of conversion to motor incomplete status from initial AIS grade B appears to be the primary driving factor of increased overall motor recovery. Individuals with initial AIS grade B had greater improvement in sensory scores.

      Conclusions

      While UEMS recovery is similar in persons with initial AIS grades A and B, the rate of conversion to motor incomplete status, LEMS, and sensory recovery are significantly different. This information is important for clinical as well as research considerations.

      Keywords

      List of abbreviations:

      AIS (American Spinal Injury Association Impairment Scale), EMSCI (European Multicenter Study about Spinal Cord Injury), LEMS (lower extremity motor score), NLI (neurologic level of injury), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems), TMS (total motor score), UEMS (upper extremity motor score)
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