The journal of spinal cord medicine · 2026
Recovery rate of functional motor independence during inpatient rehabilitation after traumatic cervical spinal cord injury predicts functional status at years 1 and 5 after surgery: A multicenter, longitudinal cohort study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Abraham Benjamin M, Naik Anant, Falavigna Asdrubal, Harrop James, Zuckerman Scott L, Arnold Paul M
Аннотация
BACKGROUND: Cervical traumatic spinal cord injury (SCI) is a devastating condition that can result in tetraplegia. Early surgical decompression and rehabilitative efforts in cervical SCI patients has been shown to improve neurological outcomes. In this study, we sought to evaluate the impact of various factors at the time of injury and throughout the rehabilitative period on motor functional independence after 1 and 5 years after injury in patients undergoing cervical spinal cord decompression.
METHODS: A longitudinal, retrospective cohort study from the multicenter spinal cord injury Model Systems (SCIMS) database was conducted on patients who presented between 1998 and 2011 with motor Functional Independence Measure (mFIM) scores at rehabilitation admission (RA) and discharge (DC) from inpatient rehabilitation (IPR), year 1, and year 5. Patients who had undergone surgical decompression with neurological levels of injury limited to the cervical region and those with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A and B were included. The mFIM score was utilized to calculate changes in mFIM (ΔmFIM) scores over each respective time period. Multivariable logistical regression was performed to identify longitudinal predictors associated with functional independence controlling for demographics, SCI etiology and level, vertebral bony fracture/dislocation, associated injuries, AIS grade, and discharge disposition.
RESULTS: A total of 351 patients were included. A majority were 15-29 years old (53.6%) and 80.1% male. Vehicular-related etiologies (49.9%) were most commonly implicated as the mechanism of cervical SCI. Most patients were AIS grade A at the time of RA (66.4%), with an average time from injury to RA of 19 days (IQR 11-32) for all patients. A total of 131 patients required ventilatory support at the time of RA, and of those, only 12 eventually became FI by year 5. Although the number of patients requiring ventilatory support decreased from 131 to 20 by year 5, no additional patients became FI if they required support at the time of DC or year 1. By 1 year, 43 (12.3%) patients achieved functional independence, and an additional 12 (3.42%) achieved functional independence by year 5. Although those with AIS B injuries (aOR = 5.23, P = 0.0014) and AIS improvement (aOR = 5.14, P = 0.0004) had a greater likelihood of FI by year 1, year 1 FI was more strongly predicted by greater ΔmFIM score during a shorter IPR time period (ΔmFIM score during IPR, aOR = 14.2, P < 0.0001). While AIS grade and AIS improvement were no longer predictive of year 5 FI (P > 0.09 for both), the ΔmFIM score during IPR remained as the strongest predictor towards achieving FI by year 5 (aOR = 23.1, P < 0.0001). Furthermore, a stratified analysis of those patients who did not achieve FI at year 1 revealed that the ΔmFIM score during IPR was an even greater predictor of FI at year 5 (aOR = 53.0, P < 0.0001). A similar relationship was observed where stratification of patients by AIS grade showed that AIS A injuries demonstrated a higher likelihood of 5-year FI due to ΔmFIM score during IPR (aOR = 51.3, P = 0.0002 vs. AIS B: aOR = 42.2, P = 0.0009). Similarly, stratification by need for ventilatory support at RA revealed those who did require ventilatory assistance at RA also had a higher likelihood of 5-year FI due to ΔmFIM score during IPR (aOR = 171, P = 0.035).
CONCLUSION: In patients who suffered an AIS A/B cervical SCI, IPR contributed to achieving functional independence in up to 5 years after the inciting injury. By year 1, 12.3% of patients achieved functional independence, and from years 1 to 5, an additional 3.42% of patients achieved functional independence. Although AIS B patients and patients with AIS improvement had improved outcomes at year 1, only the ΔmFIM score during IPR predicted eventual FI status by year 5. Due to the increased likelihood attaining functional independence at year 5 in AIS A SCI, carries emphasized importance for patients who do not attain functional independence by year 1. Our study highlights the crucial role of early and aggressive rehabilitation following surgical intervention toward ultimate functional independence in traumatic cervical SCI patients enduring complete loss of motor function.
METHODS: A longitudinal, retrospective cohort study from the multicenter spinal cord injury Model Systems (SCIMS) database was conducted on patients who presented between 1998 and 2011 with motor Functional Independence Measure (mFIM) scores at rehabilitation admission (RA) and discharge (DC) from inpatient rehabilitation (IPR), year 1, and year 5. Patients who had undergone surgical decompression with neurological levels of injury limited to the cervical region and those with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A and B were included. The mFIM score was utilized to calculate changes in mFIM (ΔmFIM) scores over each respective time period. Multivariable logistical regression was performed to identify longitudinal predictors associated with functional independence controlling for demographics, SCI etiology and level, vertebral bony fracture/dislocation, associated injuries, AIS grade, and discharge disposition.
RESULTS: A total of 351 patients were included. A majority were 15-29 years old (53.6%) and 80.1% male. Vehicular-related etiologies (49.9%) were most commonly implicated as the mechanism of cervical SCI. Most patients were AIS grade A at the time of RA (66.4%), with an average time from injury to RA of 19 days (IQR 11-32) for all patients. A total of 131 patients required ventilatory support at the time of RA, and of those, only 12 eventually became FI by year 5. Although the number of patients requiring ventilatory support decreased from 131 to 20 by year 5, no additional patients became FI if they required support at the time of DC or year 1. By 1 year, 43 (12.3%) patients achieved functional independence, and an additional 12 (3.42%) achieved functional independence by year 5. Although those with AIS B injuries (aOR = 5.23, P = 0.0014) and AIS improvement (aOR = 5.14, P = 0.0004) had a greater likelihood of FI by year 1, year 1 FI was more strongly predicted by greater ΔmFIM score during a shorter IPR time period (ΔmFIM score during IPR, aOR = 14.2, P < 0.0001). While AIS grade and AIS improvement were no longer predictive of year 5 FI (P > 0.09 for both), the ΔmFIM score during IPR remained as the strongest predictor towards achieving FI by year 5 (aOR = 23.1, P < 0.0001). Furthermore, a stratified analysis of those patients who did not achieve FI at year 1 revealed that the ΔmFIM score during IPR was an even greater predictor of FI at year 5 (aOR = 53.0, P < 0.0001). A similar relationship was observed where stratification of patients by AIS grade showed that AIS A injuries demonstrated a higher likelihood of 5-year FI due to ΔmFIM score during IPR (aOR = 51.3, P = 0.0002 vs. AIS B: aOR = 42.2, P = 0.0009). Similarly, stratification by need for ventilatory support at RA revealed those who did require ventilatory assistance at RA also had a higher likelihood of 5-year FI due to ΔmFIM score during IPR (aOR = 171, P = 0.035).
CONCLUSION: In patients who suffered an AIS A/B cervical SCI, IPR contributed to achieving functional independence in up to 5 years after the inciting injury. By year 1, 12.3% of patients achieved functional independence, and from years 1 to 5, an additional 3.42% of patients achieved functional independence. Although AIS B patients and patients with AIS improvement had improved outcomes at year 1, only the ΔmFIM score during IPR predicted eventual FI status by year 5. Due to the increased likelihood attaining functional independence at year 5 in AIS A SCI, carries emphasized importance for patients who do not attain functional independence by year 1. Our study highlights the crucial role of early and aggressive rehabilitation following surgical intervention toward ultimate functional independence in traumatic cervical SCI patients enduring complete loss of motor function.