Traumatic and non-traumatic spinal cord lesions: an Italian comparison of neurological and functional outcomes.

STUDY
DESIGN: Retrospective study.
OBJECTIVE: To compare the rehabilitation outcomes of non-traumatic and traumatic spinal cord injury patients.
SETTING: Spinal cord unit of a rehabilitation hospital in Italy. PATIENTS AND METHODS: In total, 380 patients at first rehabilitation stay after the lesion (144 traumatic patients and 236 non-traumatic patients; 244 men and 136 women; mean age 46.1±19.9 years; mean lesion to admission time 49.6±39.8 days).
INTERVENTIONS: Not applicable. MEASURES: American Spinal Injury Association standards; Barthel index (BI), Rivermead mobility index and walking index for spinal cord injury. STATISTICAL ANALYSIS: Poisson regression models with relative risks and 95% confidence intervals adjusted for the following confounders: age, sex, lesion level and Asia impairment. Models were stratified by age because a strong interaction between different variables and age was found.
RESULTS: Traumatic and non-traumatic populations showed several significant differences with regard to age, level and severity of lesion. When adjusted for these factors patients with traumatic injuries showed a significantly lower BI score at admission and significantly better improvement in the BI score by discharge. The two populations were discharged with similar functional outcome. No significant differences were found with regard to the others outcomes.
CONCLUSIONS: In clinically stable patients, spinal cord injury etiology does not seem to affect the rehabilitative prognosis. At admission, traumatic patients show lower autonomy in daily life activities, probably because of the associated lesions that these patients often have. At discharge, traumatic and non-traumatic spinal cord lesion patients achieved similar results with regard to neurological and functional improvement.