Paula Valerie Ter Wengel1,2,3, Marcel W M Post4,5, Enrico Martin6, Janneke Stolwijk-Swuste4, Allard Jan Frederik Hosman7, Said Sadiqi8, William Peter Vandertop9, Fetullah Cumhur Öner8. 1. Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands. v.ter.wengel@haaglandenmc.nl. 2. Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands. v.ter.wengel@haaglandenmc.nl. 3. Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands. v.ter.wengel@haaglandenmc.nl. 4. Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands. 5. Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 6. Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 7. Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. 8. Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 9. Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
Abstract
STUDY DESIGN: Cross-sectional survey. OBJECTIVES: Most studies on neurological recovery after traumatic spinal cord injury (tSCI) assess treatment effects using the American Spinal Injury Association Impairment Scale (AIS grade) or motor points recovery. To what extent neurological recovery is considered clinically meaningful is unknown. This study investigated the perceived clinical benefit of various degrees of neurological recovery one year after C5 AIS-A tSCI. SETTING: The Netherlands. METHODS: By means of a web-based survey SCI patients and physicians evaluated the benefit of various scenarios of neurological recovery on a scale from 0 to 100% (0% no benefit to 100% major benefit). Recovery to AIS-C and D, was split into C/C+ and D/D+, which was defined by the lower and upper limit of recovery for each grade. RESULTS: A total of 79 patients and 77 physicians participated in the survey. Each AIS grade improvement from AIS-A was considered significant benefit (all p < 0.05), ranging from 47.8% (SD 26.1) for AIS-B to 86.8% (SD 24.3) for AIS-D+. Motor level lowering was also considered significant benefit (p < 0.05), ranging from 66.1% (SD 22.3) for C6 to 81.7% (SD 26.0) for C8. CONCLUSIONS: Meaningful recovery can be achieved without improving in AIS grade, since the recovery of functional motor levels appears to be as important as improving in AIS grade by both patients and physicians. Moreover, minor neurological improvements within AIS-C and D are also considered clinically meaningful. Future studies should incorporate more detailed neurological outcomes to prevent potential underestimation of neurological recovery by only using the AIS grade.
STUDY DESIGN: Cross-sectional survey. OBJECTIVES: Most studies on neurological recovery after traumatic spinal cord injury (tSCI) assess treatment effects using the American Spinal Injury Association Impairment Scale (AIS grade) or motor points recovery. To what extent neurological recovery is considered clinically meaningful is unknown. This study investigated the perceived clinical benefit of various degrees of neurological recovery one year after C5 AIS-A tSCI. SETTING: The Netherlands. METHODS: By means of a web-based survey SCI patients and physicians evaluated the benefit of various scenarios of neurological recovery on a scale from 0 to 100% (0% no benefit to 100% major benefit). Recovery to AIS-C and D, was split into C/C+ and D/D+, which was defined by the lower and upper limit of recovery for each grade. RESULTS: A total of 79 patients and 77 physicians participated in the survey. Each AIS grade improvement from AIS-A was considered significant benefit (all p < 0.05), ranging from 47.8% (SD 26.1) for AIS-B to 86.8% (SD 24.3) for AIS-D+. Motor level lowering was also considered significant benefit (p < 0.05), ranging from 66.1% (SD 22.3) for C6 to 81.7% (SD 26.0) for C8. CONCLUSIONS: Meaningful recovery can be achieved without improving in AIS grade, since the recovery of functional motor levels appears to be as important as improving in AIS grade by both patients and physicians. Moreover, minor neurological improvements within AIS-C and D are also considered clinically meaningful. Future studies should incorporate more detailed neurological outcomes to prevent potential underestimation of neurological recovery by only using the AIS grade.
Authors: Najib E El Tecle; Nader S Dahdaleh; Mohamad Bydon; Wilson Z Ray; James C Torner; Patrick W Hitchon Journal: J Neurosurg Spine Date: 2018-01-19
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Authors: J W Fawcett; A Curt; J D Steeves; W P Coleman; M H Tuszynski; D Lammertse; P F Bartlett; A R Blight; V Dietz; J Ditunno; B H Dobkin; L A Havton; P H Ellaway; M G Fehlings; A Privat; R Grossman; J D Guest; N Kleitman; M Nakamura; M Gaviria; D Short Journal: Spinal Cord Date: 2006-12-19 Impact factor: 2.772