Tsunehiko Konomi1,2, Kota Suda3, Masahiro Ozaki3,4, Satoko Matsumoto Harmon3, Miki Komatsu3, Seiji Iimoto3,5, Osahiko Tsuji3,6, Akio Minami3, Masahiko Takahata7, Norimasa Iwasaki7, Morio Matsumoto6, Masaya Nakamura6. 1. Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan. konomitsunehiko@gmail.com. 2. Department of Orthopaedic Surgery, Murayama Medical Center, National Hospital Organization, 2-37-1 Gakuen, Musashimurayama, Tokyo, 208-0011, Japan. konomitsunehiko@gmail.com. 3. Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, 3-1 Higashi 4 Minami 1, Bibai, Hokkaido, 072-0015, Japan. 4. Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi, Yokohama, Kanagawa, 230-8765, Japan. 5. Department of Orthopaedic Surgery, Ehime Prefectural Central Hospital, 83 Kasugamachi, Matsuyama, Ehime, 790-0024, Japan. 6. Department of Orthopaedic Surgery, Graduate School of Medicine, Keio University, 35 Shinanomachi, Shinjyuku-ku, Tokyo, 160-8582, Japan. 7. Department of Orthopaedic Surgery, Graduate School of Medicine, Hokkaido University, Kita 8, Nishi 5, Kita-ku, Sapporo, Hokkaido, 060-0808, Japan.
Abstract
STUDY DESIGN: A retrospective observational study. OBJECTIVES: To elucidate predictive clinical factors associated with irreversible complete motor paralysis following traumatic cervical spinal cord injury (CSCI). SETTING: Hokkaido Spinal Cord Injury Center, Japan. METHODS: A consecutive series of 447 traumatic CSCI persons were eligible for this study. Individuals with complete motor paralysis at admission were selected and divided into two groups according to the motor functional outcomes at discharge. Initial findings in magnetic resonance imaging (MRI) and other clinical factors that could affect functional outcomes were compared between two groups of participants: those with and those without motor recovery below the level of injury at the time of discharge. RESULTS: Of the 73 consecutive participants with total motor paralysis at initial examination, 28 showed some recovery of motor function, whereas 45 remained complete motor paralysis at discharge, respectively. Multivariate logistic regression analysis showed that the presence of intramedullary hemorrhage manifested as a confined low intensity changes in diffuse high-intensity area and more than 50% of cord compression on MRI were significant predictors of irreversible complete motor paralysis (odds ratio [OR]: 8.4; 95% confidence interval [CI]: 1.2-58.2 and OR: 14.4; 95% CI: 2.5-82.8, respectively). CONCLUSION: The presence of intramedullary hemorrhage and/or severe cord compression on initial MRI were closely associated with irreversible paralysis in persons with motor complete paralysis following CSCI. Conversely, subjects with a negligible potential for recovery could be identified by referring to these negative findings.
STUDY DESIGN: A retrospective observational study. OBJECTIVES: To elucidate predictive clinical factors associated with irreversible complete motor paralysis following traumatic cervical spinal cord injury (CSCI). SETTING: Hokkaido Spinal Cord Injury Center, Japan. METHODS: A consecutive series of 447 traumatic CSCI persons were eligible for this study. Individuals with complete motor paralysis at admission were selected and divided into two groups according to the motor functional outcomes at discharge. Initial findings in magnetic resonance imaging (MRI) and other clinical factors that could affect functional outcomes were compared between two groups of participants: those with and those without motor recovery below the level of injury at the time of discharge. RESULTS: Of the 73 consecutive participants with total motor paralysis at initial examination, 28 showed some recovery of motor function, whereas 45 remained complete motor paralysis at discharge, respectively. Multivariate logistic regression analysis showed that the presence of intramedullary hemorrhage manifested as a confined low intensity changes in diffuse high-intensity area and more than 50% of cord compression on MRI were significant predictors of irreversible complete motor paralysis (odds ratio [OR]: 8.4; 95% confidence interval [CI]: 1.2-58.2 and OR: 14.4; 95% CI: 2.5-82.8, respectively). CONCLUSION: The presence of intramedullary hemorrhage and/or severe cord compression on initial MRI were closely associated with irreversible paralysis in persons with motor complete paralysis following CSCI. Conversely, subjects with a negligible potential for recovery could be identified by referring to these negative findings.
Authors: Steven C Kirshblum; Stephen P Burns; Fin Biering-Sorensen; William Donovan; Daniel E Graves; Amitabh Jha; Mark Johansen; Linda Jones; Andrei Krassioukov; M J Mulcahey; Mary Schmidt-Read; William Waring Journal: J Spinal Cord Med Date: 2011-11 Impact factor: 1.985
Authors: D Lammertse; M H Tuszynski; J D Steeves; A Curt; J W Fawcett; C Rask; J F Ditunno; M G Fehlings; J D Guest; P H Ellaway; N Kleitman; A R Blight; B H Dobkin; R Grossman; H Katoh; A Privat; M Kalichman Journal: Spinal Cord Date: 2006-12-19 Impact factor: 2.772
Authors: M H Tuszynski; J D Steeves; J W Fawcett; D Lammertse; M Kalichman; C Rask; A Curt; J F Ditunno; M G Fehlings; J D Guest; P H Ellaway; N Kleitman; P F Bartlett; A R Blight; V Dietz; B H Dobkin; R Grossman; A Privat Journal: Spinal Cord Date: 2006-12-19 Impact factor: 2.772
Authors: F M Maynard; M B Bracken; G Creasey; J F Ditunno; W H Donovan; T B Ducker; S L Garber; R J Marino; S L Stover; C H Tator; R L Waters; J E Wilberger; W Young Journal: Spinal Cord Date: 1997-05 Impact factor: 2.772
Authors: Michael G Fehlings; Nicholas Theodore; James Harrop; Gilles Maurais; Charles Kuntz; Chris I Shaffrey; Brian K Kwon; Jens Chapman; Albert Yee; Allyson Tighe; Lisa McKerracher Journal: J Neurotrauma Date: 2011-05 Impact factor: 5.269