Prognosis for Recovery After Spinal Cord Injury

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Prognosis for Recovery After Spinal Cord Injury

• Suzanne L. Groah, MD, MSPH

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Recovery After SCI

• Most neurologic recovery occurs in the first 3-6
  months after injury
• Some lesser recovery may continue for up to 18
  months to 2 years

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Recovery After Complete Tetraplegia

• Initial exam at 72 hours to 1 week
• 30-80 regain one motor level by 1 yr
• Initial strength of muscles is significant
  predictor of outcome
• Faster a 0/5 muscles starts to recover, the
  better prognosis

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Recovery After Complete Tetraplegia

• At initial exam ? recovery to 3/5 strength
• 30-40 of first 0/5 muscles
• 70-80 of muscles 1-2/5
• Presence of sensation
• If at 1 month. ? then at 1 year..
• gt95 of 1-2/5 muscles ? 3/5
• 50-60 of first 0/5 muscles ? 1/5
• 25 of first 0/5 muscles ? 3/5
• lt 10 of second 0/5 muscles ? 1/5
• 1 of second 0/5 ? 3/5

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Recovery of Walking

• 90 of people with Brown-Sequard
• 50 with central cord syndrome
• Very few with anterior cord lesion
• 70-90 if ASIA B preservation of PP within
  first few weeks
• Unlikely if ASIA B preservation of LT but not PP

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Recovery of Walking in Tetraplegia

• Very likely if ASIA C/D and age lt 50
• 40 if ASIA C/D and age gt 50
• 46 of incomplete tetraplegics walk at 1 year
• Poor prognosis if LE motor score 20/50 at 1
  month
• Good prognosis if LE motor score 30/50 at 1
  month

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Recovery of Walking in Paraplegics

• More difficult to predict
• Changes from 1 month to 1 year
• 73 do not change NLI
• 18 improve 1 level
• 7 improve 2 levels

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Recovery of Walking in Paraplegics

• No neurologic recovery if complete injury above
  T8
• Some recovery of function
• 15 of those T9 T11
• 55 of those T12 and below
• Incomplete paraplegia has the best potential for
  recovery

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Other Prognostic Factors to Consider

• Reflexes and spinal shock do NOT have an effect
  on outcome
• Exception(s)
• Persistence of Deep Plantar Reflex (DPR)
• Poor prognosis for ambulation
• Absence of bulbocavernosus
• LMN bowel, bladder and sexual function

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Prognosis Related to MRI Findings

• Severe injury associated with
• Intramedullary hemorrhage
• Cord edema more than 1 segment
• Residual spinal cord compression
• Poor recovery associated with
• Severe cord compression, swelling, abnormal
  signal on T1 and T2 images
• No resolution of signal abnormalities

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Prognosis Related to MRI Findings

• 4 indicators for poor prognosis
• Spinal cord hemorrhage
• Length of hemorrhage
• Length of edema
• Spinal cord compression
• CT spinal canal compromise by 25 or more
  correlates with compression on MRI

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Prognosis Related to MRI Findings

• No motor improvement if hemorrhagic lesion
• 72 had some motor recovery if edema segment

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Functional Outcomes by LOI

• C1,2,3- power chair, ECU, ventilator
• C5 - feeding
• C6 - tenodesis grasp
• C7 independent w/ most ADLs
• mobility - manual W/C, transfers
• C8/T1 - bladder/bowel independence
• L 2,3 - Ambulation

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Clinical Impairments after SCI

• Motor
• Sensory
• Bladder/Bowel
• Sexuality
• Autonomic Nervous System

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Acute Secondary Complications After SCI

• Cardiovascular
• Hypotension
• Bradycardia
• Autonomic dysreflexia
• DVT/PE
• Pulmonary
• Restrictive gt Obstructive dysfunction
• Impaired cough
• Atalectasis

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Acute Secondary Complications After SCI

• Bladder
• Inability to void and/or store
• Bowel
• Neurogenic bowel
• Constipation
• Ileus
• Skin decubitus ulcers

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Acute Secondary Complications After SCI

• Osteoporosis
• Hypercalcemia
• Diabetes
• Cardiovascular disease
• Changes in body composition