Recovery after thoracic and lumbar traumatic spinal cord injury: the neurological level of lesion matters
Radboud University Medical Center, Nijmegen, Gelderland, The netherlands
Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are well-known neurological entities. It is assumed that these syndromes are different regarding neurological and functional prognosis. However, literature concerning spinal trauma is ambiguous about the exact definition of the syndromes. In may 2017 a systematic review was published by Spinal Cord. Based on this review and anatomical data from cadaveric and radiological studies, CMS and CES could be more precisely defined. CMS may result from injury of vertebrae Th12–L2, and it involves damage to neural structures from spinal cord segment Th12 to nerve root S5. CES may result from an injury of vertebrae L3–L5, and it involves damage to nerve roots L3–S5. This differentiation between CMS and CES is necessary to examine the hypothesis that CES patients tend to have a better functional outcome. Consequently, we have applied this allocation of traumatic SCI patients in a successive study to identify the differences in neurological and functional outcome in patients with a thoracic spinal cord injury (TSCI) compared with a Conus Medullaris (CMS) and Cauda Equina syndrome (CES) to help care givers to understand the differences in functional outcome and to provide patients clear view about the prognosis.
Design/Methods: neurological outcome was measured with the Lower Extremity Motor Score (LEMS) of the International Standard of Neurological Classification of Spinal Cord Injury (ISNCSCI) and functional outcome was measured with the Spinal Cord Independence Measure III (SCIM III). Outcome of patients with a Thoracic spinal cord injury (TSCI) was compared to outcome of patients with CMS and CES. Outcome measurement was performed in the acute phase and at 1, 3, 6 and 12 months after injury. Linear mixed models were used to statistically analyze the differences in outcome between patients with TSCI and patients with CMS/CES.
Results: Data from 1573 patients could be extracted of whom 852 (54%) suffered from traumatic TSCI, 415 (26%) from traumatic CMS, and 306 (20%) from a traumatic CES. Irrespective of the severity of the initial AIS, all patients showed the similar recovery pattern. Patients with AIS D had the best outcome, followed by AIS C, B, and finally A. Neurological recovery as measured with the LEMS in TSCI, CMS and CES was respectively 5.2, 11.2 and 9.4 motor points. Functional recovery as measured with the SCIM in TSCI, CMS and CES was respectively 51.4, 54.9 and 52.7 points. Functional outcome differed significantly between T-SCI, CMS and CES for AIS A and B patients.
Conclusion: patients with CES showed a significantly better recovery compared with CMS patients, and patients with a CMS recovered significantly better that patients with TSCI. However, 12 months after trauma difference in functional outcome was only seen in AIS A and B patients. For AIS C and D patients, this difference was not significant.
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