Abstract
Study design
Retrospective cohort study.
Objectives
To define the prognosis and predictive factors for neurological improvement in older patients with incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale grade C (AIS-C).
Settings
Multi-institutions in Japan.
Methods
We included patients aged ≥65 years with traumatic SCI of AIS-C who were treated conservatively or surgically with >3 follow-up months. To identify factors related to neurological improvement, patients were divided into three groups according to their neurological status at the final follow-up, with univariate among-group comparisons of demographics, radiographic, and therapeutic factors. Significant variables were included in the multivariate logistic regression analysis.
Results
Overall, 296 older patients with SCI of AIS-C on admission were identified (average age: 75.2 years, average follow-up: 18.7 months). Among them, 190 (64.2%) patients improved to AIS-D and 21 (7.1%) patients improved to AIS-E at final follow-up. There were significant among-group differences in age (p = 0.026), body mass index (p = 0.007), status of pre-traumatic activities of daily living (ADL) (p = 0.037), and serum albumin concentrations (p = 0.011). Logistic regression analysis showed no significant differences in variables in the stratified group of patients who improved to AIS-D. Meanwhile, serum albumin was a significant variable in patients who improved to AIS-E (p = 0.026; OR: 6.20, pre-traumatic ADL was omitted due to data skewness).
Conclusions
Most older patients with incomplete AIS-C SCI demonstrated at least 1 grade of neurological improvement. However, <10% of patients achieved complete recovery. Key predictors of complete recovery were high serum albumin levels on admission and independent pre-traumatic ADL.
Sponsorship
No funding was received for this study.
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Data availability
The datasets generated during the current study are available from the corresponding author on reasonable request.
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All authors contributed to the collection of clinical data. KT and HT led the drafting of this manuscript in collaboration with other authors. SK, GI, KA, HN, TK, TF, and KW closely revised many sections. All authors contributed to all sections of the manuscript and edited it for key intellectual content. All other authors have read and provided substantive intellectual comments to the draft and have approved the final version of the paper.
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The authors declare no competing interests.
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The institutional review board of the representative facility reviewed and approved this study (Institutional Review Board of Kanazawa University, No. 3352-1).
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Tamai, K., Terai, H., Nakamura, H. et al. Neurological recovery rate and predictive factors of incomplete AIS grade C spinal cord injury in the older aged population. Spinal Cord 62, 149–155 (2024). https://doi.org/10.1038/s41393-024-00963-0
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DOI: https://doi.org/10.1038/s41393-024-00963-0
