Prognostic value of tissue bridges in cervical spinal cord injury: a longitudinal, multicentre, retrospective cohort study
Year: 2024
Type: article
Study design: Observational Study
Abstract: BACKGROUND: The accuracy of prognostication in patients with cervical spinal cord injury (SCI) needs to be improved. We aimed to explore the prognostic value of preserved spinal tissue bridges-injury-spared neural tissue adjacent to the lesion-for prediction of sensorimotor recovery in a large, multicentre cohort of people with SCI. METHODS: For this longitudinal study, we included patients with acute cervical SCI (vertebrae C1-C7) admitted to one of three trauma or rehabilitation centres: Murnau, Germany (March 18, 2010-March 1, 2021); Zurich, Switzerland (May 12, 2002-March 2, 2019); and Denver, CO, USA (Jan 12, 2010-Feb 16, 2017). Patients were clinically assessed at admission (baseline), at discharge (3 months), and at 12 months post SCI. Midsagittal tissue bridges were quantified from T2-weighted images assessed at 3-4 weeks post SCI. Fractional regression and unbiased recursive partitioning models, adjusted for age, sex, centre, and neurological level of injury, were used to assess associations between tissue bridge width and baseline-adjusted total motor score, pinprick score, and light touch scores at 3 months and 12 months. Patients were stratified into subgroups according to whether they showed better or worse predicted recovery. FINDINGS: The cohort included 227 patients: 93 patients from Murnau (22 [24%] female); 43 patients from Zurich (four [9%] female); and 91 patients from Denver (14 [15%] female). 136 of these participants (from Murnau and Zurich) were followed up for up to 12 months. At 3 months, per preserved 1 mm of tissue bridge at baseline, patients recovered a mean of 9·3% (SD 0·9) of maximal total motor score (95% CI 7·5-11.2), 8·6% (0·8) of maximal pinprick score (7·0-10·1), and 10·9% (0·8) of maximal light touch score (9·4-12·5). At 12 months post SCI, per preserved 1 mm of tissue bridge at baseline, patients recovered a mean of 10·9% (1·3) of maximal total motor score (8·4-13·4), 5·7% (1·3) of maximal pinprick score (3·3-8·2), and 6·9% (1·4) of maximal light touch score (4·1-9·7). Partitioning models identified a tissue bridge cutoff width of 2·0 mm to be indicative of higher or lower 3-month total motor, pinprick, and light touch scores, and a cutoff of 4·0 mm to be indicative of higher and lower 12-month scores. Compared with models that contained clinical predictors only, models additionally including tissue bridges had significantly improved prediction accuracy across all three centres. INTERPRETATION: Tissue bridges, measured in the first few weeks after SCI, are associated with short-term and long-term clinical improvement. Thus, tissue bridges could potentially be used to guide rehabilitation decision making and to stratify patients into more homogeneous subgroups of recovery in regenerative and neuroprotective clinical trials. FUNDING: Wings for Life, International Foundation for Research in Paraplegia, EU project Horizon 2020 (NISCI grant), and ERA-NET NEURON.
Source: The Lancet Neurology
Institutions: University of Zurich, Universitätsklinik Balgrist, Stanford Medicine, Stanford University, Craig Hospital, University of Colorado Anschutz, University of Colorado Denver, Berufsgenossenschaftliche Unfallklinik Murnau, Paracelsus Medical University, The Ohio State University Wexner Medical Center, Stiftung Charité, The Ohio State University, Charité – Universitätsmedizin Berlin, UCL Queen Square Institute of Neurology, University College London, Wellcome Centre for Human Neuroimaging, Max Planck Institute for Human Cognitive and Brain Sciences
Language: English
Topic: Spinal Cord Injury Research
Subfield: Pathology and Forensic Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $6,300
Funders: National Science Foundation, Craig H. Neilsen Foundation, Boettcher Foundation, Ohio State University, Wings for Life, Wings for Life, European Commission, International Foundation for Research in Paraplegia, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Bundesministerium für Bildung und Forschung, Universität Zürich, National Institutes of Health, HORIZON EUROPE Framework Programme, Horizon 2020, National Institute of Neurological Disorders and Stroke, National Institute of Child Health and Human Development, National Institute on Disability, Independent Living, and Rehabilitation Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: Investigating movement-induced corticospinal modulation of pain in fibromyalgia using simultaneous brain and spinal cord functional magnetic resonance imaging, G1266080218, G192810579, G2027012013, G2088932917, G2462965080, Neuroimaging-Based Brain and Spinal Cord Biomarkers for Cervical Radiculopathy, G2779677476, Characterization of central pain mechanisms using simultaneous spinal cord-brain functional imaging, Reducing Infection Susceptibility by Immune Function Restoration in Spinal Cord Injury, NEURON-Verbund hMRTofScI: Entschlüsselung der pathophysiologischen Prozesse induziert durch eine Querschnittlähmung: Anwendung von MRT basierter in vivo und ex vivo Histologie, G3910624553, G4315722230, G434337789, G4781570407, G558841523, NEURON-Verbund hMRIofSCI: Entschlüsselung der pathophysiologischen Prozesse induziert durch eine Querschnittlähmung: Anwendung von MRT basierter in vivo und ex vivo Histologie, G5927361938, G6502170807, G6654945512, G7412116791, Antibodies against Nogo-A to enhance plasticity, regeneration and functional recovery after acute spinal cord injury, a multicenter European clinical proof of concept trial, G78808603, Protecting Endogenous Recovery from the "Infectious Insult" in Spinal Cord Injury, Improving mechanistic understanding of responsiveness to spinal cord stimulation after spinal cord injury
OpenAlex ID: W4400066735