Recovery after spinal cord infarcts: Long-term outcome in 115 patients

Carrie E. Robertson, Robert D Jr. Brown, Eelco F M Wijdicks, Alejandro Rabinstein

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Objective: To investigate the long-term outcome of patients with spinal cord infarct (SCI) and identify prognostic predictors. Methods: We reviewed 115 patients with SCI treated between 1990 and 2007. Severity of impairment was defined using the American Spinal Injury Association (ASIA) scoring. Functional outcome endpoints were ambulatory status, need for bladder catheterization, and pain. Results: Mean age was 64 years; 72 (62.6%) patients were men. A total of 45% of infarcts were perioperative (69% aortic surgeries). A total of 68% reached maximal deficit within 1 hour (mean = 5 hours). Impairment at nadir was ASIA A 23%, B 26%, C 14%, and D 37%. A total of 75/93 (81%) patients studied with MRI had cord signal abnormality. At nadir, 81% required wheelchair, 86% required catheterization, and 32% had pain. At last follow-up (mean = 3 years), 23% had died. Among survivors, 42% required a wheelchair, 54% required catheterization, and 29% had pain upon last follow-up. Of 74 patients using a wheelchair at hospital dismissal, 41% were walking by final follow-up. Of 83 patients catheterized at dismissal, 33% were catheterfree at last follow-up. Older age (p < 0.0001), increased severity of impairment at nadir (p = 0.02), and peripheral vascular disease (p = 0.003) were independent risk factors for mortality. Severe impairment (ASIA A/B) at nadir predicted wheelchair use (p < 0.0001) and bladder catheterization (p < 0.0001) at last follow-up. Conclusions: Gradual improvement in not uncommon after spinal cord infarction and it may continue long after hospital dismissal. While severe impairment at nadir is the strongest predictor of poor functional outcome, meaningful recovery is also possible in a substantial minority of these patients.

Original languageEnglish (US)
Pages (from-to)114-121
Number of pages8
JournalNeurology
Volume78
Issue number2
DOIs
StatePublished - Jan 10 2012

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Spinal Cord
Wheelchairs
Catheterization
Spinal Injuries
Pain
Urinary Bladder
Peripheral Vascular Diseases
Recovery
Cord
Infarction
Walking
Survivors
Impairment
Mortality
Wheelchair

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Recovery after spinal cord infarcts : Long-term outcome in 115 patients. / Robertson, Carrie E.; Brown, Robert D Jr.; Wijdicks, Eelco F M; Rabinstein, Alejandro.

In: Neurology, Vol. 78, No. 2, 10.01.2012, p. 114-121.

Research output: Contribution to journalArticle

Robertson, Carrie E. ; Brown, Robert D Jr. ; Wijdicks, Eelco F M ; Rabinstein, Alejandro. / Recovery after spinal cord infarcts : Long-term outcome in 115 patients. In: Neurology. 2012 ; Vol. 78, No. 2. pp. 114-121.
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AB - Objective: To investigate the long-term outcome of patients with spinal cord infarct (SCI) and identify prognostic predictors. Methods: We reviewed 115 patients with SCI treated between 1990 and 2007. Severity of impairment was defined using the American Spinal Injury Association (ASIA) scoring. Functional outcome endpoints were ambulatory status, need for bladder catheterization, and pain. Results: Mean age was 64 years; 72 (62.6%) patients were men. A total of 45% of infarcts were perioperative (69% aortic surgeries). A total of 68% reached maximal deficit within 1 hour (mean = 5 hours). Impairment at nadir was ASIA A 23%, B 26%, C 14%, and D 37%. A total of 75/93 (81%) patients studied with MRI had cord signal abnormality. At nadir, 81% required wheelchair, 86% required catheterization, and 32% had pain. At last follow-up (mean = 3 years), 23% had died. Among survivors, 42% required a wheelchair, 54% required catheterization, and 29% had pain upon last follow-up. Of 74 patients using a wheelchair at hospital dismissal, 41% were walking by final follow-up. Of 83 patients catheterized at dismissal, 33% were catheterfree at last follow-up. Older age (p < 0.0001), increased severity of impairment at nadir (p = 0.02), and peripheral vascular disease (p = 0.003) were independent risk factors for mortality. Severe impairment (ASIA A/B) at nadir predicted wheelchair use (p < 0.0001) and bladder catheterization (p < 0.0001) at last follow-up. Conclusions: Gradual improvement in not uncommon after spinal cord infarction and it may continue long after hospital dismissal. While severe impairment at nadir is the strongest predictor of poor functional outcome, meaningful recovery is also possible in a substantial minority of these patients.

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