Article

OBJECTIVE: To assess the patterns of sacral sparing and recovery in newly injured
persons with traumatic spinal cord injury (SCI). DESIGN: Retrospective analysis
of data from the national Spinal Cord Injury Model Systems (SCIMS) database for
patients enrolled from January 2011 to February 2015. SETTING: SCIMS centers.
PARTICIPANTS: Individuals (N=1738; age >/=16y) with traumatic SCI admitted to
rehabilitation within 30 days after injury with follow-up at discharge, at 1 year, or both. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES:
International Standards for Neurological Classification of Spinal Cord Injury
examination results at admission and follow-up (discharge or 1y, or both).
RESULTS: Conversion from an initial American Spinal Injury Association Impairment
Scale (AIS) grade A to incomplete status was 20% at rehabilitation discharge and
27.8% at 1 year, and was greater in cervical and low paraplegia levels (T10 and
below) than in high paraplegia level injuries (T1-9). Conversion from AIS B to
motor incomplete was 33.9% at discharge and 53.6% at 1 year, and the initial
sparing of all sacral sensory components was correlated with the greatest
conversion to motor incomplete status at discharge and at 1 year. For patients
with initial AIS C, the presence of voluntary anal contraction (VAC) in
association with other sacral sparing was most frequently observed to improve to
AIS D status at discharge. However, the presence of VAC alone as the initial
sacral sparing component had the poorest prognosis for recovery to AIS D status.
At follow-up, regaining sacral sparing components correlated with improvement in
conversion for patients with initial AIS B and C. CONCLUSIONS: The components of
initial and follow-up sacral sparing indicated differential patterns of
neurologic outcome in persons with traumatic SCI. The more sacral components
initially spared, the greater the potential for recovery; and the more sacral
components gained, the greater the chance of motor recovery. Consideration of
whether VAC should remain a diagnostic criterion sufficient for motor incomplete
classification in the absence of other qualifying sublesional motor sparing is
recommended.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS