Diagnosis and Prognosis of Traumatic Spinal Cord Injury

摘要

Despite promising advances in basic spinal cord repair research, no effective therapy resulting in major neurological or functional recovery after traumatic spinal cord injury (tSCI) is available to date. The neurological examination according to the International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients (International Standards) has become the cornerstone in the assessment of the severity and level of the injury. Based on parameters from the International Standards, physicians are able to inform patients about the predicted long-term outcomes, including the ability to walk, with high accuracy. In those patients who cannot participate in a reliable physical neurological examination, magnetic resonance imaging and electrophysiological examinations may provide useful diagnostic and prognostic information. As clinical research on this topic continues, the prognostic value of the reviewed diagnostic assessments will become more accurate in the near future. These advances will provide useful information for physicians to counsel tSCI patients and their families during the catastrophic initial phase after the injury. Keywords: spinal cord injury, diagnosis, prognosis, review Traumatic spinal cord injury (SCI) is a serious disorder that has a profound impact on a patient’s physical and psychosocial well-being. The incidence of tSCI is estimated to be 11 to 53 new cases per million population. 1 2 Epidemiological data from the 1980s show that spinal cord injury (SCI) primarily affects young adults (mean age: 29 years). During the last three decades, however, the proportion of elderly SCI subjects increased considerably. Currently, the average age at injury is estimated to be 45 years. 3–5 For all age groups, people with incomplete tetraplegia made up the highest number (30.1%), followed by complete paraplegia (25.6%), complete tetraplegia (20.4%), and incomplete paraplegia (18.5%). 1 Although promising advances in basic spinal cord repair research have been made, no effective therapy resulting in major neurological or functional recovery after tSCI is available to date. 6 Despite the absence of a cure, significant progress has been made with regard to the care of SCI patients during the 21st century. Since the discovery and use of antibiotics, the prevention of complications, and the introduction of specialized care by the founding fathers of SCI rehabilitation, Dr. Donald Munro and Sir Ludwig Guttmann, survival rates in the SCI population increased dramatically. 7 After the initial medical stabilization of a patient with tSCI, the following aspects are of importance: (1) invasive monitoring and hemodynamic support to maintain mean blood pressure above 90 mm Hg, 8 (2) preventing occurrence of complications, and (3) determining long-term outcomes as accurately as possible. In the early days after the injury, patients and their families want to know whether they will be able to walk again and whether they will be able to perform self-care activities such as feeding, bathing, and clothing. 9 An accurate assessment of the level and severity of the tSCI is the key for predicting functional outcomes. This review will present the prognostic value and clinical utility of contemporary diagnostic instruments for tSCI.