Unveiling the mosaic: comparing demographics and outcomes in traumatic vs. non-traumatic spinal cord injuries.

Abstract

Background: This study analyzed the percentage of patients with nontraumatic spinal cord injury (SCI) which is increasing with the increase of population age. However, little is known about the effect of the etiology of SCI on the outcome of these subjects.

Aim: The aim of this study was to investigate functional and neurological outcomes in patients with traumatic and nontraumatic spinal cord lesions, with a focus on factors influencing rehabilitation outcomes.

Design: The design of this study was that of a retrospective analysis of prospectively recorded data.

Setting: The setting of this analysis was a single Spinal Unit in Italy.

Population: The population included 1080 subjects, of which 599 (55%) had injuries of traumatic origin and 481 (45%) had nontraumatic injuries.

Methods: International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI) were utilized as measurement tools. Multivariate (backwards selection, P=0.20) logistic regression was used to assess the associations of "complication during hospitalization," "bowel management autonomy," "spontaneous micturition," "home destination" and "neurological improvement" with the following variables: etiology, age, sex, lesion level and severity and length of stay. Multivariate (backwards selection, P=0.20) negative binomial regression was used to assess the relative risks of higher SCIM and WISCI Scores at discharge after adjusting for the abovementioned variables.

Results: Our work highlighted several significant differences between the traumatic and nontraumatic groups (including age, sex, lesion severity, and time from lesion onset to admission). Both groups exhibited comparable improvements in neurological and functional status, although some data were in favor of subjects with traumatic lesions. However, the regression analyses demonstrated that the main factors impacting the neurological and functional status at discharge were age, lesion level and severity, rather than the etiology of the lesion.

Conclusions: Our study provides valuable insights into the rehabilitation trajectories of traumatic and nontraumatic spinal cord injuries and demonstrates that the cause of SCI has no impact on rehabilitation outcomes.

Clinical rehabilitation impact: An understanding of neurological and functional recovery after spinal cord lesions is essential for answering patients' questions about their potential functional capabilities. It also assists in determining the necessary resources for inpatient rehabilitation and post discharge care. Moreover, the possession of a thorough grasp of the course and factors influencing the natural recovery of a spinal cord lesion is now a scientific necessity and is crucial for assessing the efficacy of new pharmacological and rehabilitative methods.