Study of neurological and functional outcomes in individuals with iatrogenic spinal cord injury.

Abstract

Objective: Spinal cord injury (SCI) can result in serious disability and requires a high level of medical care. The aim of this study is to determine the incidence and common causes of iatrogenic SCI and to assess the neurological and functional recovery at two years post injury.

Design: This was a retrospective study.

Setting: Single-center study in a dedicated spinal cord injury center conducted between April 2013 and March 2017.

Participants: All patients admitted with postoperative iatrogenic SCI.

Interventions: The study reviewed details of the initial surgical procedure leading to iatrogenic SCI, along with the neurological and functional outcomes.

Outcome measures: The neurological outcome was assessed using ASIA Impairment Scale (AIS) while the functional outcome was assessed by the Spinal Cord Independence Measure (SCIM) scale.

Results: The mean age was 57.3 ± 19.0 years, with 55.8% over 60 years. The leading causes of iatrogenic SCI were ischemic insult following vascular procedures (18.6%), inadequate spinal decompression (13.9%), mechanical pressure from postoperative hematoma or pseudomeningocele (11.6%). In 37.2% of cases, no definitive cause was identified.Partial recovery was observed at 2 years (AIS A: 5, B: 2, C: 12, D: 8, E: 1). Functional independence improved significantly as indicated by the rise in SCIM scores. At 2-year follow-up, 39.5% individuals regained some ambulation. Bladder and bowel function normalized in 34.8% and 41.8% individuals respectively. Persistent neuropathic pain and muscle spasms were reported in 10 and 8 patients, respectively.

Conclusion: Although there may be varied etiologies for iatrogenic SCI, a rapid and thorough workup and prompt intervention ensures the best chance of neurological recovery.