Romanian Neurosurgery (Dec 2024)
Initial ASIA impairment scale and its association with improvement in cervical spinal cord injury
Abstract
Background: Cervical spinal cord injuries (SCI) are a severe subset of trauma cases, with important impacts on functional abilities and quality of life. Effective management strategies are crucial for improving outcomes. Objective: This study evaluates the impact of initial ASIA impairment scale (AIS) grades on recovery and outcomes in cervical SCI. Methods: A retrospective analysis of 565 patients with cervical SCI was conducted. Variables included age, gender, mode of injury, the timing of intervention, injury levels, management strategies, and outcomes based on initial and discharge AIS scores were analysed. Results: The cohort comprised 565 patients, with age distribution as follows: 1-20 years (12.9%, n=73), 21-40 years (47.6%, n=269), 41-60 years (31.4%, n=177), and over 60 years (8.1%, n=46). Males predominated (86.9%, n=491). Age did not significantly affect outcomes (p=0.42), and while males had a 28.5% good outcome rate, females had a 39.2% rate (p=0.06). Road traffic accidents were the leading cause of injury (41.8%, n=236) but had a lower good outcome rate (22.9%) compared to falls (34.7%, n=196) with a higher good outcome rate (38.3%). Animal attacks showed the highest good outcome rate (66.7%, n=20). Timing of intervention did not significantly impact outcomes (p=0.16 for injury-to-admission and p=0.793 for timing of surgery). Subaxial cervical injuries were the most common (93.9%). Among 247 surgical patients, discectomy was most frequently performed. Complications occurred in 19.65% of patients, primarily pressure sores. The in-hospital mortality rate was 8.67%, with 79.47% discharged and 11.86% leaving against medical advice. Recovery was most pronounced in ASIA C (93.7%) and ASIA D (94.3%) patients. ASIA B patients showed a significant improvement rate (74.1%), while ASIA A patients had the lowest improvement (34.8%) (p<0.0001). Conclusion: Initial ASIA grades are strong predictors of neurological recovery in cervical SCI, with incomplete injuries (ASIA C and D) showing good outcomes. Management strategies, including early intervention and surgical approaches, play a crucial role in recovery. Despite some variability in outcomes based on injury cause and management, ASIA grading remains a critical tool for assessing prognosis and guiding treatment.
