Superiority of Brain and Spinal Injury Center Score for Assessing Injury Severity and Predicting Prognosis in Patients with Acute Traumatic Spinal Cord Injury

Midsagittal Tissue Bridges as Predictors of Neurological Recovery in Traumatic Cervical Spinal Cord Injury

OBJECTIVE

This study aimed to explore the relationship between intramedullary injury and midsagittal tissue bridges at the epicenter of subacute traumatic cervical spinal cord injury (SCI) and long-term clinical recovery.

METHODS

Imaging and clinical data from 57 traumatic cervical SCI patients at the First Affiliated Hospital of Nanchang University were retrospectively assessed. Midsagittal T2-weighted scans at 1 month postinjury were used to quantify lesion size and tissue bridge width. Correlation analyses were performed to determine the association among tissue bridge width, lesion size, and long-term clinical recovery.

RESULTS

At 1 month after SCI, ventral midsagittal tissue bridges (VMTB), dorsal midsagittal tissue bridges (DMTB), and total midsagittal tissue bridges (TMTB) were associated with better American spinal injury association Impairment Scale grades at 1 year postinjury. Shorter intramedullary lesion length (IMLL) and smaller intramedullary lesion width (IMLW) were linked to better outcomes. TMTB exhibited a stronger correlation with improved American spinal injury association Impairment Scale grades compared to VMTB, DMTB, IMLL, and IMLW. Moreover, IMLL and IMLW were significantly higher, while the DMTB, VMTB, and TMTB widths were significantly lower in patients with a poor prognosis than in those with a good prognosis. Receiver operating characteristic analysis showed TMTB had better predictive performance than other measures.

CONCLUSIONS

The observed association between clinical prognosis and midsagittal tissue bridges underscores the clinical relevance of these structures as neuroimaging biomarkers in patients with subacute SCI. Thus, midsagittal tissue bridges may serve as promising and reliable magnetic resonance imaging biomarkers during the transition from acute to chronic phase for stratifying, treating, and evaluating patient subgroups in clinical trials.

Mapping Theme Trends and Recognizing Hot Spots in Acute Spinal Cord Injury: A Bibliometric Analysis

BACKGROUND

Acute spinal cord injury causes severe motor and sensory dysfunction, significantly burdening individuals and society. This study uses bibliometric analysis to identify research trends and key areas, providing insights for future advancements in treatment.

METHODS

Scientific publications on acute spinal cord injury were collected from PubMed and the Web of Science Core Collection between 2000 and 2022. Data were analyzed using Bibliometric, CiteSpace, and Bibliographic Item Co-occurrence Matrix Builder, with gCLUTO applied for co-word bicluster analysis based on MeSH term matrices.

RESULTS

Two thousand five hundred thirteen publications on acute spinal cord injury were published, with the number of articles increasing annually from 38 to 268. Spinal cord has emerged as the leading journal in this field, and the United States maintains its dominant position in global research impact. The University of Toronto ranks first among research institutions, with significant contributions from researchers such as Fehlings and Kwon. Research on acute spinal cord injury primarily focuses on 7 key areas: metabolism, pharmacology, surgical timing, rehabilitation, pathology, clinical predictors, and diagnostic imaging.

CONCLUSIONS

Our study reveals substantial growth in acute spinal cord injury research over the past 2 decades, emphasizing leading countries, researchers, institutions, and journals. Animal models remain pivotal in drug development for basic medicine and neuroscience. Consensus has been reached among experts regarding the timing of surgical intervention, while artificial intelligence and multidisciplinary approaches are emerging as promising avenues for comprehensive treatment. Additionally, ongoing research into spinal cord injury pathophysiology provides essential guidance for pharmacological and surgical treatments.

MRI variables and peripheral inflammatory response biomarkers predict severity and prognosis in patients with acute cervical traumatic spinal cord injury

OBJECTIVE

Traumatic spinal cord injury (TSCI) stands as one of the most profoundly damaging and debilitating conditions. This study aims to explore the potential of magnetic resonance imaging (MRI) variables and peripheral inflammatory indicators as promising biomarkers. It aims to understand their significance in evaluating the severity and predicting the prognosis of TSCI. Furthermore, the study aims to ascertain whether combining these indicators could enhance the accuracy of injury assessment and predictive prognostic ability.

METHODS

A multicentre retrospective cohort study was conducted to assess the severity and prognostic value of MRI variables and peripheral inflammatory response biomarkers in patients with acute cervical TSCI. The study involved 374 patients with acute cervical TSCI drawn from the First Affiliated Hospital of Nanchang University and the Second Affiliated Hospital of Nanchang University. The severity and prognosis of patients with acute cervical TSCI were assessed using the American Spinal Injury Association Impairment Scale (AIS). The correlation between MRI variables, peripheral inflammatory response biomarkers, admission severity, and the 1-year follow-up prognosis was analysed.

RESULTS

After the initial assessment using the AIS grade system, 169 (49.2%) patients fell into the severe category for cervical TSCI (AIS A-B), while 205 (50.8%) patients were classified as non-severe cases (AIS C-E). The MRI variables (intramedullary lesion length [IMLL], Brain and Spinal Injury Centre [BASIC], maximum spinal cord compression [MSCC], and maximum canal compromise [MCC]) and inflammatory response biomarkers (white blood cells [WBCs], neutrophils, and C-reactive protein [CRP]) exhibited a consistent decrease correlating with the severity grades noted upon admission. Among the 374 patients assessed, 147 (39.3%) experienced a poor prognosis, as indicated by the AIS grade during the 1-year follow-up. MRI variables and peripheral inflammatory response biomarkers declined in correspondence with the follow-up AIS grades. Sex (p < 0.001), IMLL (p < 0.001), MSCC (p < 0.001), MCC (p < 0.001), BASIC (p < 0.001), WBC (p < 0.001), neutrophils (p < 0.001), and CRP (p < 0.001) were statistically significant in predicting poor outcomes. Through multivariate logistic regression analysis, BASIC score and CRP emerged as independent predictors of poor prognosis. Notably, the model combining the BASIC score and CRP yielded a larger area under the curve compared to models using only the BASIC score or CRP individually.

CONCLUSIONS

The BASIC score and CRP are crucial biomarkers for evaluating the severity of cervical TSCI and predicting prognosis. Their combination proved to be a more robust determinant of injury severity and a better predictor of neurological recovery.

Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury

The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a spinal cord injury (SCI), supraspinal influences on the spinal segmental control system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, pain and dysesthesia, sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of traumatic SCI, current and emerging methods of classification, and its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue.