Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Nov;67(5):567–571. doi: 10.1136/jnnp.67.5.567

Prognosis and recovery in ischaemic and traumatic spinal cord injury: clinical and electrophysiological evaluation

E Iseli 1, A Cavigelli 1, V Dietz 1, A Curt 1
PMCID: PMC1736605  PMID: 10519858

Abstract

OBJECTIVES—To compare prognostic factors and functional recovery between paraplegic patients with either ischaemic (28 patients) or traumatic (39 patients) spinal cord injury (SCI).
METHODS—On admission to the spinal injury centre and 6 months later the patients underwent clinical (following the guidelines set down by the American Spinal Injury Association) and electrophysiological (tibial and pudendal somatosensory evoked potentials) examinations in parallel. The degree of ambulatory capacity was assessed after discharge from the rehabilitation programme or at least 6 months after trauma.
RESULTS—At the acute stage of either ischaemic or traumatic SCI similar motor and sensory deficits and pathological SSEP recordings were present. Both patient groups recovered to similar degrees with respect to motor, sensory, and ambulatory capacity. The clinical examination in both patient groups was the most sensitive prognostic factor of functional recovery irrespective of the aetiology of the SCI. In the ischaemic patients only the tibial SSEP whereas in the traumatic patients both the pudendal and tibial SSEP were of value in predicting recovery.
CONCLUSIONS—Although the two patient groups are pathophysiologically different, the severity and extent of neurological deficits and rate of recovery are quite similar. In both ischaemic and traumatic SCI clinical and electrophysiological examinations are of prognostic value for the functional recovery.



Full Text

The Full Text of this article is available as a PDF (88.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bednarczyk J. H., Sanderson D. J. Comparison of functional and medical assessment in the classification of persons with spinal cord injury. J Rehabil Res Dev. 1993;30(4):405–411. [PubMed] [Google Scholar]
  2. Cheshire W. P., Santos C. C., Massey E. W., Howard J. F., Jr Spinal cord infarction: etiology and outcome. Neurology. 1996 Aug;47(2):321–330. doi: 10.1212/wnl.47.2.321. [DOI] [PubMed] [Google Scholar]
  3. Curt A., Dietz V. Ambulatory capacity in spinal cord injury: significance of somatosensory evoked potentials and ASIA protocol in predicting outcome. Arch Phys Med Rehabil. 1997 Jan;78(1):39–43. doi: 10.1016/s0003-9993(97)90007-1. [DOI] [PubMed] [Google Scholar]
  4. Curt A., Dietz V. Traumatic cervical spinal cord injury: relation between somatosensory evoked potentials, neurological deficit, and hand function. Arch Phys Med Rehabil. 1996 Jan;77(1):48–53. doi: 10.1016/s0003-9993(96)90219-1. [DOI] [PubMed] [Google Scholar]
  5. Curt A., Keck M. E., Dietz V. Functional outcome following spinal cord injury: significance of motor-evoked potentials and ASIA scores. Arch Phys Med Rehabil. 1998 Jan;79(1):81–86. doi: 10.1016/s0003-9993(98)90213-1. [DOI] [PubMed] [Google Scholar]
  6. Curt A., Rodic B., Schurch B., Dietz V. Recovery of bladder function in patients with acute spinal cord injury: significance of ASIA scores and somatosensory evoked potentials. Spinal Cord. 1997 Jun;35(6):368–373. doi: 10.1038/sj.sc.3100423. [DOI] [PubMed] [Google Scholar]
  7. Ditunno J. F., Jr, Young W., Donovan W. H., Creasey G. The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia. 1994 Feb;32(2):70–80. doi: 10.1038/sc.1994.13. [DOI] [PubMed] [Google Scholar]
  8. Elksnis S. M., Hogg J. P., Cunningham M. E. MR imaging of spontaneous spinal cord infarction. J Comput Assist Tomogr. 1991 Mar-Apr;15(2):228–232. doi: 10.1097/00004728-199103000-00007. [DOI] [PubMed] [Google Scholar]
  9. Foo D., Rossier A. B. Anterior spinal artery syndrome and its natural history. Paraplegia. 1983 Feb;21(1):1–10. doi: 10.1038/sc.1983.1. [DOI] [PubMed] [Google Scholar]
  10. Gaeta T. J., LaPolla G. A., Balentine J. R. Anterior spinal artery infarction. Ann Emerg Med. 1995 Jul;26(1):90–93. doi: 10.1016/s0196-0644(95)70243-1. [DOI] [PubMed] [Google Scholar]
  11. Grundy B. L., Friedman W. Electrophysiological evaluation of the patient with acute spinal cord injury. Crit Care Clin. 1987 Jul;3(3):519–548. [PubMed] [Google Scholar]
  12. Haldeman S., Bradley W. E., Bhatia N. N., Johnson B. K. Pudendal evoked responses. Arch Neurol. 1982 May;39(5):280–283. doi: 10.1001/archneur.1982.00510170022006. [DOI] [PubMed] [Google Scholar]
  13. Houlden D. A., Schwartz M. L., Klettke K. A. Neurophysiologic diagnosis in uncooperative trauma patients: confounding factors. J Trauma. 1992 Aug;33(2):244–251. doi: 10.1097/00005373-199208000-00014. [DOI] [PubMed] [Google Scholar]
  14. Hughes J. T., Brownell B. Spinal cord ischemia due to arteriosclerosis. Arch Neurol. 1966 Aug;15(2):189–202. doi: 10.1001/archneur.1966.00470140079011. [DOI] [PubMed] [Google Scholar]
  15. Jacobs S. R., Yeaney N. K., Herbison G. J., Ditunno J. F., Jr Future ambulation prognosis as predicted by somatosensory evoked potentials in motor complete and incomplete quadriplegia. Arch Phys Med Rehabil. 1995 Jul;76(7):635–641. doi: 10.1016/s0003-9993(95)80632-6. [DOI] [PubMed] [Google Scholar]
  16. Kaplan P. E., Rosen J. S. Somatosensory evoked potentials in spinal cord injured patients. Paraplegia. 1981;19(2):118–122. doi: 10.1038/sc.1981.26. [DOI] [PubMed] [Google Scholar]
  17. Kim S. W., Kim R. C., Choi B. H., Gordon S. K. Non-traumatic ischaemic myelopathy: a review of 25 cases. Paraplegia. 1988 Aug;26(4):262–272. doi: 10.1038/sc.1988.40. [DOI] [PubMed] [Google Scholar]
  18. Pelser H., van Gijn J. Spinal infarction. A follow-up study. Stroke. 1993 Jun;24(6):896–898. doi: 10.1161/01.str.24.6.896. [DOI] [PubMed] [Google Scholar]
  19. Rowed D. W., McLean J. A., Tator C. H. Somatosensory evoked potentials in acute spinal cord injury: prognostic value. Surg Neurol. 1978 Mar;9(3):203–210. [PubMed] [Google Scholar]
  20. Silver J. R., Buxton P. H. Spinal stroke. Brain. 1974 Sep;97(3):539–550. doi: 10.1093/brain/97.1.539. [DOI] [PubMed] [Google Scholar]
  21. Waters R. L., Adkins R., Yakura J., Vigil D. Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association. Arch Phys Med Rehabil. 1994 Jul;75(7):756–760. [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES