Prognostic Factors of Ambulation and Lower Extremity Motor Outcomes after Cervical Spinal Cord Injury

Introduction: Improvement of ambulation and motor function is a key criterion of recovery for cervical spinal cord injury (cSCI) patients. While various motor function scoring systems have provided a quantitative metric for trending recovery, it has been difficult to predict which patients will recover lower extremity motor function after injury. Although studies have identified individual factors associated with improved recovery after cervical spinal cord injury, there has been no summary review on this topic. The objective of this study was to systematically review the literature for the prognostic factors of lower extremity motor and ambulation outcomes after cSCI to better inform patient care.

Methods: We searched MEDLINE (PubMed), Embase (Elsevier), Scopus (Elsevier), and SPORT Discus (EBSCOhost) for terms related to cSCI, ambulation, motor outcomes, and prognostic factors. Pediatric populations, case reports, editorials, letters, and comments to the editor were excluded.

Results: Of 3,191 studies identified, 66 texts met inclusion and exclusion criteria. There was a total of 10,364 patients. A majority of patients had traumatic injury. Of the prognostic factors identified, the most frequently published prognostic factors included initial motor score as well as initial imaging findings including intramedullary lesion length, hemorrhage, cord compression, cord swelling, canal compromise and MRI cord intensity/pattern. Age and timing of surgical intervention were also key features, with younger patients and earlier time to surgery generally associated with improved motor and ambulation outcomes. Other patient specific factors that were related to decreased functional outcomes included male gender, Black race, previous spine comorbidities, and CSF biomarkers.

Conclusion : There have been a wide variety of prognostic factors identified in the literature associated with ambulation and motor outcomes after cSCI. Initial motor score, MRI findings, timing to surgical intervention, and patient specific factors should be carefully considered in the care of these patients to optimize motor and ambulation recovery.