Neurological and functional recovery after thoracic spinal cord injury

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Study examined the neurological and functional outcomes after thoracic spinal cord injury (SCI) through a retrospective analysis of data from the SCI Model Systems database for 661 subjects with initial neurological level of injury from T2–12. Two hundred sixty-five subjects had second neurological exams and 400 subjects had Functional Independence Measure (FIM) scores 6 or more months after injury. Data on American Spinal Injury Association Impairment Scale (AIS) grade, sensory level (SL), lower-extremity motor scores (LEMS), and FIM scores were included in the analysis. At baseline, 73 percent of subjects were AIS A, and among them, 15.5 percent converted to motor incomplete. The mean SL increase for subjects with an AIS A grade was 0.33; 86 percent remained within two levels of baseline. Subjects with low thoracic paraplegia (T10–12) demonstrated greater LEMS gain than high paraplegia (T2–9), and also had higher 1-year FIM scores. Better FIM scores were also correlated with better AIS grades, younger age, and increase in AIS grade. Ability to walk at 1 year was associated with low thoracic injury, higher initial LEMS, incomplete injury, and increase in AIS grade. Findings suggest that minimal neurological recovery is seen in individuals with complete thoracic SCI, especially those with levels above T10. People who are older at the time of injury have poorer functional recovery than younger people. Also, conversion to a better AIS grade is associated with improvement in self-care and mobility at 1 year.

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