Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: An update from the national spinal cord injury database

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Study describes changes in upper- (UEMS) and lower-extremity (LEMS) motor scores, the American Spinal Injury Association Impairment Scale (AIS) grade, and motor level in people with traumatic tetraplegia from the National Spinal Cord Injury Database. Data were extracted for 1,436 subjects with tetraplegia with at least 2 examinations, the first within 7 days of injury. For subjects initially classified as AIS grade A, 22 percent converted to AIS grade B or better by rehabilitation discharge; 30 percent converted to grade B by 1 year, with 8 percent to grade C and 7.1 percent to grade D. Conversion from complete to motor incomplete was not related to timing of the initial examination or initial neurologic level. For AIS grade B, 34 percent remained motor complete, 30 percent became AIS grade C, and 37 percent became grade D by 1 year. Although 82.5 percent of those with AIS grade C improved to AIS grades D and E, mean 1-year UEMS score was only 35 points. UEMS scores in patients with AIS grade A increased a mean of 9 to 11 points, except for C1 to C3 and C8 to T1 motor levels (gain, 2 to 3 points). Motor level was unchanged or ascended in 35 percent and improved 1 level in 42 percent, 2 levels in 14 percent, and more than 2 levels in 9 percent. Motor zone of partial preservation of 2 segments or more was associated with gain of 2 or more motor levels, with a relative risk of 5.0.

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