Long-term Outcomes After Periprocedural and Spontaneous Spinal Cord Infarctions: A Population-Based Cohort Study

Neurology, 2023 · DOI: 10.1212/WNL.0000000000207377 · Published: July 11, 2023

Simple Explanation

Spinal cord infarction (SCInf) is a rare condition where consensus regarding diagnostic criteria is lacking, and misdiagnosis or delayed diagnosis can be detrimental. Patients with SCInf may experience a wide array of symptoms, from back pain to sensory or motor deficits, affecting bladder, bowel, and autonomic functions, making diagnosis challenging. This study reviews institutional experience of SCInf, focusing on risk factors and outcome predictors, evaluated in relation to diagnostic criteria proposed by Zalewski et al.

Study Duration

2006-2019

Participants

57 adult patients with spinal cord infarction

Evidence Level

Not specified

Key Findings

1
Patients with spontaneous SCInf showed significantly better admission AIS, fewer multilevel SCInf, shorter hospital stay, and better AIS and ambulatory status on long-term follow-up.
2
Spontaneous SCInfs and more favorable admission AIS were significant predictors of more favorable AIS at follow-up, with admission AIS demonstrating independent predictive ability.
3
Significant improvements were seen in the AIS and FIM motor scores at follow-up, highlighting the importance of active rehabilitation.

Research Summary

This study reviewed institutional experience with SCInf and evaluated predictors of outcome, dividing the cohort into spontaneous and periprocedural cases. Spontaneous SCInf tended to affect a single spinal cord segment and was associated with better AIS on admission, while periprocedural cases affected more segments and had poorer AIS on admission. Significant improvements were seen in AIS and FIM motor scores at follow-up, with spontaneous SCInf patients showing more favorable AIS compared to periprocedural SCInf patients.

Practical Implications

Diagnostic Criteria Adoption

The study supports the adoption of diagnostic criteria proposed by Zalewski et al. for SCInf, highlighting the importance of clinical examination and alternative diagnostic tools when MRI is inconclusive.

Tailored Management Approach

The findings suggest that a tailored approach may be warranted in the management of patients based on the nature of their SCInf, considering the differences in outcomes between spontaneous and periprocedural cases.

Active Rehabilitation Importance

Long-term improvements in both AIS and FIM motor scores emphasize the critical role of active rehabilitation in improving outcomes for patients with SCInf.

Study Limitations

1
Small sample size
2
Retrospective study design
3
The exact time interval from symptom onset to MRI examination could not be deﬁned

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