Medical Student Carle Illinois College of Medicine, Minnesota, United States
Introduction: Cervical spinal cord injury (C-SCI) is associated with high rates of morbidity and mortality. Surgical management can provide stabilization for some patients and prevent further neurological damage to the cervical spinal cord. The impact of surgery on rehabilitation is less understood, and the authors investigated how surgical intervention after cervical SCI impacted functional recovery in in-patient rehabilitation.
Methods: We queried the Spinal Cord Injury Model Systems (SCIMS) database for patients with known cervical spinal cord injury discharge functional outcomes for measures of the Functional Independence Measure (FIM). Multivariate analysis used propensity-adjustment for demographic and clinical characteristics. Multiple subcategories of the FIM were investigated, and dichotomized to independent (FIM = 6, 7) and dependent (FIM = 1-5).
Results: 451 patients were abstracted (Surgery = 397; No Surgery = 54). There was a significant difference in age between patients that received surgery and those that did not (p = 0.03). A greater proportion of non-surgical patients were older than 75 years (18.5% vs. 6.5%). Patients that received surgery had a prolonged hospitalization prior to rehabilitation. FIM was greater for non-surgical patients at admission to rehabilitation (p < 0.001). A greater proportion of surgical patients were ASA-A and -B (36% vs. 18.5%). 67% of non-surgical patients had ASA-D neurological impairment (p = 0.02). In a propensity-adjusted analysis, surgical patients had greater odds of independent walk/wheelchair mobility (OR = 1.99, 95% CI: 1.01 - 3.91, p = 0.045), but lower odds of independent bathing (OR = 0.47, 95% CI: 0.23 - 1.00, p = 0.047).
Conclusion : After surgery for C-SCI, patients in in-patient rehabilitation are likely to regain functional mobility, but less likely to regain functional independence in self-care activities such as bathing. More aggressive intervention post-operatively could be performed to reduce this association. Additional longitudinal studies should be performed to validate these findings.
