Determining prognosis after spinal cord injury

Abstract 

Introduction

Disability following traumatic spine injury often requires assessment for judicial reasons.

Objective

To determine the optimum time to carry out a medico-legal evaluation.

Methods

Retrospective study (1995–2000) of patients with traumatic spine injury with a follow-up of five years. The American Spinal Injury Association (ASIA) scale was used to determine level and extent of the injury. Statistical analysis by SPSS 11.0.

Results and discussion

173 injuries were analyzed (39.3% ASIA A; 15.6% ASIA B; 29.47% ASIA C; 15.6% ASIA D). Neurological improvement was detected in 35.83%, more frequently in incomplete injuries. ASIA A injuries remained mainly complete from admission to discharge and in no case reached functional levels. Only a third of ASIA B patients showed improvement, of whom 33.3% were functional. Improvement in ASIA C patients was 76.4%, these and all ASIA D patients were functional on discharge. The condition a year after the injury remained unchanged in all cases, regardless of the extent of injury. Patients who showed improvement did so early on, mainly during hospitalization.

Conclusions

The optimum time for evaluation of spinal cord injury for medicolegal purposes is at one year after the injury. In cases of complete injury, evaluation can be carried out on discharge with no need to wait for one year.

Keywords: Posttraumatic spinal cord injury, Neurological improvement, Sequelae, Medico-legal assessment