Characterizing Natural Recovery after Traumatic Spinal Cord Injury pdf

The predominant tool used to predict outcomes after traumatic spinal cord injury (SCI) is the International Standards for
Neurological Classification of Spinal Cord Injury (ISNCSCI), in association with the American Spinal Injury Association
(ASIA) Impairment Scale (AIS). These measures have evolved based on analyses of large amounts of longitudinal
neurological recovery data published in numerous separate studies. This article reviews and synthesizes published data
on neurological recovery from multiple sources, only utilizing data in which the sacral sparing definition was applied for
determination of completeness. Conversion from a complete to incomplete injury is more common in tetraplegia than
paraplegia. The majority of AIS conversion and motor recovery occurs within the first 6–9 months, with the most rapid
rate of motor recovery occurring in the first three months after injury. Motor score changes, as well as recovery of motor
levels, are described with the initial strength of muscles as well as the levels of the motor zone of partial preservation
influencing the prognosis. Total motor recovery is greater for patients with initial AIS B than AIS A, and greater after
initial AIS C than with motor complete injuries. Older age has a negative impact on neurological and functional recovery
after SCI; however, the specific age (whether >50 or >65 years) and underlying reasons for this impact are unclear.
Penetrating injury is more likely to lead to a classification of a neurological complete injury compared with blunt trauma
and reduces the likelihood of AIS conversion at one year. There are insufficient data to support gender having a major
effect on neurological recovery after SCI.