The combination of a person's age and the results of four neurological tests accurately predicts the chances of that person walking again after a serious spinal cord injury. The findings are reported in an Article Online First and in an upcoming Lancet, written by Dr Joost J van Middendorp, Spine Unit, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands, and colleagues.
This pan-European study looked at 1442 patients with spinal cord injuries at 19 centres. A combination of age (being under 65 versus over 65 years), and tests assessing the motor scores of the quad muscles (in the leg), calf muscles, and sensation of skin at the inner side of the knee and outer side of the ankle showed excellent discrimination in distinguishing independent walkers from dependent walkers and non-walkers. The very accurate (>95%) prediction of walking outcomes was confirmed in a second series of patients.
The authors conclude: "We have developed a simple clinical prediction rule derived from data from a large prospective European database that can be used by physicians to counsel patients with traumatic spinal cord injury and their families during the initial phase after injury. On the basis of age and four clinical neurological parameters, a patient's long-term probability of walking independently after injury can be calculated more accurately than it can with [contemporary neurological] grading systems."
In a linked Comment, Professor Wagih Shafik El Masri and Dr Naveen Kumar, Keele University, UK and the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK, say: "van Middendorp and colleagues should be congratulated for providing further strong evidence for the emerging view that accurate prediction of an individual's clinical ability to walk independently after traumatic spinal cord injury is possible. Further studies are needed to assess the power of the various prognostic indicators and assess their value when applied at different times after injury."
Dr Joost J van Middendorp, Spine Unit, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. T) +31 (0)24 361 89 10 E) jvanmiddendorp@gmail.com
Professor Wagih Shafik El Masri and Dr Naveen Kumar, Keele University, UK and the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry. T) +44 (0) 1691 404645 E) wagih.elmasri@rjah.nhs.uk
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Journal
The Lancet