Neurologic recovery after traumatic spinal cord injury: Data from the model spinal cord injury systems

Objective: To present data on neurologic recovery gathered by the Model Spi nal Cord Injury (SCI) Systems over a 10-year period. Design: Case series. Setting: Twenty-one Model SCI Systems. Patients: A total of 3,585 individuals with traumatic SCI admitted between January 1, 1988 and December 31, 1997. Main Outcome Measures: Neurologic impairment category; Frankel grade; Ameri can Spinal Injury Association (ASIA) Impairment Scale (AIS) grade; motor sc ore. Results: SCI caused by violence is more likely than SCI from nonviolent eti ologies to result in a complete injury. Changes in severity of injury were similar using the older Frankel scale and the newer ASIA Impairment Scale. Individuals who were motor-complete with extended zones of sensory preserva tion but without sacral sparing were less likely to convert to motor-incomp lete status than those with sacral sparing (13.3% vs 53.6%; p<.001). Motor score improvements at 1 year were related to severity of injury, with great er increases for better AIS grades except grade D, because of ceiling effec ts. Individuals with AIS grade B injuries have a mixed prognosis. Conclusion: Neurologic recovery after SCI is influenced by etiology and sev erity of injury. Multicenter studies on prognostic features such as preserv ed pin sensation in grade B injuries may identify subgroups with similar re covery patterns. Identification of such groups would facilitate clinical tr ials for neurologic recovery in acute SCI. (C) 1999 by the American Congres s of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.