Influence of the anatomical level of spinal cord injury on the severity of neurological impairments in spinal cord trauma

Abstract

Background. Traumatic spinal cord injury is a significant medical and social issue. Despite numerous studies, substantial success in reducing neurological consequences in such patients has not yet been achieved, and several aspects remain understudied, particularly the response of the spinal cord to injury at different anatomical levels. The purpose is to analyze the influence of the anatomical level of injury, the patient’s gender, and the mechanism of injury on the pattern of functional disorders in the acute period of spinal cord trauma using the largest publicly available database of patients with traumatic spinal cord injuries. Materials and methods. A statistical analysis of data from the National Spinal Cord Injury Model Systems Database (version 2021 ARPublic) was conducted. It included 21,343 cases containing information on gender, age at the time of injury, circumstances of injury, the degree of neurological disorders at hospitalization, and the anatomical level of traumatic injury (with precision down to the spinal cord segment). Results. The data analysis revealed significant differences in the pattern of distribution of functional classes according to the American Spinal Injury Association scale depending on the anatomical level of spinal cord injury. For the cervical region, the distribution of frequencies for A, B, C, and D classes was as follows: 43.06 % (95% confidence interval (CI): 42.15–43.97 %), 14.99 % (95% CI: 14.35–15.66 %), 16.17 % (95% CI: 15.50–16.86 %) and 25.78 % (95% CI: 24.98–26.59 %), respectively, for the thoracic region — 70.97 % (95% CI: 69.94–71.97 %), 10.27 % (95% CI: 9.60–10.97 %), 9.92 % (95% CI: 9.26–10.61 %) and 8.85 % (95% CI: 8.23–9.51 %), for the lumbar region — 21.29 % (95% CI: 19.57–23.12 %), 15.87 % (95% CI: 14.35–17.52 %), 24.43 % (95% CI: 22.62–26.34 %) and 38.40 % (95% CI: 36.32–40.52 %). Conclusions. The pattern of distribution of functional classes of neurological impairments significantly depends on the anatomical level of spinal cord injury. Thoracic segment injuries are characterized by the most clinically severe symptoms, whereas lumbar segment injuries are the least severe. The patient’s gender does not have a statistically significant influence, while the circumstances of the injury correlate with the frequency of neurological impairments in cervical segments and do not affect this indicator in the lumbar region.