Prediction of Patient Outcomes after Traumatic Spinal Cord Injury using Acute Clinical and Radiological Variables

There is a pressing unmet need, in the acute setting after traumatic spinal cord injury (SCI), to predict both short and long-term clinical outcomes for individuals affected. Possessing this ability would not only facilitate improved communication and treatment planning in the clinical realm, but also would allow for enhanced study of SCI patients in the research realm. Presently, there is little available to scientifically guide clinicians and researchers alike with respect to this topic. In this thesis, it is hypothesized that clinical outcomes can accurately be predicted after SCI based on acute patient, injury and radiological features. In order to investigate this hypothesis, a series of investigations have been undertaken, using a combination of two large prospective SCI datasets, to explore the impact of acute clinical and radiological factors on long-term functional outcome, long-term neurological outcome and in-hospital complication occurrence. First, after performing a comprehensive systematic review of existing literature, a clinico-radiographic model was created and internally validated using a combination of pre-specified clinical and magnetic resonance imaging (MRI) variables obtained in the first 3 days after injury, to predict functional outcome at 1 year. Second, the acute radiological finding of facet dislocation (FD) was evaluated and found to predict reduced motor neurological recovery at 1 year, even after adjusting for individuals’ baseline degree of injury severity. Third, a combination of clinical variables predicting in-hospital complication development after cervical SCI were identified and used to develop a model to predict the occurrence of these complication events. Finally, the impact of age as an effect modifier governing the relationship between acute neurologic status and long-term functional outcome was evaluated. This analysis demonstrated older age to have the greatest negative impact on functional outcome in patients with lesions of intermediate severity. Although future validation studies are required, the findings presented in this thesis have provided new insights into relationships between acute predictor and outcome variables in the context of traumatic SCI. Further, these analyses have demonstrated the feasibility, and potential advantages, of using a combination of acute clinical and radiological variables, to predict outcome after SCI.Ph