On the injuries of the vertebrae and spinal marrow: prognostic factors & classifications.

The general aim of this thesis was to critically appraise current concepts of prognostication and classification of spinal column and spinal cord injuries. To date, only a few reliable, validated spinal column injury classifications exist. Moreover, the scientific validity of currently known prognostic factors, including risk factors for complications, in the spinal trauma population is limited. Based on literature findings and clinical data, methodological recommendations are provided to facilitate future research initiatives which aim to identify valid risk factors or to introduce a novel classification system for the spinal column injury population. Whereas reliable and validation classification systems are scarce in the field of spinal column injuries, spinal cord injury (SCI) physicians from all over the world rely on the methodologically-sound ‘International Standards for Neurological Classification of SCI’ for over a decade. In collaboration with the ‘European Multicenter study for human Spinal Cord Injury’ (EM-SCI) network, two research projects were conducted and presented in this thesis. In the first project, the reproducibility and construct validity of the most prevalent syndrome in SCI, the traumatic central cord syndrome, was evaluated. In the second project, the predictive value of the initial neurological examination on ambulation outcomes after traumatic SCI was studied. This latter project resulted in the introduction of a novel and validated clinical prediction rule for independent ambulation outcomes after traumatic SCI. Based on his thesis, the author concludes the following: ‘Before progressing into an era of comparative therapeutic trials, a clear insight into the most relevant prognostic factors influencing patient outcomes is warranted. Furthermore, as patients are commonly stratified by spinal cord and/or spinal column injury severity in clinical trials, categorizations and classification of these injuries should ideally have been validated by demonstrating their clinical relevance, reliability, and accuracy. With regard to the methodological quality of clinical studies in the field of spinal trauma, there is considerable room for improvement. To improve the quality of everyday spinal trauma care in the future, it is our duty to improve the validity of future clinical studies’ findings.