Tissue bridges linked with short, long-term benefits in those with spinal cord injury

Key takeaways:

• A global study examined 227 individuals with spinal cord injury seen at three centers in Europe, North America.
• Improvements in total motor, pinprick and light touch scores occurred at 3 and 12 months.

Implementation of tissue bridges measured within the first weeks after spinal cord injury are linked with short-and-long-term clinical improvement, according to research from The Lancet Neurology.

“Patients with spinal cord injury usually have sensorimotor and autonomic disfuncton and the extent of recovery after an SCI depends on the degree of spinal cord tissue damage,” Dario Pfyffer, PhD, postdoctoral research scholar at Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich in Switzerland, and colleagues wrote. “Accurate outcome prediction is of utmost importance for patients, treating therapists and attending physicians.”

Researchers sought to examine the prognostic value of preserved spinal tissue bridges — injury-spared neural tissue adjacent to the lesion — to ascertain its accuracy in predicting sensorimotor recovery in a large cohort of individuals with spinal cord injury (SCI).

Their global, multicenter, longitudinal study included 227 enrollees with acute cervical SCI (vertebrae C1–C7) admitted to one of three trauma or rehabilitation centers in Europe and North America: Murnau, Germany (n = 93; March 18, 2010, to March 1, 2021); Zurich (n = 43; May 12, 2002, to March 2, 2019); and Denver (n = 91; January 12, 2010, to February 16, 2017).

All participants were clinically assessed at baseline, at discharge (3 months), then once more at 12 months post-SCI based on international protocol regarding bilateral sensorimotor testing of 20 muscle groups including upper and lower extremities along with pinprick and light touch testing.

Midsagittal tissue bridges quantified from T2-weighted images were assessed at 3 to 4 weeks post-SCI. From the analyzed cohort, 136 patients (from Murnau and Zurich) were followed for up to 12 months.

Multiple models were employed to analyze age, sex, center and neurological level of injury, as well as to assess associations between tissue bridge width and baseline-adjusted total motor score, pinprick score and light touch scores at 3 and 12 months.

Participants were subsequently stratified into subgroups according to whether they showed better or worse predicted recovery.

At 3 months, results showed that, for every preserved 1 mm of tissue bridge at baseline, patients recovered a mean of 9.3% of maximal total motor score, 8.6% of maximal pinprick score and 10.9% of maximal light touch score.

At 12 months post-SCI, the percentages were 10.9% of maximal total motor score, 5.7% of maximal pinprick score and 6.9% of maximal light touch score.

Data additionally revealed partitioning models identified a tissue bridge cutoff width of 2.0 mm to be indicative of higher or lower 3-month total motor, pinprick and light touch scores, and a cutoff of 4 mm indicative of higher and lower 12-month scores.

“Tissue bridge widths could be assessed as part of the clinical care standards to counsel patients and guide rehabilitation decision making,” Pfyffer and colleagues wrote. “They have the potential to improve design of future interventional, multicenter trials.”