Relevance of the diagnosis traumatic cervical Brown-Séquard-plus syndrome: an analysis based on the neurological and functional recovery in a prospective cohort of 148 patients.
METHODS
Prospective multi-center cohort study.


OBJECTIVE
To compare the neurological and functional recovery between tetraplegic Brown-Séquard-plus syndrome (BSPS) and incomplete tetraplegia (non-BSPS).


METHODS
European Multicenter Study of Human Spinal Cord Injury (EM-SCI).


METHODS
BSPS was defined as a traumatic incomplete spinal cord injury (SCI) with ipsilateral weakness and contralateral loss of pinprick sensation at neurologic levels C2-T1. Acute (0-15 days) and chronic phase (6 or 12 months) were assessed for the American Spinal Injury Association (ASIA) sensory scores, upper extremity motor scores and lower extremity motor scores. Furthermore, chronic phase scores of all Spinal Cord Independence Measure (SCIM) II items were analyzed. Differences in neurological and functional outcome between BSPS patients and non-BSPS patients were calculated using Student's t-tests and Wilcoxon signed rank tests.


RESULTS
Out of 148 tetraplegic patients, 30 were diagnosed with BSPS. Patients with an ASIA impairment scale (AIS) B were significantly (P<0.001) more identified in non-BSPS patients (25%) compared with BSPS patients (3%), respectively. After 12 months, the median scores for sphincter management of the bladder for both BSPS and non-BSPS patients were 15. Both 25 and 75% quartile median scores were 15 for BSPS patients and 12 and 15 for non-BSPS patients (P<0.02). Except for the difference in bladder function, no significant differences were identified in other SCIM II subitems and ASIA motor or sensory scores between BSPS and non-BSPS patients when stratified for injury severity by excluding AIS B patients.


CONCLUSIONS
Compared with incomplete tetraplegic patients, patients with cervical BSPS have a similar neurological and functional recovery when matched for the AIS.
Pouw
M H
MH
Department of Orthopedic Surgery, Spine Unit, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Martinpouw@yahoo.com
van de Meent
H
H
van Middendorp
J J
JJ
Hirschfeld
S
S
Thietje
R
R
van Kampen
A
A
Hosman
A J F
AJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018437:Brown-Sequard Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D015331:Cohort Studies; D004185:Disability Evaluation; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D017063:Outcome Assessment, Health Care / Q000379:methods; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D055815:Young Adult