title: Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury.
abstract: Evidence indicates that, over time, patients with spinal cord injury (SCI) improve neurologically in various degrees. We sought to further investigate indicators of grade conversion in cervical SCI.
  
  
  
  To detect predictors of ASIA impairment scale (AIS) grade conversion in SCI following surgical decompression.
  
  
  
  In a retrospective study, demographics, clinical, imaging, and surgical data from 100 consecutive patients were assessed for predictors of AIS grade conversion.
  
  
  
  American Spinal Injury Association motor score was 17.1. AIS grade was A in 52%, B in 29%, and C in 19% of patients. Surgical decompression took place on an average of 17.6 h following trauma (≤12 h in 51 and >12 h in 49). Complete decompression was verified by magnetic resonance imaging (MRI) in 73 patients. Intramedullary lesion length (IMLL) on postoperative MRI measured 72.8 mm, and hemorrhage at the injury epicenter was noted in 71 patients. Grade conversion took place in 26.9% of AIS grade A patients, 65.5% of AIS grade B, and 78.9% of AIS grade C. AIS grade conversion had statistical relationship with injury severity score, admission AIS grade, extent of decompression, presence of intramedullary hemorrhage, American Spinal Injury Association motor score, and IMLL. A stepwise multiple logistic regression analysis indicated IMLL was the sole and strongest indicator of AIS grade conversion (odds ratio 0.950, 95% CI 0.931-0.969). For 1- and 10-mm increases in IMLL, the model indicates 4% and 40% decreases, respectively, in the odds of AIS grade conversion.
  
  
  
  Compared with other surrogates, IMLL remained as the only predictor of AIS grade conversion.
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.|R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sansur
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: David M
authors.initials: DM
authors.lastname: Ibrahimi
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: J Marc
authors.initials: JM
authors.lastname: Simard
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: David S
authors.initials: DS
authors.lastname: Hersh
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Le
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Cara
authors.initials: C
authors.lastname: Diaz
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Massetti
authors.affiliation: School of Nursing and Depart-ment of Clinical Epidemiology and Bio-statistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Noori
authors.initials: N
authors.lastname: Akhtar-Danesh
mesh_terms: D000328:Adult; D066193:Cervical Cord / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: ASIA; Cervical spine; Decompression; MRI; Outcome; Spinal cord injury