Predictive Value of Midsagittal Tissue Bridges on Functional Recovery After Spinal Cord Injury.
Dario Pfyffer, Kevin Vallotton, Armin Curt and 1 others
PMID 33190619WHAT IT FOUND
Wider ventral and dorsal tissue bridges seen on 1-month MRI were associated with better neurological grade and functional recovery at 12 months after spinal cord injury.
This helps set prognosis, not a treatment target.
Key findings
01Larger ventral and dorsal tissue bridges were associated with higher AIS grades at 12 months.
02Among patients with a 1-month total motor score of 50 or less, a ventral tissue bridge wider than 0.4 mm was linked with a 12-month total motor score of 59.43, versus 36.79 when it was 0.4 mm or less.
03In tetraplegic patients with a 1-month upper extremity motor score of 34 or less, a ventral tissue bridge wider than 1.82 mm was linked with a 12-month change in upper extremity motor score of 20.50, versus 7.73 when it was 1.82 mm or less.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was retrospective and single-center, so it describes an association between MRI findings and later recovery, not a treatment effect. The sample had more tetraplegic than paraplegic patients, 45 versus 25, and some analyses used smaller subgroups, such as 31 patients with AIS grades A to C at 1 month and 39 patients with AIS grades A to C at the acute stage. The study measured only midsagittal tissue bridges. It did not assess lateral tissue bridges, so some spared tracts may have been missed. The number of patients described as improving in AIS grade differs across the paper, with 17 improved in the whole cohort, 26 among patients with acute AIS grades A to C, and 28 converted in the discussion. SCIM data were not available for all patients, with missing data from only 2 patients for the 12-month SCIM analysis. The baseline MRI was done about 1 month after injury, so the findings do not show what tissue bridges look like in the very acute stage.
Declared interests
The authors declared no potential conflicts of interest. Funding came from Wings for Life, the International Foundation for Research in Paraplegia, the EU Horizon 2020 NISCI project, ERA-NET NEURON, a Swiss National Science Foundation Eccellenza Professorial Fellowship, and the Wellcome Trust for open access.
The easy way to misread this
Do not conclude that a therapy caused the better recovery. This was a retrospective MRI study of recovery over time, not a trial, and tissue bridge width was only one measure used with baseline clinical scores in prediction models.