Clinical diagnosis and prognosis following spinal cord injury

Spinal cord injury (SCI) is a sudden, life-altering event. Injury severity and accompanying recovery vary considerably from individual to individual. The most important determinant of prognosis is whether an injury is clinically complete or incomplete. While approximately 10-20% of complete injuries convert to incomplete during the first year post-injury, the magnitude of motor recovery following complete SCI is limited or absent. Robust functional motor recovery (e.g., weight-bearing, ambulation) distal to the zone of injury is rare. Recovery following incomplete SCI is particularly variable, and anywhere from 20% to 75% of individuals will recover some degree of walking capacity by 1 year post-injury. This is related to presenting injury severity (American Spinal Injury Association Impairment Scale grade); however, even 20-50% of individuals who present as motor complete, sensory incomplete will walk in some capacity by 1 year post-injury. Regardless, for both complete and incomplete injuries, the majority of recovery is observed during the initial 9-12 months, with a relative plateau reached by 12-18 months post-injury. Magnetic resonance imaging (MRI) provides valuable adjunct information when a bedside clinical assessment cannot be completed. The presence of intramedullary hemorrhage and extended segments of edema have been associated with clinically complete SCI.