Predictors of Acute and Late Spasticity After Traumatic Spinal Cord Injury: Implications for Recovery

Spasticity is a common complication following traumatic spinal cord injury (TSCI) that impacts neurofunctional recovery.

This study aimed to determine the prevalence of acute and late spasticity and identify clinical predictors associated with spasticity onset within the first year after TSCI.

We conducted a retrospective longitudinal cohort study involving 156 adults hospitalized for acute supraconal (C1-T12) TSCI at a level 1 trauma center from April 1, 2010, to December 31, 2021. Independent factors included demographic variables (age, sex, body mass index), trauma-related characteristics, and acute medical complications. Spasticity onset was categorized as acute (during acute hospitalization), late (after acute hospitalization within 1 year), or none. Multinomial logistic regression model was used to identify factors associated with the period of spasticity onset.

Among the patients, 57 (36.5%) developed acute spasticity (mean onset at 24.7 ± 13.7 days after admission), 55 (35.3%) experienced late spasticity, and 44 (28.2%) showed no spasticity within the first year. Higher AIS motor score at admission was associated with greater likelihood of either late or no spasticity (OR 1.05, P < .001; OR 1.02, P = .04). High-energy trauma increased the risk of developing acute spasticity (OR 0.37, P = .04). An AIS motor score below 50 (most severely impaired) at admission identified individuals at higher risk of acute spasticity, with 85.7% sensitivity and 71% overall accuracy.

Greater injury severity and high-energy trauma are associated with early spasticity onset, highlighting the need for early risk stratification and personalized management strategies to optimize patient outcomes.