Ulnar nerve integrity predicts 1-year outcome in cervical spinal cord injury

Neurological Research and Practice, 2019 · DOI: https://doi.org/10.1186/s42466-019-0017-1 · Published: April 4, 2019

Spinal Cord Injury Neurology Research Methodology & Design

Simple Explanation

This study investigates whether the health of the ulnar nerve can predict recovery after a cervical spinal cord injury. Ulnar nerve function, measured by CMAP amplitudes, was analyzed in relation to ASIA Impairment Scale (AIS) grades to assess recovery. The study found that higher ulnar nerve CMAP amplitudes early after injury were associated with better AIS grades at the 1-year follow-up, suggesting it can be used as a predictor of neurological recovery.

Study Duration

1 year

Participants

EMSCI-HD cohort: n = 114; EMSCI-nonHD cohort: n = 508

Evidence Level

Not specified

Key Findings

1
Higher ulnar nerve CMAP amplitudes are associated with better AIS grades over the entire follow-up period in cervical SCI patients.
2
Early ulnar nerve CMAP amplitude within 4 weeks post-injury is an independent predictor of 1-year neurological recovery (AIS grade D versus A-C).
3
The combination of baseline AIS grade and ulnar nerve CMAP amplitude improves prognostic accuracy compared to using AIS grade alone.

Research Summary

This study demonstrates a positive correlation between ulnar nerve CMAP amplitudes and AIS incompleteness over time in cervical SCI patients. Early ulnar nerve axonal integrity (within 4 weeks) is an independent predictor of good 1-year neurological outcome in cervical SCI. The prediction model, including baseline AIS and ulnar nerve CMAP amplitude, is robust and applicable to other cervical SCI cohorts.

Practical Implications

Improved Prognostic Accuracy

Early assessment of ulnar nerve CMAP can enhance the prediction of neurological recovery in cervical SCI patients.

Better Risk Stratification

Ulnar nerve CMAP measurements can aid in proper risk stratification in clinical trials for SCI, improving the balance of baseline variables.

Objective Assessment

Ulnar nerve CMAP measurements offer an objective assessment, especially useful in intensive care settings where patients might be less cooperative, and can compensate for uncertainties in clinical AIS grading.

Study Limitations

1
The data contains many missing values.
2
Possibility of a systematic bias regarding missing CMAP measurements in more severe SCI patients.
3
Inference is limited to the spinal segments C8-T1 (ulnar nerve).

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