Objective:

To describe a cohort of patients with spinal cord infarct (SCI) and determine factors predictive of ambulatory status at discharge and follow-up.

Background:

SCI has distinct pathophysiology compared to cerebral infarcts. There are limited data on effects of acute treatment of SCI on long-term outcomes. 

Design/Methods:

Retrospective chart review of 130 adults diagnosed with SCI within a health system consisting of 12 academic and community hospitals from 2000-2024. Demographics, vascular risk factors, clinical presentation, treatments, and ambulatory status at discharge and outpatient follow up were collected. Binomial logistic regression was utilized to determine factors predictive of ambulatory status (ambulatory or not ambulatory).

Results:

Among 130 patients, median age was 57 years (range 13-95 years), 40.8% were female, and SCI was spontaneous in 60.0% and periprocedural in 40.0%. 30.0% of patients had SCI that involved the cervical cord, 82.3% thoracic, and 36.2% conus. 75.4% had clinical nadir within 12 hours of symptom onset. Acute treatment consisted of lumbar cerebrospinal fluid drain in 30 (23.1%), anticoagulation in 23 (17.7%), antiplatelet agent in 69 (53.1%), corticosteroids in 31 (23.8%), and blood pressure augmentation in 52 (40.0%). Distribution of American Spinal Injury Association (ASIA) grades were A 26 (20.0%), B 33 (25.4%), C 37 (28.5%), and D 34 (26.2%). 86 (66.2%) were non-ambulatory at time of discharge. At mean follow-up of 81.2 days (SD 73.5 days), 41 (38.0%) were non-ambulatory while 67 (62.0%) were ambulatory. Lower severity of SCI (scale D, OR 34.5, p = 0.01) was predictive of ambulatory status at time of discharge and use of blood pressure augmentation (OR 0.05, p = 0.04) was predictive of not being ambulatory at discharge.

Conclusions:

Blood pressure augmentation appeared to be detrimental to ambulatory status at time of discharge. The value of other acute treatments on SCI prognosis is unclear.