Pub Date : 2026-01-14DOI: 10.1038/s41393-025-01161-2
Nan Lu, Mengjie Li, Xiaoyu Gou, Teng Yang, Wen Li, Luyao Yan, Lijuan Yang, Yuanyuan Li, Yan Li
A systematic review and thematic synthesis of qualitative studies. To systematically explore and synthesize the telerehabilitation experiences and needs of patients with spinal cord injury (SCI). Six databases were searched. Findings were reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines and the Joanna Briggs Institute (JBI) Reviewer’s Manual standards. Two reviewers independently screened studies, extracted data, and assessed quality using the JBI Critical Appraisal Tool for Qualitative Research. Data were synthesized using thematic synthesis, a core analytical approach for integrating findings from qualitative research to identify cross-study patterns. The search identified 15 eligible studies, including 12 qualitative studies and 3 mixed-methods studies (only qualitative data were extracted). A total of 286 participants were included comprising SCI patients, medical staff, and nursing staff. The synthesis yielded four core themes: participants’ attitudes toward telerehabilitation, perceived benefits, perceived barriers, and needs and expectations. For spinal cord injury patients with SCI, telerehabilitation offer multiple benefits alongside distinct challenges and unmet needs. Telerehabilitation provides a promising option and novel experience for home-based rehabilitation in SCI patients. Professionals should take full account of patients’ perspectives, offer diverse and effective support, address individual needs, enhance the practicality, technical performance, and accessibility of telerehabilitation, and continuously work to improve patient outcomes.
{"title":"Exploring the experience and needs of telerehabilitation in patients with spinal cord injury: a systematic review and thematic synthesis of qualitative research","authors":"Nan Lu, Mengjie Li, Xiaoyu Gou, Teng Yang, Wen Li, Luyao Yan, Lijuan Yang, Yuanyuan Li, Yan Li","doi":"10.1038/s41393-025-01161-2","DOIUrl":"10.1038/s41393-025-01161-2","url":null,"abstract":"A systematic review and thematic synthesis of qualitative studies. To systematically explore and synthesize the telerehabilitation experiences and needs of patients with spinal cord injury (SCI). Six databases were searched. Findings were reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines and the Joanna Briggs Institute (JBI) Reviewer’s Manual standards. Two reviewers independently screened studies, extracted data, and assessed quality using the JBI Critical Appraisal Tool for Qualitative Research. Data were synthesized using thematic synthesis, a core analytical approach for integrating findings from qualitative research to identify cross-study patterns. The search identified 15 eligible studies, including 12 qualitative studies and 3 mixed-methods studies (only qualitative data were extracted). A total of 286 participants were included comprising SCI patients, medical staff, and nursing staff. The synthesis yielded four core themes: participants’ attitudes toward telerehabilitation, perceived benefits, perceived barriers, and needs and expectations. For spinal cord injury patients with SCI, telerehabilitation offer multiple benefits alongside distinct challenges and unmet needs. Telerehabilitation provides a promising option and novel experience for home-based rehabilitation in SCI patients. Professionals should take full account of patients’ perspectives, offer diverse and effective support, address individual needs, enhance the practicality, technical performance, and accessibility of telerehabilitation, and continuously work to improve patient outcomes.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 2","pages":"103-112"},"PeriodicalIF":2.2,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-08DOI: 10.1038/s41393-025-01163-0
Tetsuhiko Mimura, Ali Moghaddamjou, Jetan H. Badhiwala, Alexander R. Vaccaro, Christopher I. Shaffrey, James S. Harrop, James D. Guest, Bizhan Aarabi, Michael G. Fehlings
Cohort study. Although the effectiveness of methylprednisolone sodium succinate (MPSS) in spinal cord injury (SCI) is controversial, it is hypothesized that the effectiveness and safety profile of MPSS may vary in select cervical SCI sub-populations. The objective of this study is to clarify the effect of MPSS and its impact on adverse events in patients with cervical SCI, stratified by baseline neurological status. Three large prospective, multicenter data sets of patients with acute SCI. Patients with acute cervical SCI were enrolled. The primary outcomes were upper extremity motor scores (UEMS) and lower extremity motor scores (LEMS) at 1 year. Patients were grouped by baseline American Spinal Injury Association Impairment Scale (AIS) grade. 908 patients meeting inclusion criteria were analyzed. In AIS grade A patients, the use of MPSS resulted in significantly improved LEMS (mean difference [MD], 3.0; 95% CI, 0.3–5.6; p = 0.02), but not UEMS (MD, 0.5; 95% CI, −2.5–3.5; p = 0.74), at 1 year. In contrast, no significant benefit was observed in patients with AIS grades B, C, or D. In AIS grade A patients, the MPSS group had a lower incidence of cardiopulmonary adverse events (42.5 vs. 62.8%; p < 0.001) and gastrointestinal/genitourinary adverse events (13.7 vs. 22.4%; p = 0.04). MPSS was associated with improved lower extremity motor recovery in AIS grade A cervical SCI patients. No significant effect was seen in patients with incomplete injuries. MPSS was not associated with an overall increase in adverse events, suggesting it may be selectively beneficial in severe cervical SCI.
研究设计：队列研究。目的：虽然甲基强的松龙琥珀酸钠（MPSS）在脊髓损伤（SCI）中的有效性存在争议，但假设MPSS的有效性和安全性可能在特定的脊髓损伤亚群中有所不同。本研究的目的是阐明MPSS的作用及其对脊髓损伤患者不良事件的影响，并按基线神经状态分层。背景：三个大型前瞻性、多中心的急性脊髓损伤患者数据集。方法：纳入急性颈椎脊髓损伤患者。主要结果为1年上肢运动评分（UEMS）和下肢运动评分（LEMS）。患者按基线美国脊髓损伤协会损伤量表（AIS）分级进行分组。结果：908例患者符合纳入标准。在AIS A级患者中，使用MPSS可显著改善1年的LEMS（平均差值[MD]， 3.0; 95% CI, 0.3-5.6; p = 0.02），但UEMS没有改善（MD, 0.5; 95% CI, -2.5-3.5; p = 0.74）。相比之下，在AIS分级为B级、C级或d级的患者中没有观察到明显的获益。在AIS分级为A级的患者中，MPSS组心肺不良事件发生率较低（42.5% vs. 62.8%）。不完全性损伤患者未见明显效果。MPSS与不良事件的总体增加无关，这表明它可能对严重颈椎脊髓损伤有选择性的有益。
{"title":"Effect of methylprednisolone in cervical spinal cord injury stratified by injury severity: analysis in 908 patients","authors":"Tetsuhiko Mimura, Ali Moghaddamjou, Jetan H. Badhiwala, Alexander R. Vaccaro, Christopher I. Shaffrey, James S. Harrop, James D. Guest, Bizhan Aarabi, Michael G. Fehlings","doi":"10.1038/s41393-025-01163-0","DOIUrl":"10.1038/s41393-025-01163-0","url":null,"abstract":"Cohort study. Although the effectiveness of methylprednisolone sodium succinate (MPSS) in spinal cord injury (SCI) is controversial, it is hypothesized that the effectiveness and safety profile of MPSS may vary in select cervical SCI sub-populations. The objective of this study is to clarify the effect of MPSS and its impact on adverse events in patients with cervical SCI, stratified by baseline neurological status. Three large prospective, multicenter data sets of patients with acute SCI. Patients with acute cervical SCI were enrolled. The primary outcomes were upper extremity motor scores (UEMS) and lower extremity motor scores (LEMS) at 1 year. Patients were grouped by baseline American Spinal Injury Association Impairment Scale (AIS) grade. 908 patients meeting inclusion criteria were analyzed. In AIS grade A patients, the use of MPSS resulted in significantly improved LEMS (mean difference [MD], 3.0; 95% CI, 0.3–5.6; p = 0.02), but not UEMS (MD, 0.5; 95% CI, −2.5–3.5; p = 0.74), at 1 year. In contrast, no significant benefit was observed in patients with AIS grades B, C, or D. In AIS grade A patients, the MPSS group had a lower incidence of cardiopulmonary adverse events (42.5 vs. 62.8%; p < 0.001) and gastrointestinal/genitourinary adverse events (13.7 vs. 22.4%; p = 0.04). MPSS was associated with improved lower extremity motor recovery in AIS grade A cervical SCI patients. No significant effect was seen in patients with incomplete injuries. MPSS was not associated with an overall increase in adverse events, suggesting it may be selectively beneficial in severe cervical SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 2","pages":"177-185"},"PeriodicalIF":2.2,"publicationDate":"2026-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145935041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-27DOI: 10.1038/s41393-025-01165-y
Patrick Romijn, Paul G. P. Kussige, Miranda L. van Hooff, Nathan Evaniew, Henk van de Meent, Joost J. van Middendorp, Martin H. Pouw, Allard J. F. Hosman
Pre-specified secondary endpoint analysis from a prospective cohort study. Evaluate whether early surgical decompression (≤12 h) improves quality of life (QOL) compared to late surgical decompression (>12 h and <14 days) in patients with acute traumatic spinal cord injury (tSCI). European multicentre study. Data were drawn from the Prospective, Observational European Multicentre study on the efficacy of acute surgical decompression after tSCI (SCI-POEM). Patients were grouped by decompression timing. Neurological status was assessed using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). QOL was assessed at 6 and 12 months post-injury using the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). The early group (n = 126) had greater baseline neurological impairment than the late group (n = 100). Despite these imbalances, unadjusted analysis showed no significant differences between groups in WHOQOL-BREF domains at one year post-injury (physical: 65.2 vs. 65.6, p = 0.868; psychological: 68.0 vs. 68.6, p = 0.806; social: 69.8 vs. 67.4, p = 0.397; environmental: 75.2 vs. 71.4, p = 0.083). A multivariate mixed model revealed no significant differences in WHOQOL-BREF domains between early and late groups one year post-injury (physical: 65.7 vs. 63.8, p = 1.000; psychological: 68.5 vs. 66.9, p = 1.000; social: 72.8 vs. 68.0, p = 1.000; environmental: 80.1 vs. 74.7, p = 0.209). No significant differences in WHOQOL-BREF domain scores were observed between early and late surgical decompression following acute tSCI in both unadjusted and adjusted analyses. QOL outcomes provide improved understanding of therapeutic interventions’ impact on patients’ lives and should be incorporated into evaluations of early decompression efficacy. NCT01674764.
{"title":"Early versus late surgical decompression in acute traumatic spinal cord injury: does it impact the quality of life?","authors":"Patrick Romijn, Paul G. P. Kussige, Miranda L. van Hooff, Nathan Evaniew, Henk van de Meent, Joost J. van Middendorp, Martin H. Pouw, Allard J. F. Hosman","doi":"10.1038/s41393-025-01165-y","DOIUrl":"10.1038/s41393-025-01165-y","url":null,"abstract":"Pre-specified secondary endpoint analysis from a prospective cohort study. Evaluate whether early surgical decompression (≤12 h) improves quality of life (QOL) compared to late surgical decompression (>12 h and <14 days) in patients with acute traumatic spinal cord injury (tSCI). European multicentre study. Data were drawn from the Prospective, Observational European Multicentre study on the efficacy of acute surgical decompression after tSCI (SCI-POEM). Patients were grouped by decompression timing. Neurological status was assessed using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). QOL was assessed at 6 and 12 months post-injury using the World Health Organization Quality of Life-BREF questionnaire (WHOQOL-BREF). The early group (n = 126) had greater baseline neurological impairment than the late group (n = 100). Despite these imbalances, unadjusted analysis showed no significant differences between groups in WHOQOL-BREF domains at one year post-injury (physical: 65.2 vs. 65.6, p = 0.868; psychological: 68.0 vs. 68.6, p = 0.806; social: 69.8 vs. 67.4, p = 0.397; environmental: 75.2 vs. 71.4, p = 0.083). A multivariate mixed model revealed no significant differences in WHOQOL-BREF domains between early and late groups one year post-injury (physical: 65.7 vs. 63.8, p = 1.000; psychological: 68.5 vs. 66.9, p = 1.000; social: 72.8 vs. 68.0, p = 1.000; environmental: 80.1 vs. 74.7, p = 0.209). No significant differences in WHOQOL-BREF domain scores were observed between early and late surgical decompression following acute tSCI in both unadjusted and adjusted analyses. QOL outcomes provide improved understanding of therapeutic interventions’ impact on patients’ lives and should be incorporated into evaluations of early decompression efficacy. NCT01674764.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 2","pages":"142-150"},"PeriodicalIF":2.2,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01165-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-24DOI: 10.1038/s41393-025-01159-w
Clarissa Volpato Sombrio Foschi, Aline de Lima, Stella Maris Michaelsen, Jocemar Ilha
Systematic Review (PROSPERO CRD42022297211). To evaluate the measurement properties of Spinal Cord Independence Measure (SCIM) versions and to derive recommendations. We followed the COSMIN methodology for systematic reviews of Patient-Reported Outcome Measures (PROM) and adapted criteria for non-PROM to conduct the review and derive SCIM evidence-based recommendations. PubMed, CINAHL, EMBASE, Scopus and Lilacs databases were searched (November 2025). Studies reporting the development or evaluation of any SCIM measurement properties were included. We used the COSMIN Risk of Bias tool and the Criteria for Good Measurement Properties to critically appraise the studies and to summarise and rate the measurement properties. Evidence levels were established using a modified GRADE system. The review included 50 articles, reporting five SCIM versions and 127 individual measurement property studies. The SCIM SR presented low-level evidence for sufficient content validity. The SCIM II, III, SR and IV presented high-level evidence for sufficient criterion validity and indeterminate structural validity. The SCIM III, SR and IV presented high-level evidence for sufficient internal consistency. The SCIM SR also presented high-level evidence for sufficient reliability. Moderate-level evidence for sufficient reliability was presented by SCIM II, III and IV, and for measurement error by SCIM III and SR. None of the SCIM versions fully fit all the COSMIN criteria for recommendation. The SCIM III, SR, and IV present the highest evidence levels for most measurement properties. Additionally, the SCIM SR meets the criteria for potential recommendation for having at least low-level evidence for sufficient content validity. UDESC.
{"title":"Spinal cord independence measure evidence-based recommendation: a systematic review of measurement properties","authors":"Clarissa Volpato Sombrio Foschi, Aline de Lima, Stella Maris Michaelsen, Jocemar Ilha","doi":"10.1038/s41393-025-01159-w","DOIUrl":"10.1038/s41393-025-01159-w","url":null,"abstract":"Systematic Review (PROSPERO CRD42022297211). To evaluate the measurement properties of Spinal Cord Independence Measure (SCIM) versions and to derive recommendations. We followed the COSMIN methodology for systematic reviews of Patient-Reported Outcome Measures (PROM) and adapted criteria for non-PROM to conduct the review and derive SCIM evidence-based recommendations. PubMed, CINAHL, EMBASE, Scopus and Lilacs databases were searched (November 2025). Studies reporting the development or evaluation of any SCIM measurement properties were included. We used the COSMIN Risk of Bias tool and the Criteria for Good Measurement Properties to critically appraise the studies and to summarise and rate the measurement properties. Evidence levels were established using a modified GRADE system. The review included 50 articles, reporting five SCIM versions and 127 individual measurement property studies. The SCIM SR presented low-level evidence for sufficient content validity. The SCIM II, III, SR and IV presented high-level evidence for sufficient criterion validity and indeterminate structural validity. The SCIM III, SR and IV presented high-level evidence for sufficient internal consistency. The SCIM SR also presented high-level evidence for sufficient reliability. Moderate-level evidence for sufficient reliability was presented by SCIM II, III and IV, and for measurement error by SCIM III and SR. None of the SCIM versions fully fit all the COSMIN criteria for recommendation. The SCIM III, SR, and IV present the highest evidence levels for most measurement properties. Additionally, the SCIM SR meets the criteria for potential recommendation for having at least low-level evidence for sufficient content validity. UDESC.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 2","pages":"113-125"},"PeriodicalIF":2.2,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145828091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
a cross-sectional study. To determine the prevalence and associated factors of abnormal sensory nerve conduction study of sural nerve and to describe the characteristics of sural sensory neuropathy in patients with spinal cord injury (SCI). Electrodiagnostic unit, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University. Patients with any level of SCI who had no evidence of lower motor neuron lesion at the sacral level who visited the outpatient department, inpatient department, and urodynamic clinic at Maharaj Nakorn Chiang Mai Hospital between October 2023 and November 2024 were recruited. Nerve conduction studies (NCS) were performed following the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Guideline. The primary assessment was sural sensory NCS then the prevalence of sural neuropathy was calculated. Demographic and medical parameters were collected and analyzed to demonstrate the associations with sural neuropathy. Among 95 participants, 23 were diagnosed with sural neuropathy, indicating a prevalence of 0.24 (95%CI: 0.16–0.34). Sural neuropathies observed in all participants were categorized into a type without evidence of compressive neuropathy. The independent associated factors of sural neuropathy were female, time since SCI longer than 10 years, cervical SCI, and history of pressure injury at the ischium. In people with SCI, the prevalence of sural neuropathy is 24%. Due to limitations in the study design and data collection for detecting neuropathy and risk factors, further longitudinal studies are needed to understand the neurophysiological deterioration following SCI and to confirm these findings.
{"title":"Prevalence, characteristics, and associated factors of abnormal sensory nerve conduction study of sural nerve in patients with traumatic spinal cord injury: a cross-sectional study","authors":"Nutchaya Kantasena, Siam Tongprasert, Sintip Pattanakuhar","doi":"10.1038/s41393-025-01164-z","DOIUrl":"10.1038/s41393-025-01164-z","url":null,"abstract":"a cross-sectional study. To determine the prevalence and associated factors of abnormal sensory nerve conduction study of sural nerve and to describe the characteristics of sural sensory neuropathy in patients with spinal cord injury (SCI). Electrodiagnostic unit, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University. Patients with any level of SCI who had no evidence of lower motor neuron lesion at the sacral level who visited the outpatient department, inpatient department, and urodynamic clinic at Maharaj Nakorn Chiang Mai Hospital between October 2023 and November 2024 were recruited. Nerve conduction studies (NCS) were performed following the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) Guideline. The primary assessment was sural sensory NCS then the prevalence of sural neuropathy was calculated. Demographic and medical parameters were collected and analyzed to demonstrate the associations with sural neuropathy. Among 95 participants, 23 were diagnosed with sural neuropathy, indicating a prevalence of 0.24 (95%CI: 0.16–0.34). Sural neuropathies observed in all participants were categorized into a type without evidence of compressive neuropathy. The independent associated factors of sural neuropathy were female, time since SCI longer than 10 years, cervical SCI, and history of pressure injury at the ischium. In people with SCI, the prevalence of sural neuropathy is 24%. Due to limitations in the study design and data collection for detecting neuropathy and risk factors, further longitudinal studies are needed to understand the neurophysiological deterioration following SCI and to confirm these findings.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 2","pages":"134-141"},"PeriodicalIF":2.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01164-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1038/s41393-025-01162-1
Alberto Borraccino, Roberta Onorati, Alessio Conti, Andrea Ricotti, Carlo Mamo
Study design: retrospective, population-based cohort study.
Objectives: to evaluate long-term survival outcomes and factors affecting mortality in individuals with traumatic (TSCI) and non-traumatic spinal cord injury (NTSCI) in Italy.
Setting: Publicly funded rehabilitation units for SCI patients across Italy.
Methods: A total of 1070 individuals with confirmed TSCI (56.5%) or NTSCI, predominantly male (70.5%), residing in the Piedmont region, were identified through admission to specialized SCI rehabilitation units (2008-2020) using administrative data. Survival probabilities were estimated using Kaplan-Meier curves; Mortality risk was assessed using multivariate Cox regression models, and adjusted hazard ratios (HRs) were reported for sex, comorbidity burden (combined Charlson Comorbidity Index, CCI), and injury level (paraplegia/tetraplegia). Causes of death were retrieved from national mortality records.
Results: The overall case fatality rate was 25.1%, higher in NTSCI (32.9%) than in TSCI (19.2%). Mortality increased with age and comorbidity burden. Among individuals with TSCI and CCI ≥ 3, mortality risk was significantly higher (HR 1.81; 95% CI 1.29-2.53). Sex (HR 1.05) and injury level (HR 1.10) were not significant predictors. Leading causes of death were cancer in NTSCI and circulatory diseases in both groups.
Conclusions: Age, comorbidities and injury type are the primary determinants of survival in SCI. The higher case fatality rate observed in NTSCI compared with TSCI underscores the prognostic relevance of etiology alongside frailty and multimorbidity. Our findings support early frailty screening, personalized comorbidity management, and the need for developing a dedicated national registry to inform long-term care strategies and improve outcomes in aging SCI populations.
研究设计：回顾性、基于人群的队列研究。目的：评估意大利创伤性（TSCI）和非创伤性脊髓损伤（NTSCI）患者的长期生存结果和影响死亡率的因素。环境：意大利各地为脊髓损伤患者提供公共资助的康复单位。方法：2008年至2020年，通过使用行政数据，对居住在Piedmont地区的1070例确诊TSCI（56.5%）或NTSCI患者进行鉴定，其中以男性为主（70.5%）。使用Kaplan-Meier曲线估计生存概率；使用多变量Cox回归模型评估死亡风险，并报告性别、合并症负担（联合Charlson合并症指数，CCI）和损伤水平（截瘫/四肢瘫痪）的调整风险比（HRs）。死亡原因从国家死亡率记录中检索。结果：病死率为25.1%，NTSCI（32.9%）高于TSCI（19.2%）。死亡率随年龄和合并症负担的增加而增加。在TSCI和CCI≥3的个体中，死亡风险显著增加（HR 1.81; 95% CI 1.29-2.53）。性别（HR 1.05）和损伤程度（HR 1.10）不是显著的预测因子。两组患者的主要死亡原因均为NTSCI患者的癌症和循环系统疾病。结论：年龄、合并症和损伤类型是脊髓损伤患者存活的主要决定因素。与TSCI相比，NTSCI中观察到的更高病死率强调了病因学与虚弱和多病的预后相关性。我们的研究结果支持早期虚弱筛查，个性化的合并症管理，以及开发专门的国家登记处的需求，以告知长期护理策略并改善老龄SCI人群的预后。
{"title":"Factors associated with long-term survival after traumatic and non-traumatic spinal cord injury: a 12-year population-based retrospective cohort study in Italy.","authors":"Alberto Borraccino, Roberta Onorati, Alessio Conti, Andrea Ricotti, Carlo Mamo","doi":"10.1038/s41393-025-01162-1","DOIUrl":"https://doi.org/10.1038/s41393-025-01162-1","url":null,"abstract":"<p><strong>Study design: </strong>retrospective, population-based cohort study.</p><p><strong>Objectives: </strong>to evaluate long-term survival outcomes and factors affecting mortality in individuals with traumatic (TSCI) and non-traumatic spinal cord injury (NTSCI) in Italy.</p><p><strong>Setting: </strong>Publicly funded rehabilitation units for SCI patients across Italy.</p><p><strong>Methods: </strong>A total of 1070 individuals with confirmed TSCI (56.5%) or NTSCI, predominantly male (70.5%), residing in the Piedmont region, were identified through admission to specialized SCI rehabilitation units (2008-2020) using administrative data. Survival probabilities were estimated using Kaplan-Meier curves; Mortality risk was assessed using multivariate Cox regression models, and adjusted hazard ratios (HRs) were reported for sex, comorbidity burden (combined Charlson Comorbidity Index, CCI), and injury level (paraplegia/tetraplegia). Causes of death were retrieved from national mortality records.</p><p><strong>Results: </strong>The overall case fatality rate was 25.1%, higher in NTSCI (32.9%) than in TSCI (19.2%). Mortality increased with age and comorbidity burden. Among individuals with TSCI and CCI ≥ 3, mortality risk was significantly higher (HR 1.81; 95% CI 1.29-2.53). Sex (HR 1.05) and injury level (HR 1.10) were not significant predictors. Leading causes of death were cancer in NTSCI and circulatory diseases in both groups.</p><p><strong>Conclusions: </strong>Age, comorbidities and injury type are the primary determinants of survival in SCI. The higher case fatality rate observed in NTSCI compared with TSCI underscores the prognostic relevance of etiology alongside frailty and multimorbidity. Our findings support early frailty screening, personalized comorbidity management, and the need for developing a dedicated national registry to inform long-term care strategies and improve outcomes in aging SCI populations.</p>","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-16DOI: 10.1038/s41393-025-01158-x
Fin Biering-Sørensen
Review. To describe the development of standardized data related to individuals with spinal cord injury (SCI). These are needed to compare and share data across centres, countries, and studies, to improve prevention and treatment. International. The SCI community works to obtain consensus regarding the best available data and measures for use in clinical practice and research. Data elements are continuously developed and updated. Efforts are made to ensure that the variables and elements are as universal as possible, not least by involving individuals from diverse regions of the world in their development and review. Including people with lived experience helps ensure data are relevant and enhances quality of life. The first standardisation to gain international impact was the Frankel Classification, which was developed into the International Standards for Neurological Classification of SCI. Similarly, the Spinal Cord Independence Measure for Activities of Daily Living for individuals with SCI was developed. The International SCI Data Sets have been developed across many areas relevant for individuals with SCI including the SCI Core Data Set, 24 SCI Basic, and five SCI Extended Data Sets. These international data elements/measurements are included as part of SCI registries and electronic medical records worldwide. Big Data perspectives are needed, requiring multi-modal data and open science and data to be FAIR (Findable, Accessible, Interoperable and Reusable). Artificial intelligence requires data to be interoperable so data can be exchanged. This work will hopefully identify new associations and new possibilities for prevention and treatment.
{"title":"The Guttmann Lecture 2025: standardization of data collection in individuals with spinal cord injury","authors":"Fin Biering-Sørensen","doi":"10.1038/s41393-025-01158-x","DOIUrl":"10.1038/s41393-025-01158-x","url":null,"abstract":"Review. To describe the development of standardized data related to individuals with spinal cord injury (SCI). These are needed to compare and share data across centres, countries, and studies, to improve prevention and treatment. International. The SCI community works to obtain consensus regarding the best available data and measures for use in clinical practice and research. Data elements are continuously developed and updated. Efforts are made to ensure that the variables and elements are as universal as possible, not least by involving individuals from diverse regions of the world in their development and review. Including people with lived experience helps ensure data are relevant and enhances quality of life. The first standardisation to gain international impact was the Frankel Classification, which was developed into the International Standards for Neurological Classification of SCI. Similarly, the Spinal Cord Independence Measure for Activities of Daily Living for individuals with SCI was developed. The International SCI Data Sets have been developed across many areas relevant for individuals with SCI including the SCI Core Data Set, 24 SCI Basic, and five SCI Extended Data Sets. These international data elements/measurements are included as part of SCI registries and electronic medical records worldwide. Big Data perspectives are needed, requiring multi-modal data and open science and data to be FAIR (Findable, Accessible, Interoperable and Reusable). Artificial intelligence requires data to be interoperable so data can be exchanged. This work will hopefully identify new associations and new possibilities for prevention and treatment.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"96-102"},"PeriodicalIF":2.2,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01158-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145769181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-14DOI: 10.1038/s41393-025-01160-3
Jason Silvestre, Michael G. Fehlings, Charles A. Reitman, James P. Lawrence, Robert A. Ravinsky
Cross-sectional study. Given recent epidemiological data which indicate a rising incidence of traumatic and non-traumatic spinal cord injury, we sought to analyze changes in the annual number of training positions, applicants, and unfilled training positions in United States spinal cord injury medicine (SCIM) training. Fellowship programs participating in the SCIM Match. Data were obtained from the National Resident Matching Program from 2016 to 2024. Annual trends were analyzed with linear regression. The annual number of SCIM training programs (19–22, 15.8% increase, P < 0.001) and training positions (28–32, 14.3% increase, P < 0.001) increased over the study period. There was no significant change in the annual number of applicants (16–19, 18.8% increase, P = 0.878). The annual training position-to-applicant ratio ranged from 1.2–1.8 with no significant change over the study period (P = 0.555). The rate of unfilled training positions did not change over the study period (50.0–43.8%, P = 0.523). The annual match rate ranged between 87.0–100% with no clear trend over the study period (P = 0.423). There were no differences in the percentage of applicants matching at their first-choice (62.5–73.7%, P = 0.780) second-choice (12.5–10.5%, P = 0.333), and third-choice (12.5–0%, P = 0.966) fellowships over the study period. There has been an increase in the number of SCIM training programs and positions, but this has not been matched by an increased number of interested applicants. Policy efforts are needed to increase interest in SCIM and meet anticipated growth in clinical needs.
{"title":"Trends in the supply of spinal cord injury medicine physicians in the united states: an evolving human resource shortfall","authors":"Jason Silvestre, Michael G. Fehlings, Charles A. Reitman, James P. Lawrence, Robert A. Ravinsky","doi":"10.1038/s41393-025-01160-3","DOIUrl":"10.1038/s41393-025-01160-3","url":null,"abstract":"Cross-sectional study. Given recent epidemiological data which indicate a rising incidence of traumatic and non-traumatic spinal cord injury, we sought to analyze changes in the annual number of training positions, applicants, and unfilled training positions in United States spinal cord injury medicine (SCIM) training. Fellowship programs participating in the SCIM Match. Data were obtained from the National Resident Matching Program from 2016 to 2024. Annual trends were analyzed with linear regression. The annual number of SCIM training programs (19–22, 15.8% increase, P < 0.001) and training positions (28–32, 14.3% increase, P < 0.001) increased over the study period. There was no significant change in the annual number of applicants (16–19, 18.8% increase, P = 0.878). The annual training position-to-applicant ratio ranged from 1.2–1.8 with no significant change over the study period (P = 0.555). The rate of unfilled training positions did not change over the study period (50.0–43.8%, P = 0.523). The annual match rate ranged between 87.0–100% with no clear trend over the study period (P = 0.423). There were no differences in the percentage of applicants matching at their first-choice (62.5–73.7%, P = 0.780) second-choice (12.5–10.5%, P = 0.333), and third-choice (12.5–0%, P = 0.966) fellowships over the study period. There has been an increase in the number of SCIM training programs and positions, but this has not been matched by an increased number of interested applicants. Policy efforts are needed to increase interest in SCIM and meet anticipated growth in clinical needs.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"66-70"},"PeriodicalIF":2.2,"publicationDate":"2025-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1038/s41393-025-01157-y
Kyohei Matsuda, Junji Nakano, Osamu Uemura
A retrospective cohort study. To develop a machine learning (ML) model to predict ambulation prognosis one year post-injury in rehabilitation-phase spinal cord injury (SCI) individuals classified as American Spinal Injury Association Impairment Scale (AIS) grades B and C, and to implement it as a web application. A multicenter database in the United States. Data were collected from the National Spinal Cord Injury Database (NSCID) for the years 2011 to 2021. Traumatic SCI cases with complete neurological data at rehabilitation admission were included, based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Model predictors included age at injury, acute length of stay, neurological level of injury, motor scores, and sensory scores. ML models were developed using nested 5-fold cross-validation and four algorithms: logistic regression, random forest, support vector machine, and extreme gradient boosting (XGB). Performance was assessed and compared using area under the curve (AUC), Brier score, and calibration slope, with a focus on AIS grades B and C. A web application was developed using the R package shiny and deployed via shinyapps.io. 2034 cases were included in the analysis. XGB demonstrated the best performance in terms of AUC (0.855), Brier score (0.153), and calibration slope (0.900) and was selected as the final model. This model was implemented as a web application. The developed model showed good performance for AIS grades B and C and was made practical via web application implementation.
{"title":"Web-based machine learning application for ambulation prognosis in the rehabilitation phase of spinal cord injury: a retrospective multicenter cohort study","authors":"Kyohei Matsuda, Junji Nakano, Osamu Uemura","doi":"10.1038/s41393-025-01157-y","DOIUrl":"10.1038/s41393-025-01157-y","url":null,"abstract":"A retrospective cohort study. To develop a machine learning (ML) model to predict ambulation prognosis one year post-injury in rehabilitation-phase spinal cord injury (SCI) individuals classified as American Spinal Injury Association Impairment Scale (AIS) grades B and C, and to implement it as a web application. A multicenter database in the United States. Data were collected from the National Spinal Cord Injury Database (NSCID) for the years 2011 to 2021. Traumatic SCI cases with complete neurological data at rehabilitation admission were included, based on the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Model predictors included age at injury, acute length of stay, neurological level of injury, motor scores, and sensory scores. ML models were developed using nested 5-fold cross-validation and four algorithms: logistic regression, random forest, support vector machine, and extreme gradient boosting (XGB). Performance was assessed and compared using area under the curve (AUC), Brier score, and calibration slope, with a focus on AIS grades B and C. A web application was developed using the R package shiny and deployed via shinyapps.io. 2034 cases were included in the analysis. XGB demonstrated the best performance in terms of AUC (0.855), Brier score (0.153), and calibration slope (0.900) and was selected as the final model. This model was implemented as a web application. The developed model showed good performance for AIS grades B and C and was made practical via web application implementation.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"88-95"},"PeriodicalIF":2.2,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-12DOI: 10.1038/s41393-025-01152-3
Gregory J. R. States, Alice Shum-Siu, Darlene A. Burke, David S. K. Magnuson
Longitudinal pre-clinical study. To determine the impact of crank length and cadence on pedal reaction forces and cardiovascular responses in a preclinical model of high thoracic severe spinal cord injury. The Kentucky Spinal Cord Injury Research Center at the University of Louisville, Louisville, KY USA. Five female Sprague-Dawley rats received T2 severe contusion SCIs and served as their own controls. To better understand the biomechanical and cardiovascular responses to cycling, we utilized a commercially available motorized rat cycle with custom cranks and pedals to collect pedal reaction forces using two different crank lengths and at a range of cycling cadences. Simultaneously, heart rate (HR) and blood pressure (BP) were collected via an indwelling telemeter. Collected data were analyzed pre-, during, and post-cycling, weekly up to six weeks post-injury. The longer crank length increased forces and spasticity, although differences were more pronounced during extension that involved lengthening of the flexor muscles. HR and systolic/diastolic pressures were elevated during cycling and changed in parallel with force events, although few differences were observed between standard and short crank length cycling. These results suggest that MC may constitute a mild exercise strategy post-SCI; clinical translation may be dependent on the ability of the subject-specific cycling parameters to generate reflex-induced eccentric muscle contractions during cycling, emphasizing the importance of crank length (leg range-of-motion) and cycling cadence on the value of motorized cycling after severe SCI.
{"title":"Effects of crank length on the cardiovascular response in a rat model of motorized cycling","authors":"Gregory J. R. States, Alice Shum-Siu, Darlene A. Burke, David S. K. Magnuson","doi":"10.1038/s41393-025-01152-3","DOIUrl":"10.1038/s41393-025-01152-3","url":null,"abstract":"Longitudinal pre-clinical study. To determine the impact of crank length and cadence on pedal reaction forces and cardiovascular responses in a preclinical model of high thoracic severe spinal cord injury. The Kentucky Spinal Cord Injury Research Center at the University of Louisville, Louisville, KY USA. Five female Sprague-Dawley rats received T2 severe contusion SCIs and served as their own controls. To better understand the biomechanical and cardiovascular responses to cycling, we utilized a commercially available motorized rat cycle with custom cranks and pedals to collect pedal reaction forces using two different crank lengths and at a range of cycling cadences. Simultaneously, heart rate (HR) and blood pressure (BP) were collected via an indwelling telemeter. Collected data were analyzed pre-, during, and post-cycling, weekly up to six weeks post-injury. The longer crank length increased forces and spasticity, although differences were more pronounced during extension that involved lengthening of the flexor muscles. HR and systolic/diastolic pressures were elevated during cycling and changed in parallel with force events, although few differences were observed between standard and short crank length cycling. These results suggest that MC may constitute a mild exercise strategy post-SCI; clinical translation may be dependent on the ability of the subject-specific cycling parameters to generate reflex-induced eccentric muscle contractions during cycling, emphasizing the importance of crank length (leg range-of-motion) and cycling cadence on the value of motorized cycling after severe SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"79-87"},"PeriodicalIF":2.2,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01152-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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