Pub Date : 2025-12-04DOI: 10.1038/s41393-025-01155-0
Teleale F. Gebeyehu, Mohammad Amin Sabbaghalvani, Giovanna Failla, Ashmal S. Kabani, Yashvi Shah, Alexander Kharichev, Joshua A. Dian, Stavros Matsoukas, Alexander R. Vaccaro, Gregory D. Schroeder, Srinivas K. Prasad, Jack Jallo, Joshua E. Heller, Michael G. Fehlings, James S. Harrop
Systematic Review. To describe applications of AI for traumatic SCI management with focus on diagnostics, prognostication, and therapeutic interventions. PubMed, Scopus and Cochrane libraries were searched (March 2025). Studies published in English between January 1st, 2020, and March 18, 2025, dealing with clinical aspects in the acute, post-injury rehabilitative and first year phases of SCI were included. Studies on brain computer interface, robotics and non-neurologic aspects of SCI were excluded. Extracted were country of study, study design, focus of study, total participants, American Spinal Injury Association (ASIA) Impairment Scale (AIS), machine learning (ML) models, inputs, outcomes and performance metrices. A total of 23 studies with 120,931 individuals were identified. Classical Machine Learning Models, Ensemble Learning Models and Deep Learning Models were the most used ML families. Age, AIS, neurologic level of injury, sex, mechanism of injury and motor score were the most common inputs. Predictions of neurologic status, functionality status, Hospital/ICU utilizations, complications, survival, discharge destination and results of image segmentation and patient grouping were the outputs of interest. The performance metrices were satisfactory in most and higher than humans in some studies. AI can facilitate personalized approach to diagnosis of SCI, prediction of outcomes like neurological improvement, complications, functionality indicators like walking, selfcare and independence, re-admissions, prolonged length of stays, discharge destination and mortality after injury. It was also useful to suggest specific MAP goals and time of surgical intervention. These functions complement clinical judgement.
{"title":"The application of artificial intelligence in the acute and sub-acute phases of spinal cord injury- a systematic review","authors":"Teleale F. Gebeyehu, Mohammad Amin Sabbaghalvani, Giovanna Failla, Ashmal S. Kabani, Yashvi Shah, Alexander Kharichev, Joshua A. Dian, Stavros Matsoukas, Alexander R. Vaccaro, Gregory D. Schroeder, Srinivas K. Prasad, Jack Jallo, Joshua E. Heller, Michael G. Fehlings, James S. Harrop","doi":"10.1038/s41393-025-01155-0","DOIUrl":"10.1038/s41393-025-01155-0","url":null,"abstract":"Systematic Review. To describe applications of AI for traumatic SCI management with focus on diagnostics, prognostication, and therapeutic interventions. PubMed, Scopus and Cochrane libraries were searched (March 2025). Studies published in English between January 1st, 2020, and March 18, 2025, dealing with clinical aspects in the acute, post-injury rehabilitative and first year phases of SCI were included. Studies on brain computer interface, robotics and non-neurologic aspects of SCI were excluded. Extracted were country of study, study design, focus of study, total participants, American Spinal Injury Association (ASIA) Impairment Scale (AIS), machine learning (ML) models, inputs, outcomes and performance metrices. A total of 23 studies with 120,931 individuals were identified. Classical Machine Learning Models, Ensemble Learning Models and Deep Learning Models were the most used ML families. Age, AIS, neurologic level of injury, sex, mechanism of injury and motor score were the most common inputs. Predictions of neurologic status, functionality status, Hospital/ICU utilizations, complications, survival, discharge destination and results of image segmentation and patient grouping were the outputs of interest. The performance metrices were satisfactory in most and higher than humans in some studies. AI can facilitate personalized approach to diagnosis of SCI, prediction of outcomes like neurological improvement, complications, functionality indicators like walking, selfcare and independence, re-admissions, prolonged length of stays, discharge destination and mortality after injury. It was also useful to suggest specific MAP goals and time of surgical intervention. These functions complement clinical judgement.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"3-13"},"PeriodicalIF":2.2,"publicationDate":"2025-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01155-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678935","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 : 2025-12-03DOI: 10.1038/s41393-025-01151-4
Weichu Sun, Yuqing Wang, Hui Xiao, Jiachen Liu
{"title":"Comment on ‘Increased risk of osteoarthritis in persons with spinal cord injury: a population-based longitudinal follow-up study in Taiwan’","authors":"Weichu Sun, Yuqing Wang, Hui Xiao, Jiachen Liu","doi":"10.1038/s41393-025-01151-4","DOIUrl":"10.1038/s41393-025-01151-4","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"1-2"},"PeriodicalIF":2.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669551","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}
Cross-sectional observational study. Deep-tissue injury (DTI) originates in subcutaneous soft tissue and progresses outward without early skin changes, making diagnosis difficult in people with spinal-cord injury (SCI). We evaluated the incidence of DTI with magnetic resonance imaging (MRI) and sought associated risk factors. Kibikogen Rehabilitation Center for Employment Injuries, Japan. Fifty-six wheelchair-dependent adults with SCI of at least 1 month’s duration underwent pelvic sagittal STIR MRI screening. DTI-positive sites were defined by signal changes in subcutaneous fat or muscle. Ultrasonography, body composition, seating-related variables, and laboratory data were collected concurrently. Univariate and multivariate logistic-regression analyses identified independent risk factors. MRI detected subclinical DTI in 33 of 112 ischial regions (29.5%). Ultrasonography was concordant in only 15 sites (45.5%). Multivariable analysis showed that longer daily wheelchair use (p = 0.018), greater subcutaneous-tissue thickness at the ischial tuberosities (p = 0.028), and less-frequent pressure-relief manoeuvres (p = 0.031; protective) were independently associated with DTI. BMI, peak interface pressure, and routine haematologic or nutritional markers were not significant. MRI screening revealed subclinical DTI in nearly one-third of wheelchair-dependent patients with SCI and outperformed ultrasonography for early detection. Extended sitting time, thicker subcutaneous fat at the ischial tuberosity, and infrequent pressure relief emerged as modifiable risk factors. A risk-based MRI surveillance strategy may enable timely preventive interventions and reduce progression to overt pressure ulcers.
{"title":"Deep tissue injury in patients with spinal cord injury: a magnetic resonance imaging–based risk assessment study","authors":"Yasuhiro Sakata, Takanori Namba, Yasunori Umemoto, Tatsuya Yoshikawa, Kazunari Furusawa, Gen Yamada, Shinichi Asamura","doi":"10.1038/s41393-025-01150-5","DOIUrl":"10.1038/s41393-025-01150-5","url":null,"abstract":"Cross-sectional observational study. Deep-tissue injury (DTI) originates in subcutaneous soft tissue and progresses outward without early skin changes, making diagnosis difficult in people with spinal-cord injury (SCI). We evaluated the incidence of DTI with magnetic resonance imaging (MRI) and sought associated risk factors. Kibikogen Rehabilitation Center for Employment Injuries, Japan. Fifty-six wheelchair-dependent adults with SCI of at least 1 month’s duration underwent pelvic sagittal STIR MRI screening. DTI-positive sites were defined by signal changes in subcutaneous fat or muscle. Ultrasonography, body composition, seating-related variables, and laboratory data were collected concurrently. Univariate and multivariate logistic-regression analyses identified independent risk factors. MRI detected subclinical DTI in 33 of 112 ischial regions (29.5%). Ultrasonography was concordant in only 15 sites (45.5%). Multivariable analysis showed that longer daily wheelchair use (p = 0.018), greater subcutaneous-tissue thickness at the ischial tuberosities (p = 0.028), and less-frequent pressure-relief manoeuvres (p = 0.031; protective) were independently associated with DTI. BMI, peak interface pressure, and routine haematologic or nutritional markers were not significant. MRI screening revealed subclinical DTI in nearly one-third of wheelchair-dependent patients with SCI and outperformed ultrasonography for early detection. Extended sitting time, thicker subcutaneous fat at the ischial tuberosity, and infrequent pressure relief emerged as modifiable risk factors. A risk-based MRI surveillance strategy may enable timely preventive interventions and reduce progression to overt pressure ulcers.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 3","pages":"227-232"},"PeriodicalIF":2.2,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145655603","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 : 2025-11-27DOI: 10.1038/s41393-025-01154-1
Fatma Kumbara, Zuhal Ozisler, Elif Yalçın
Retrospective cohort study. To identify clinical and demographic factors associated with functional recovery and length of hospital stay in individuals with spinal cord injury undergoing inpatient rehabilitation. Physical Medicine and Rehabilitation Center at Ankara Bilkent City Hospital, Turkey. Medical records of patients with spinal cord injury admitted for inpatient rehabilitation between January 2020 and September 2023 were retrospectively reviewed. Demographic characteristics, injury-related variables, neurological level, ASIA classification, SCIM III scores, complications, assistive rehabilitation interventions, bladder management, and functional status were collected. Univariate analyses (Mann–Whitney U, Kruskal–Wallis, Chi-square) were performed, followed by multivariate regression to identify independent predictors of functional outcomes. A total of 342 patients were included (mean age 38.9 ± 16.2 years). The mean length of stay was 41.6 ± 20.3 days. Univariate analyses showed that age, time since injury, neurological level, multiple hospitalizations, SCIM III scores, complications, advanced rehabilitation technologies, and bladder catheterization were significantly associated with both functional status and hospitalization duration (p < 0.05). Multivariate regression demonstrated that age (β = –0.24, 95% CI: –0.35 to –0.13, p < 0.001), presence of complications (β = –0.31, 95% CI: –0.46 to –0.17, p < 0.001), and bladder catheterization (β = –0.19, 95% CI: –0.32 to –0.07, p = 0.004) were independent predictors of discharge SCIM III scores. Age, neurological integrity, complications, and bladder management are key determinants of functional outcomes in SCI rehabilitation, while these factors also influence length of stay. Early complication prevention, optimized bladder care, and tailored rehabilitation strategies may enhance recovery and shorten hospitalization. No commercial sponsorship was received for this study.
研究设计：回顾性队列研究。目的：确定与脊髓损伤患者接受住院康复的功能恢复和住院时间相关的临床和人口学因素。地点：土耳其安卡拉比尔肯市医院物理医学和康复中心。方法：回顾性分析2020年1月至2023年9月住院康复的脊髓损伤患者的医疗记录。收集人口统计学特征、损伤相关变量、神经学水平、ASIA分类、SCIM III评分、并发症、辅助康复干预、膀胱管理和功能状态。进行单变量分析（Mann-Whitney U, Kruskal-Wallis，卡方），然后进行多变量回归以确定功能结局的独立预测因子。结果：共纳入342例患者，平均年龄38.9±16.2岁。平均住院时间为41.6±20.3天。单因素分析显示，年龄、损伤时间、神经系统水平、多次住院、SCIM III评分、并发症、先进的康复技术和膀胱导尿与功能状态和住院时间显著相关(p)。结论：年龄、神经完整性、并发症和膀胱管理是脊髓损伤康复中功能结局的关键决定因素，同时这些因素也影响住院时间。早期并发症预防、优化膀胱护理和量身定制的康复策略可促进康复和缩短住院时间。赞助：本研究未收到任何商业赞助。
{"title":"Determinants of functional recovery and length of stay in spinal cord injury inpatients: a retrospective analysis","authors":"Fatma Kumbara, Zuhal Ozisler, Elif Yalçın","doi":"10.1038/s41393-025-01154-1","DOIUrl":"10.1038/s41393-025-01154-1","url":null,"abstract":"Retrospective cohort study. To identify clinical and demographic factors associated with functional recovery and length of hospital stay in individuals with spinal cord injury undergoing inpatient rehabilitation. Physical Medicine and Rehabilitation Center at Ankara Bilkent City Hospital, Turkey. Medical records of patients with spinal cord injury admitted for inpatient rehabilitation between January 2020 and September 2023 were retrospectively reviewed. Demographic characteristics, injury-related variables, neurological level, ASIA classification, SCIM III scores, complications, assistive rehabilitation interventions, bladder management, and functional status were collected. Univariate analyses (Mann–Whitney U, Kruskal–Wallis, Chi-square) were performed, followed by multivariate regression to identify independent predictors of functional outcomes. A total of 342 patients were included (mean age 38.9 ± 16.2 years). The mean length of stay was 41.6 ± 20.3 days. Univariate analyses showed that age, time since injury, neurological level, multiple hospitalizations, SCIM III scores, complications, advanced rehabilitation technologies, and bladder catheterization were significantly associated with both functional status and hospitalization duration (p < 0.05). Multivariate regression demonstrated that age (β = –0.24, 95% CI: –0.35 to –0.13, p < 0.001), presence of complications (β = –0.31, 95% CI: –0.46 to –0.17, p < 0.001), and bladder catheterization (β = –0.19, 95% CI: –0.32 to –0.07, p = 0.004) were independent predictors of discharge SCIM III scores. Age, neurological integrity, complications, and bladder management are key determinants of functional outcomes in SCI rehabilitation, while these factors also influence length of stay. Early complication prevention, optimized bladder care, and tailored rehabilitation strategies may enhance recovery and shorten hospitalization. No commercial sponsorship was received for this study.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 3","pages":"222-226"},"PeriodicalIF":2.2,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640048","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 : 2025-11-25DOI: 10.1038/s41393-025-01124-7
M. Arora, J. Middleton, AM. Sarandrea, I. Pozzato, C. McBain, D. Myles, Y. Tran, J. Kaur, A. Craig
Guidelines update. To provide management recommendations and strategies for cognitive impairment (CI) in people with spinal cord injury (SCI) for healthcare professionals (HCPs). SCI Units, NSW, Australia. The development encompassed multiple stages, commencing with establishment of the multidisciplinary advisory committee, followed by expert consultations. A rapid review and e-Delphi surveys were undertaken for the seven identified themes to achieve consensus for a new section on CI in an existing psychosocial guide. The intended primary end-user for this guide consists of the HCPs providing treatment to people with SCI in the acute, rehabilitation, and community settings. The secondary end-user includes consumer organisations, health planners, and policy makers. The expert consultation resulted in developing seven key themes to provide a foundational structure to the guidance about CI. For the first round of the Delphi survey, 40 (out of 49) statements received agreement levels exceeding 95% and were accepted without revisions. In the second round, two statements were deleted, and seven statements were amended based on the feedback received. After the final round, a total of 47 statements were accepted and formed 20 recommendations under seven themes as the final version of the cognitive guide. This updated guidance for managing CI in people with SCI emphasises the importance of person-centred care and the identification of barriers and facilitators for improved communication between the multidisciplinary HCPs and patients with SCI and their family members. This will ultimately enhance overall rehabilitation outcomes including self-efficacy, adjustment, and quality of life.
{"title":"Evidence based recommendations for health professionals to improve care of people with spinal cord injury and cognitive impairment: an update to the psychosocial care practice guide","authors":"M. Arora, J. Middleton, AM. Sarandrea, I. Pozzato, C. McBain, D. Myles, Y. Tran, J. Kaur, A. Craig","doi":"10.1038/s41393-025-01124-7","DOIUrl":"10.1038/s41393-025-01124-7","url":null,"abstract":"Guidelines update. To provide management recommendations and strategies for cognitive impairment (CI) in people with spinal cord injury (SCI) for healthcare professionals (HCPs). SCI Units, NSW, Australia. The development encompassed multiple stages, commencing with establishment of the multidisciplinary advisory committee, followed by expert consultations. A rapid review and e-Delphi surveys were undertaken for the seven identified themes to achieve consensus for a new section on CI in an existing psychosocial guide. The intended primary end-user for this guide consists of the HCPs providing treatment to people with SCI in the acute, rehabilitation, and community settings. The secondary end-user includes consumer organisations, health planners, and policy makers. The expert consultation resulted in developing seven key themes to provide a foundational structure to the guidance about CI. For the first round of the Delphi survey, 40 (out of 49) statements received agreement levels exceeding 95% and were accepted without revisions. In the second round, two statements were deleted, and seven statements were amended based on the feedback received. After the final round, a total of 47 statements were accepted and formed 20 recommendations under seven themes as the final version of the cognitive guide. This updated guidance for managing CI in people with SCI emphasises the importance of person-centred care and the identification of barriers and facilitators for improved communication between the multidisciplinary HCPs and patients with SCI and their family members. This will ultimately enhance overall rehabilitation outcomes including self-efficacy, adjustment, and quality of life.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 2","pages":"165-176"},"PeriodicalIF":2.2,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01124-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145605732","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 : 2025-11-24DOI: 10.1038/s41393-025-01144-3
Marcel W. M. Post, Denise G. Tate, Sara Ahmed, Susan J. Bartlett, Susan Charlifue, Jennifer Coker, Ashley Craig, Stanley Ducharme, Jane Duff, Allen W. Heinemann, Duygu Kuzu, Kimberley R. Monden, Dan Rohe, Tijn van Diemen, Kathy Zebracki
Consensus exercise, narrative review. To create an International Spinal Cord Injury Psychological Functioning Basic Data Set (PSYCHBDS). International working group. Online meetings and email communications throughout 2020-2022. The authors reviewed measures used by SCI rehabilitation psychologists and reported in the literature. Selected measures and their psychometric properties were described. Consensus was reached on the measures and other data elements to include in the PSYCHBDS. The draft-PSYCHBDS was further reviewed by members of the International SCI Data Sets Committee, the American Spinal Injury Association (ASIA) Board, the International Spinal Cord Society (ISCoS) Executive and Scientific Committees, individual reviewers and societies, and posted on the ASIA and ISCoS websites for 1 month to elicit comments before final approval by ASIA and ISCoS. The group agreed to restrict the scope of the PSYCHBDS to the domains of anxiety and depressed mood and to use the 2-item versions of the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder (GAD). The PSYCHBDS consists of six standard and three optional data elements: date of data collection, professional background of data collector (optional), presence of psychological disorders before the onset of SCI, administration mode, PHQ-2 score, PHQ-9 score (optional), GAD-2 score, GAD-7 score (optional), and therapy for current psychological disorders. A data collection form and scoring instructions were developed. An international working group of experts achieved consensus on a data set to collect basic information on psychological factors and recommends its use in SCI/D rehabilitation and research.
{"title":"Development of the international spinal cord injury psychological functioning basic data set","authors":"Marcel W. M. Post, Denise G. Tate, Sara Ahmed, Susan J. Bartlett, Susan Charlifue, Jennifer Coker, Ashley Craig, Stanley Ducharme, Jane Duff, Allen W. Heinemann, Duygu Kuzu, Kimberley R. Monden, Dan Rohe, Tijn van Diemen, Kathy Zebracki","doi":"10.1038/s41393-025-01144-3","DOIUrl":"10.1038/s41393-025-01144-3","url":null,"abstract":"Consensus exercise, narrative review. To create an International Spinal Cord Injury Psychological Functioning Basic Data Set (PSYCHBDS). International working group. Online meetings and email communications throughout 2020-2022. The authors reviewed measures used by SCI rehabilitation psychologists and reported in the literature. Selected measures and their psychometric properties were described. Consensus was reached on the measures and other data elements to include in the PSYCHBDS. The draft-PSYCHBDS was further reviewed by members of the International SCI Data Sets Committee, the American Spinal Injury Association (ASIA) Board, the International Spinal Cord Society (ISCoS) Executive and Scientific Committees, individual reviewers and societies, and posted on the ASIA and ISCoS websites for 1 month to elicit comments before final approval by ASIA and ISCoS. The group agreed to restrict the scope of the PSYCHBDS to the domains of anxiety and depressed mood and to use the 2-item versions of the Patient Health Questionnaire (PHQ) and the Generalized Anxiety Disorder (GAD). The PSYCHBDS consists of six standard and three optional data elements: date of data collection, professional background of data collector (optional), presence of psychological disorders before the onset of SCI, administration mode, PHQ-2 score, PHQ-9 score (optional), GAD-2 score, GAD-7 score (optional), and therapy for current psychological disorders. A data collection form and scoring instructions were developed. An international working group of experts achieved consensus on a data set to collect basic information on psychological factors and recommends its use in SCI/D rehabilitation and research.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"60-65"},"PeriodicalIF":2.2,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145597524","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 : 2025-11-20DOI: 10.1038/s41393-025-01145-2
Anneke Hertig-Godeschalk, Joelle L. Flueck, Claudio Perret, Anke Scheel-Sailer, Martin W. G. Brinkhof, Rajeev K. Verma
Randomized, placebo-controlled, double-blind, parallel-group, superiority trial. Sufficient vitamin D levels (serum 25(OH)D > 75 nmol/L) are essential for bone health. The prevalence of insufficient 25(OH)D levels and osteoporosis is high in individuals with spinal cord injury (SCI). This study presents secondary outcomes from the VitD-SCI trial, which evaluated the effect of two D3 supplementation doses over a 12-month period on bone mineral density (BMD) in individuals with chronic SCI. Swiss SCI clinic. Forty-two individuals living with SCI for at least three years (seven females, mean age 48 ± 10 years, 18 ± 13 years since SCI onset) and having insufficient 25(OH)D levels were included. Participants were randomized to receive placebo, medium-dose (24'000 IU once every four weeks), or high-dose (24'000 IU once every two weeks) D3 supplementation for 12 months. At baseline and 12 months, 25(OH)D levels and BMD (measured at the radius, femoral neck, distal femur, and proximal tibia) were assessed. Thirty-three percent of participants who received supplementation achieved sufficient 25(OH)D levels. No effect of D3 supplementation on BMD was observed when comparing baseline to 12 months, regardless of the measurement site. None of the investigated parameters, including lesion level or smoking status, modified the effect under examination. Twelve months of D3 supplementation showed no effect on BMD in individuals with chronic SCI. This study highlights the complexity of SCI-specific physiological mechanisms that may interfere with the response to D3 supplementation and its impact on bone health in this population.
{"title":"Vitamin D supplementation has no effect on bone mineral density in individuals with chronic spinal cord injury – results from a randomized controlled trial","authors":"Anneke Hertig-Godeschalk, Joelle L. Flueck, Claudio Perret, Anke Scheel-Sailer, Martin W. G. Brinkhof, Rajeev K. Verma","doi":"10.1038/s41393-025-01145-2","DOIUrl":"10.1038/s41393-025-01145-2","url":null,"abstract":"Randomized, placebo-controlled, double-blind, parallel-group, superiority trial. Sufficient vitamin D levels (serum 25(OH)D > 75 nmol/L) are essential for bone health. The prevalence of insufficient 25(OH)D levels and osteoporosis is high in individuals with spinal cord injury (SCI). This study presents secondary outcomes from the VitD-SCI trial, which evaluated the effect of two D3 supplementation doses over a 12-month period on bone mineral density (BMD) in individuals with chronic SCI. Swiss SCI clinic. Forty-two individuals living with SCI for at least three years (seven females, mean age 48 ± 10 years, 18 ± 13 years since SCI onset) and having insufficient 25(OH)D levels were included. Participants were randomized to receive placebo, medium-dose (24'000 IU once every four weeks), or high-dose (24'000 IU once every two weeks) D3 supplementation for 12 months. At baseline and 12 months, 25(OH)D levels and BMD (measured at the radius, femoral neck, distal femur, and proximal tibia) were assessed. Thirty-three percent of participants who received supplementation achieved sufficient 25(OH)D levels. No effect of D3 supplementation on BMD was observed when comparing baseline to 12 months, regardless of the measurement site. None of the investigated parameters, including lesion level or smoking status, modified the effect under examination. Twelve months of D3 supplementation showed no effect on BMD in individuals with chronic SCI. This study highlights the complexity of SCI-specific physiological mechanisms that may interfere with the response to D3 supplementation and its impact on bone health in this population.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 2","pages":"158-164"},"PeriodicalIF":2.2,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564927","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 : 2025-11-15DOI: 10.1038/s41393-025-01140-7
Qi Guan, Mary-Ellen Hogan, Andrew Calzavara, Daniel McCormack, Aisha K. Lofters, Tejal Patel, Sander L. Hitzig, Tanya Packer, Sara J. T. Guilcher
Cohort study. To determine the prevalence and to identify predictors of prescription opioid use among persons with non-traumatic spinal cord dysfunction within one year after discharge from inpatient rehabilitation. Ontario, Canada. We conducted a retrospective cohort study using administrative data to determine predictors of receiving prescription opioids during the one year after discharge from inpatient rehabilitation among persons with non-traumatic spinal cord dysfunction between April 1, 2004 and March 31, 2015. We modelled the outcome using a Poisson multivariable regression and reported relative risks with 95% confidence intervals. We identified 3468 individuals with non-traumatic spinal cord dysfunction (50.35% male) with 66.58% who were aged ≥66. Over half of the cohort (59.46%) received opioids during the observation period. Being female, previous opioid use before rehabilitation, increasing comorbidity level, low functional status, and having a previous diagnosis of osteoarthritis were significant risk factors for receiving opioids after discharge, as shown in an adjusted multivariable analysis. Increasing length of rehabilitation stay was protective against opioid receipt after discharge. Risk of receiving opioids varied with age. Younger individuals had a significantly higher risk of future opioid use, a risk that peaked around 30–40 years of age (aRR 1.54, 95% CI 1.42–1.67 for age 40, as compared to age 80). Risk of opioid use following discharge decreased as age increased beyond 40 years, as compared to age 80. Many individuals with non-traumatic spinal cord dysfunction in Ontario are prescribed opioids after discharge from inpatient rehabilitation. This may be problematic due to the number of severe complications that may arise from opioid use and their use in this population warrants future research.
{"title":"Prevalence of prescribed opioid claims among persons with non-traumatic spinal cord dysfunction in Ontario, Canada: a population-based retrospective cohort study","authors":"Qi Guan, Mary-Ellen Hogan, Andrew Calzavara, Daniel McCormack, Aisha K. Lofters, Tejal Patel, Sander L. Hitzig, Tanya Packer, Sara J. T. Guilcher","doi":"10.1038/s41393-025-01140-7","DOIUrl":"10.1038/s41393-025-01140-7","url":null,"abstract":"Cohort study. To determine the prevalence and to identify predictors of prescription opioid use among persons with non-traumatic spinal cord dysfunction within one year after discharge from inpatient rehabilitation. Ontario, Canada. We conducted a retrospective cohort study using administrative data to determine predictors of receiving prescription opioids during the one year after discharge from inpatient rehabilitation among persons with non-traumatic spinal cord dysfunction between April 1, 2004 and March 31, 2015. We modelled the outcome using a Poisson multivariable regression and reported relative risks with 95% confidence intervals. We identified 3468 individuals with non-traumatic spinal cord dysfunction (50.35% male) with 66.58% who were aged ≥66. Over half of the cohort (59.46%) received opioids during the observation period. Being female, previous opioid use before rehabilitation, increasing comorbidity level, low functional status, and having a previous diagnosis of osteoarthritis were significant risk factors for receiving opioids after discharge, as shown in an adjusted multivariable analysis. Increasing length of rehabilitation stay was protective against opioid receipt after discharge. Risk of receiving opioids varied with age. Younger individuals had a significantly higher risk of future opioid use, a risk that peaked around 30–40 years of age (aRR 1.54, 95% CI 1.42–1.67 for age 40, as compared to age 80). Risk of opioid use following discharge decreased as age increased beyond 40 years, as compared to age 80. Many individuals with non-traumatic spinal cord dysfunction in Ontario are prescribed opioids after discharge from inpatient rehabilitation. This may be problematic due to the number of severe complications that may arise from opioid use and their use in this population warrants future research.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 2","pages":"151-157"},"PeriodicalIF":2.2,"publicationDate":"2025-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530909","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 : 2025-11-14DOI: 10.1038/s41393-025-01147-0
Sabrina Imhof, Sibylle Achermann, Maria Rasenack, Inge Eriks Hoogland, Björn Zörner
Multicenter clinical trial. Timed walking tests are commonly used in clinical and research settings to evaluate walking function in people with spinal cord injury (PwSCI), but they usually do not capture the people’s subjective walking experience. The 12-item Multiple Sclerosis Walking Scale (12-WS) is widely used to assess self-perceived walking ability in people with multiple sclerosis (PwMS), but no comparable tool exists for SCI. This study aimed to assess the reliability and validity of the 12-WS in people with cervical or thoracic incomplete SCI (PwiSCI). Balgrist University Hospital, Zurich, Switzerland; Swiss Paraplegic Centre Nottwil, Switzerland. In this clinical trial, 67 PwiSCI (more than 6 months post-injury, AIS C/D) completed the 12-WS and different clinically established gait assessments. Participants completed the 12-WS a second time within a maximum interval of 8 weeks. Results were compared to a cohort of 22 PwMS. The test–retest reliability of the 12-WS was excellent (ICC = 0.91; p < 0.001). Internal consistency was high (Cronbach’s Alpha α = 0.95). SEM and MDC95 were 6.5 and 18.1%, respectively. Strong correlations were found with all gait assessments (ρ = ± 0.62 to ± 0.67; p < 0.001), except for two items (running and cognitive effort), which showed weaker associations. Results for iSCI were consistent with those for the MS cohort. The 12-WS is a reliable and valid patient-reported outcome measure for evaluating walking function in PwSCI. It complements objective gait assessments and supports a comprehensive evaluation of walking function.
{"title":"Reliability and validity of the 12-item multiple sclerosis walking scale in adults with chronic cervical or thoracic incomplete spinal cord injury","authors":"Sabrina Imhof, Sibylle Achermann, Maria Rasenack, Inge Eriks Hoogland, Björn Zörner","doi":"10.1038/s41393-025-01147-0","DOIUrl":"10.1038/s41393-025-01147-0","url":null,"abstract":"Multicenter clinical trial. Timed walking tests are commonly used in clinical and research settings to evaluate walking function in people with spinal cord injury (PwSCI), but they usually do not capture the people’s subjective walking experience. The 12-item Multiple Sclerosis Walking Scale (12-WS) is widely used to assess self-perceived walking ability in people with multiple sclerosis (PwMS), but no comparable tool exists for SCI. This study aimed to assess the reliability and validity of the 12-WS in people with cervical or thoracic incomplete SCI (PwiSCI). Balgrist University Hospital, Zurich, Switzerland; Swiss Paraplegic Centre Nottwil, Switzerland. In this clinical trial, 67 PwiSCI (more than 6 months post-injury, AIS C/D) completed the 12-WS and different clinically established gait assessments. Participants completed the 12-WS a second time within a maximum interval of 8 weeks. Results were compared to a cohort of 22 PwMS. The test–retest reliability of the 12-WS was excellent (ICC = 0.91; p < 0.001). Internal consistency was high (Cronbach’s Alpha α = 0.95). SEM and MDC95 were 6.5 and 18.1%, respectively. Strong correlations were found with all gait assessments (ρ = ± 0.62 to ± 0.67; p < 0.001), except for two items (running and cognitive effort), which showed weaker associations. Results for iSCI were consistent with those for the MS cohort. The 12-WS is a reliable and valid patient-reported outcome measure for evaluating walking function in PwSCI. It complements objective gait assessments and supports a comprehensive evaluation of walking function.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"53-59"},"PeriodicalIF":2.2,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522855","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}
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