Are early-onset spasms predictive of poor neurological recovery after traumatic spinal cord injury?

Abstract

Context

Following spinal cord injury (SCI), early spasms are associated with decreased functional recovery. It has also been hypothesized that early spasticity might sign underlying maladaptive neuroplasticity, which could translate in worse neurological outcomes.

Objective

In this context, this paper aims to evaluate if early-onset spasms are also associated with neurological outcomes after SCI.

Methods

A retrospective review of 196 cases from a prospective SCI database was conducted. The presence of early spasms during the acute hospitalization was assessed by a single physiatrist. The characteristics and long-term neurological outcomes of individuals with and without early spasms were first compared. Multivariate regression analyses were then performed to determine the relationship between early spasms and neurological outcomes.

Results

30.1% (N = 59) of patients presented early spasms. These patients had several distinguishing characteristics including higher odds of tetraplegia (vs. paraplegia) and more severe injuries. At the bivariate level, patients with early spasms had higher odds of improving at least 1 AIS grade between baseline and follow-up. However, this was not significant at the multivariate level.

Conclusions

Early spasms are not significantly associated with poorer neurological outcomes, contrasting with the unwritten consensus that early spasticity translates maladaptive neuroplasticity.

KEYWORDS:

• Spinal cord injury
• Spasticity
• spasms
• Neurological recovery
• Baclofen

Acknowledgements

We thank all the research staff at the Laboratoire d’Orthopédie-colonne for their crucial work in recruiting patients and organizing follow-ups. We also thank our participants, without whom this research would not have been possible.

Disclaimer statements

Conflicts of interest Authors have no conflict of interests to declare.

Ethical approval This study was approved by the “Comité d’éthique de la recherche du CIUSSS du Nord-de-l’Île-de-Montréal” at Hôpital Sacré-Cœur de Montréal. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Data deposition The datasets generated during and/or analyzed during the current study are not publicly available due to the regulations defined by the ethics committee of the CIUSS Nord-de-l’Île-de-Montréal but are available from the corresponding author on reasonable request.

Additional information

Funding

This research was funded by the Fonds de recherche du Québec – Santé, the Praxis Spinal Cord Institute and the Medtronic Research Chair in Spinal Trauma at Université de Montréal.