ArticleFrontiers in neurology
Identification of clinical predictors for functional recovery in patients with thoracolumbar fractures and incomplete spinal cord injury: an internally validated prediction model.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Accurate prediction of functional recovery after thoracolumbar fracture with incomplete spinal cord injury (SCI) remains challenging. We aimed to identify independent predictors and develop a validated model for 12-month functional outcome. Methods: In this single-center, retrospective cohort study (January 2018-December 2024), consecutive adults (≥18 years) with acute T11-L2 fractures and admission American Spinal Injury Association Impairment Scale (AIS) grade B, C, or D were enrolled. Functional recovery was defined as ≥1 AIS grade improvement plus ≥10-point Spinal Cord Independence Measure version III (SCIM-III) gain at 12 months. Candidate predictors ( Results: Among 1,032 eligible patients, 206 (20.0%) achieved functional recovery. Eight predictors were independently associated: admission AIS grade (OR 4.5 per grade, 95% CI 3.5-5.8), motor score (OR 1.05 per point, 1.03-1.07), intact posterior ligamentous complex (OR 2.3, 1.6-3.2), decompression ≤ 24 h (OR 1.9, 1.4-2.7), non-smoking (OR 1.7, 1.2-2.4), Charlson Comorbidity Index = 0 (OR 1.5, 1.1-2.1), shorter intramedullary T2 lesion length (OR 0.96 per mm, 0.95-0.97) and rehabilitation intensity ≥3 h/day (OR 1.4, 1.0-1.9). The final model demonstrated an optimism-corrected AUC of 0.87 (95% CI: 0.85-0.89) and calibration characteristics with a calibration slope of 1.02, an intercept of 0.01, and a Hosmer-Lemeshow Conclusion: A parsimonious eight-factor model showed robust discrimination and satisfactory calibration in internal validation for 12-month functional recovery after thoracolumbar incomplete SCI, enabling individualized prognostication. External validation in independent multicenter cohorts is required before clinical implementation and treatment decision-making.
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