(I-549) Comparison of Initial Characteristics and Peri-operative Outcomes in Cervical Spinal Cord Injury Patients with Thoracolumbar Level Cases: A TRACK-SCI Study

Introduction: Nearly 50% of all spinal cord injuries (SCI) occur at the cervical level while 35% and 11% of SCIs occur at the thoracic and lumbar levels, respectively. This study examines the differences in initial characteristics and peri-operative outcomes of patients with cervical SCI versus those with thoracolumbar SCI.

Methods: The multi-institutional Transforming Research and Clinical Knowledge in SCI registry was queried to identify patients who had spinal cord injury at the cervical or thoracolumbar level. Demographic, clinical, imaging and outcome data were collected.

Results: N=200 patients with SCI were enrolled from 2014-2022. 153 patients (76.5%) had cervical SCI while 47 patients (23.5%) had thoracolumbar SCI. Thoracolumbar SCI patients were younger than cervical SCI patients (38 vs 58-years-old, P< 0.001) and had higher injury severity scores (ISS) (29 vs 22, P=0.004). There were significant differences (P < 0.001) in mechanism of injury between the two groups, with the falls (59%) being the most common in cervical SCI and assault (35%) and transport (35%) being the most common in thoracolumbar SCI. There were no differences in gender, race, or ethnicity. There were no differences in ICU length of stay (LOS), hospital LOS, discharge disposition, and mortality rates between the two groups. Bilateral lower extremity motor scores (LEMS) were lower at Day 0 and Day 7 (starting from time of ED admissions) for thoracolumbar SCI patients compared to cervical SCI patients (9 vs 31, P< 0.001; 10 vs 33, P< 0.001).

Conclusion : Thoracolumbar SCI patients tend to be younger, have high-velocity injuries, and worse baseline characteristics compared to cervical SCI patients. However, peri-operative outcomes tend to be similar for both groups, with comparable ICU and hospital LOS, discharge dispositions, and mortality rates.

How to Improve Patient Care: Given the comparable peri-operative outcomes between both groups, level of cord injury may not be a good predictor of perioperative outcomes when appropriate and timely SCI surgery and treatment is given.