Early Predictors of Walking Recovery in Patients after Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis.
Lihuan Cao, Jinnan Ou, Zhang Miaoyuan et al.
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In 30 seconds
This systematic review and meta-analysis examined predictors of walking recovery after traumatic spinal cord injury, drawing on 54 studies. The review grouped predictors into sociodemographic, injury-related, imaging, biomarker, and treatment-related factors. Initial injury severity was most informative: AIS was associated with higher odds of walking recovery (OR = 3.70; 95% CI: 2.86-4.79; p = 0.001; I 2 = 2%; high certainty), while neurological level of injury was also predictive (OR = 2.81; 95% CI: 1.54-5.14; p = 0.008; I 2 = 0%; moderate certainty). Diabetes was associated with lower odds of regaining ambulation; age and surgery timing had inconsistent results.
Key findings
- AIS was the strongest predictor reported: OR = 3.70; 95% CI: 2.86-4.79; p = 0.001; I 2 = 2%; high certainty.
- Neurological level of injury predicted walking recovery: OR = 2.81; 95% CI: 1.54-5.14; p = 0.008; I 2 = 0%; moderate certainty.
- Diabetes was associated with lower odds of regaining ambulation (OR = 0.64, 95% CI: 0.42-0.98; p = 0.038; I 2 = 0.0%; moderate certainty).
- Age and timing of surgery showed inconsistent results across cutoffs.
Why it matters
Walking prognosis is important to counselling and rehabilitation planning after traumatic spinal cord injury. This synthesis indicates that admission AIS and neurological level are particularly informative, while also showing that evidence for other commonly considered factors is less consistent. The certainty ratings help distinguish stronger prognostic evidence from findings that warrant more cautious interpretation.
What to keep in mind
Most included studies were rated fair quality (40 [70%] of 54 studies); only 11 (20.4%) were rated good quality. Results for age and surgery timing varied across cutoffs.