Presence of midsagittal tissue bridges and walking ability 1-year post spinal cord injury

CONTEXT/OBJECTIVE: Providing accurate walking prognosis following spinal cord injury (SCI) is challenging. Assessment of SCI lesion characteristics, captured on T2-weighted MRI, may improve return-to-walking prediction. One characteristic, the midsagittal tissue bridge (MSTB), has shown promising association with a return of sensorimotor function. The purpose of this study was to determine the association between the presence or absence of early-assessed MSTBs and walking ability 1-year post-SCI. SETTING: Inpatient Rehabilitation Facility. METHODS: This retrospective cohort study examined the imaging and walking outcome data of 264 individuals with traumatic SCI. Contingency tables were built to analyze the odds of a return to walking based on the presence or absence of a MSTB. RESULTS: For the entire sample, the odds of walking with present versus absent MSTBs was 8.5 (95%CI: 4.2, 16.8, P < .0001). Similar results were found when isolating only individuals with American Spinal Injury Association Impairment Scale (AIS) B and C injuries. For this AIS B/C subgroup, the odds of walking with present versus absent MSTBs was 4.96 (95%CI: 1.08, 22.89, P < .0401). CONCLUSION: This study found a strong association between the presence or absence of early-assessed MSTBs and walking ability 1-year post-SCI for individuals throughout the SCI severity spectrum. These findings suggest the potential importance of having MRI evidence of this spared neural tissue to increase the likelihood of walking recovery. The assessment of MSTBs presence/absence in the subacute phase of injury may assist clinicians in developing plans of care appropriately balanced between walking recovery strategies and maximizing independence with alternate modes of locomotion.