Intramedullary hemorrhage and early motor recovery as predictors of neurological recovery after acute cervical spinal cord injury.

OBJECTIVE: To investigate prognostic factors associated with neurological recovery in patients with acute cervical spinal cord injury (CSCI) with intramedullary hemorrhage and edema on magnetic resonance imaging (MRI). METHODS: We retrospectively reviewed 93 patients with acute CSCI who showed intramedullary hemorrhage and edema on MRI and underwent surgery. Clinical and radiological data were collected, including intramedullary edema length (IEL), intramedullary hematoma length (IHL), maximum spinal cord compression (MSCC), preoperative American Spinal Injury Association (ASIA) motor score (AMS), and early postoperative AMS recovery rate. Neurological recovery was defined as improvement of at least 1 grade on the ASIA Impairment Scale (AIS) at 6 months. Univariate analysis and multivariate binary logistic regression were performed to identify independent predictors of neurological recovery. RESULTS: Among the 93 patients, 67 (72.0%) showed neurological improvement at 6 months, whereas 26 (28.0%) did not. There were no significant differences between the recovery and non-recovery groups in age, sex, or injury mechanism. Univariate analysis showed that IEL, IHL, MSCC, postoperative AMS, and early AMS recovery rate were associated with neurological recovery. Multivariate logistic regression demonstrated that preoperative IHL was an independent negative predictor of neurological recovery (OR = 0.664, 95% CI 0.475-0.929), whereas early postoperative AMS recovery rate was an independent positive predictor (OR = 1.269, 95% CI 1.014-1.588). IEL and MSCC were not independently associated with recovery. CONCLUSION: In acute CSCI patients with intramedullary hemorrhage and edema, preoperative IHL and early postoperative AMS recovery rate are independent predictors of 6-month neurological recovery. Combining these indicators has prognostic value in assessing neurological recovery of CSCI patients. CLINICAL TRIAL NUMBER: Not applicable.