Disclosures: Samantha L. Houser, BS Biomedical Engineering: No financial relationships or conflicts of interest

Objective: Our goal was to stratify etiologies of spinal cord ischemia (SCI) and evaluate the success of commonly used treatments on patient outcomes.

Design: We performed a meta-analysis of case reports and series.Setting : A PubMed search was conducted using the terms (“spinal cord ischemia”) OR (“spinal cord infarction”) OR (“spinal cord stroke”) published in the past 10 years.Participants : 343 full-length case reports and case series were screened against predefined exclusion criteria. 197 articles reporting on 236 total patients were included for meta-analysis.

Interventions: N/A

Main Outcome Measures: The following data were gathered from each report: patient age, sex, etiology of SCI, degree of functional impairment, affected spinal cord levels, treatments given, and patient functional status at discharge and follow-up.

Results: Mean patient age was 51 (± 22). 59% were male. 37% of SCI was iatrogenic, commonly after surgery or endovascular procedures. Patients who experienced SCI due to aortic vascular pathology or after aortic surgery had significantly better outcomes than other etiologies (p-value=0.001 and 0.04, respectively). Cerebrospinal fluid (CSF) drainage (n=39) significantly improved outcomes at discharge when compared to patients who did not receive this treatment (p-value=0.008). Rehabilitation (n=123), anti-platelet drugs (n=57), blood pressure management (n=54), anti-coagulants (n=39), endovascular interventions (n=21), and thrombolytics (n=5) did not significantly improve patient outcomes. Median follow-up time was 16 weeks.Conclusions: Results show that standard management strategies for cerebral strokes do not improve SCI, despite similar mechanisms of tissue injury. CSF drainage is currently used for SCI prevention during endovascular aneurysm repair; our findings suggest that this may be a beneficial treatment option for all SCI, regardless of etiology. Rehabilitation did not significantly improve outcomes, which may be because patients with poor outcomes after initial treatment were more likely to admit to a rehab unit. Other possibilities are inadequate follow-up time and a lack of case report differentiation between in-patient and out-patient rehab.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2021

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/management-of-spinal-cord-ischemia-a-meta-analysis-of-196-case-reports-and-series/