The Associative Pattern Between Segmental Arterial Damage and Complete Neurological Disorder After Spinal Cord Injury: A Case-Control Study

Baptiste Boukebous; Lorenzo Serfaty; Te Ra R Hodges-Tai; Joseph F Baker; Jean Denis Moyer; Marc Antoine Rousseau

doi:10.7759/cureus.35918

The Associative Pattern Between Segmental Arterial Damage and Complete Neurological Disorder After Spinal Cord Injury: A Case-Control Study

Cureus. 2023 Mar 8;15(3):e35918. doi: 10.7759/cureus.35918. eCollection 2023 Mar.

Authors

Baptiste Boukebous¹, Lorenzo Serfaty², Te Ra R Hodges-Tai³, Joseph F Baker¹, Jean Denis Moyer⁴, Marc Antoine Rousseau⁵

Affiliations

¹ Orthopaedics and Traumatology, Waikato District Health Board, Hamilton, NZL.
² Orthopedics and Traumatology, Bichat-Claude Bernard Hospital, Paris, FRA.
³ Orthopedics and Traumatology, Waikato District Health Board, Hamilton, NZL.
⁴ Intensive Care Unit, Beaujon Hospital, Clichy, FRA.
⁵ Orthopaedics and Traumatology, Bichat-Claude Bernard Hospital, Paris, FRA.

Abstract

Introduction: The prevalence of vascular trauma surrounding the thoracic spine following Spinal Cord Injury (SCI) is unknown. The potential for neurologic recovery is uncertain in many cases; in some cases, neurologic assessment is not possible, for example, in severe head injury or early intubation, and detection of segmental artery injury may help as a predictive factor.

Objective: To assess the prevalence of segmental vessel disruption in two groups, with and without neurologic deficit.

Material and methods: This is a retrospective cohort study, with a group SCI American Spinal Injury Association (ASIA) E and a group SCI ASIA A. All patients had a high-energy thoracic or thoracolumbar fracture from T1 to L1. Patients were matched 1:1 (one ASIA A matched with one ASIA E) according to the fracture type, age, and level. The primary variable was the assessment of the presence/disruption of the segmental arteries, bilaterally, around the fracture. Analysis was performed twice by two independent surgeons in a blinded fashion.

Results: Both groups had 2 type A, 8 type B, and 4 type C fractures. The right segmental artery was detected in 14/14 (100%) of the patients with ASIA E and in 3/14 (21%) or 2/14 (14%) of the patients with ASIA A, according to the observers, p=0.001. The left segmental artery was detectable in 13/14 (93%) or 14/14 (100%) of the patients ASIA E and in 3/14 (21%) of the patients ASIA A for both observers. All in all, 13/14 of the patients with ASIA A had at least one segmental artery undetectable. The sensibility varied between 78%to 92%, and the specificity from 82% to 100%. The Kappa Score varied between 0.55 and 0.78.

Conclusion: Segmental arteries disruption was common in the group ASIA A. This may help to predict the neurological status of patients with no complete neurological assessment or potential for recovery post-injury.

Keywords: blood supply; cord ischemia; medullar blood flow; segmental artery; spinal cord injury; vasculature surrounding the spinal column.