Study Design & Setting: Prospective multi-center longitudinal cohort study within the ‘European Multicenter Study of Human Spinal Cord Injury’ (EM-SCI) consortium.

Introduction: Determination between complete and incomplete spinal cord injury (SCI) is commonly applied in prognosticating patients’ functional recovery. Complete and incomplete injury is defined by absence or presence of at least 1 of 4 ASIA sacral sparing (SS) criteria. To date, however, the ASIA SS criteria have not been validated with respect to chronic phase functional outcomes.

Objectives: To validate the prognostic value of the acute phase sacral sparing (SS) measurements regarding to chronic phase ambulation in traumatic SCI patients.

Methods: In 251 patients, acute phase (0–15 days) ASIA Impairment Scale (AIS) grades, ASIA SS measurements and chronic phase (6 or 12 months) Timed Up & Go (TUG) outcome measurements were analyzed. Calculation of sensitivity, specificity, positive and negative predictive values (PPV/NPV), univariate and multivariate logistic regressions were performed in all 4 SS criteria. The area under the receiver-operating characteristic curve (AUC) ratios of all regression equations were calculated.

Results: In completing the 1-year follow-up TUG test, presence of voluntary anal contraction (VAC) showed the best PPV (94.3%, p< 0.001, 95% CI: 80.8–99.3). Best NPV was reported in the S4–5 light touch (LT) score (96.9%, p< 0.001, 95% CI: 92.9–98.9). Presence of anal sensation in the traumatic SCI patients resulted in a PPV of 41% (p=0.124). Use of the combination VAC and S4–5 LT score (AUC: 0.917, p< 0.001, 95% CI: 0.868–0.966) showed significantly better (p< 0.001, 95% CI: 0.042–0.102) discriminating results in 1-year TUG test prognosis than with use of currently used distinction between complete and incomplete SCI (AUC: 0.845, p< 0.001, 95% CI: 0.790–0.901).

Conclusion: Out of the 4 sacral sparing criteria, VAC and S4–5 LT scores are the only acute phase measurements contributing significantly to the prognosis of ambulation. With the combination of acute phase VAC and S4–5 LT scores, significantly better chronic phase ambulation prognosis can be predicted than with use of currently used distinction between complete and incomplete SCI. This study stresses the importance of further research on functional predictive algorithms in the acute setting of traumatic SCI care.

Background: Since high incidences of serious complications like death and pneumonia during halo vest immobilization (HVI) have been reported in recent literature, a tendency of restraint in using the halo vest is rising. Nevertheless, most of these studies were small-scale retrospective reports. The real incidence of complications in a highvolume center with sufficient experience is unknown. It was our objective to determine incidence and risk factors associated with complications during HVI prospectively.

Methods: During a 5-year period a prospective cohort study was performed in a single level-I trauma and spinal disorders center. Data of all traumatic and non-traumatic patients who underwent HVI were prospectively collected. Every complication during follow-up, i.e. the period of HVI, was recorded. Primary outcome was presence or absence of complications. Statistical significance of relations between 30 covariates and primary outcome was determined with Chi-square analysis.

Results: In 239 patients treated with HVI 26 major, 59 intermediate and 132 minor complications were observed. Fourteen patients (6%) died during the treatment, although only three were possibly related directly to the immobilization. Increasing age (p=0.005) was the only risk factor significantly related to mortality during HVI. Patients over the age of 70 were especially at risk (p=0.002). Twelve patients (5%) acquired pneumonia during HVI. Halo related complications ranged from 3 patients (1%) with incorrect initial assembly of the halo vest to 29 patients (12%) with pin site infections. Both pin site infection (p=0.003) and pin loosening (p=0.021) have been identified as significant risk factors in development of pin site penetration.

Conclusions: Compared to previous retrospective reports, we found a lower percentage of mortality and pneumonia during HVI. Nevertheless, the numbers of minor complications remain substantial. This study confirms that awareness and responsiveness to minor complications can prevent subsequent development of serious morbidities and reduce mortality, while it is the first prospective report to identify risk factors for the development of complications during HVI.