International Retrospective Comparison of Inpatient Rehabilitation for Patients With Spinal Cord Dysfunction: Differences According to Etiology

• There are many causes of nontraumatic spinal cord dysfunction.
• The most common causes were degenerative, malignant tumors, infections, and ischemia.
• There were major differences between etiologies in epidemiology and outcomes.
• Besides malignant tumor, all etiologies had significant improvement in the American Spinal Injury Association Impairment Scale grade.

ObjectivesTo describe and compare epidemiologic characteristics and clinical outcomes of patients with nontraumatic spinal cord dysfunction according to etiology.DesignRetrospective, multicenter open-cohort case series.SettingSpinal rehabilitation units (SRUs) in 9 countries.ParticipantsPatients (N=956; men, 60.8%; median age, 59.0y [interquartile range, 46–70.0y]; paraplegia, n=691 [72.3%]) with initial onset of spinal cord dysfunction consecutively admitted between January 1, 2008, and December 31, 2010.InterventionsNot applicable.Main Outcome MeasuresEtiology of spinal cord dysfunction, demographic characteristics, length of stay (LOS) in rehabilitation, pattern of spinal cord dysfunction onset, discharge destination, level of spinal cord damage, and the American Spinal Injury Association Impairment Scale (AIS) grade on admission and discharge.ResultsThe most common etiologies were degenerative (30.8%), malignant tumors (16.2%), infections (12.8%), ischemia (10.9%), benign tumors (8.7%), other vascular (8.5%), and other conditions (12.1%). There were major differences in epidemiologic characteristics and clinical outcomes of patients with different etiologies of spinal cord dysfunction. Paraplegia was more common in patients with a malignant tumor and vascular etiologies, while tetraplegia was more common in those with a degenerative etiology, a benign tumor, and infections. Patients with a malignant tumor tended to have the shortest LOS in the SRU, while those with a vascular etiology tended to have the longest. Except for patients with a malignant tumor, all patient groups had a significant change in their AIS grade between admission and discharge.ConclusionsThis international study of spinal cord dysfunction showed substantial variation between the different etiologies regarding demographic and clinical characteristics, including changes in AIS between admission and discharge.