103. Factors associated with motor, sensory, bladder and bowel function recovery after traumatic cauda equina injury (TCEI)

BACKGROUND CONTEXT Traumatic cauda equina injury (TCEI) is usually caused by spine injury at L1 or below, and can result in motor and/or sensory impairments and/or neurogenic bowel and bladder. PURPOSE This study was undertaken to examine the factors that can potentially predict motor, sensory, bowel, and bladder function to aid in prognosis and optimal management. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE The study cohort included individuals with any neurological severity of injury (American Spinal Injury Association Impairment Scale [AIS] A to D) and single neurological levels from L1 up to and including S3 at admission to acute care at an RHSCIR facility as assessed using the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI). Patients were not required to have bowel and/or bladder dysfunction at admission to acute care. OUTCOME MEASURES Lower extremity motor score (LEMS), neurological level of injury, and voluntary anal contraction (VAC) were obtained from the admission and discharge International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) examination. Change in bowel and bladder function was assessed by the Functional Independence Measure (FIM), and walking status was assessed by either FIM or Spinal Cord Independence (SCIM) at admission and discharge. METHODS Multiple logistic regression analysis was used to determine which of the following variables were associated with independent walking in a predictive model: age at the time of injury, sex, neurological level of injury (categorized as 3 groups), time from injury to surgery, LOS in an acute care facility, LOS in a rehabilitation facility, and rehabilitation onset. Multiple linear regression analyses were performed to determine which of the above variables were associated with the following dependent variables: (a) change in LEMS; and (b) change in bowel and bladder scores. Stepwise variable selection methods (p-values for a variable to enter and stay in the model set to 0.30 and 0.10 respectively) were applied to all regression models. Four final models obtained included significant predictors from stepwise variable. RESULTS The cohort included 214 participants who were predominantly male (76.6%) with a mean age of 39.9±17.3 years who mostly had a fall-related injury (48.8%) at the L1 neurological level (48.1%). Multiple logistic regression analysis indicated that independent walking at discharge was associated with male sex, surgery later than 24 hours from injury, and longer length of stay (LOS) in the acute and rehabilitation facilities. Multiple linear regression analysis showed that shorter time from injury to rehabilitation facilities and longer rehabilitation LOS were significant independent predictors of improvement in bowel function. Further, older age, female sex, and longer rehabilitation LOS were associated with improvement in bladder function. Greater LEMS improvement was associated with having a spine injury at the L1 level (vs L3-S3). CONCLUSIONS Our results suggest that independent walking after TCEI is associated with sex, time of surgery, and in-patient LOS. Bowel and bladder function recovery was improved in those with longer rehabilitation LOS, and bladder function recovery was improved in females. Older age and longer time to surgery were associated with improved bladder function. This study provides key information for rehabilitation goal planning and communication with individuals and their families with regards to prognostication. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.