Intraoperative Baseline Motor Signals as a Predictor of Recovery in Complete Spinal Cord Injury

Study Design: Retrospective observational study. Objective: The purpose of the study was to investigate the association between the presence of baseline sensory and motor intraoperative neuromonitoring and follow-up functional improvement in complete SCI. Summary of background data: During surgery for complete spinal cord injury (SCI), a subset of patients may have present sensory and motor signals at baseline, suggesting that neuronal tracts may be intact as a target for novel therapeutics or even as a prognostic tool for recovery. Methods: One hundred nineteen complete SCI patients who had a decompression procedure were reviewed in this retrospective study. Intraoperative neuromonitoring signals at baseline were obtained, and the presence of motor evoked potentials (MEPs) at the level of injury and above, as well as somatosensory evoked potentials (SSEPs) at the posterior tibial (PTN) and ulnar (UN) nerves was determined. ASIA scores were collected, and grade conversions and level improvements were both considered functional improvements. Binary logistic regression was completed, with patient age, sex, race, level of injury, and all the above signals as covariates, and functional improvement as the outcome. Results: Approximately 32% of all patients had functional improvement. 17.2% of patients had MEPs present at the level of injury, whereas 49.2% had MEPs present at least one level above injury. The only significant predictor of improvement was MEPs present at the level of injury (OR=3.14, P =0.023). Conclusions: Intraoperative motor signals at the level of injury may hold prognostic value following surgery in complete SCI, which is crucial for determining patient outcomes and guiding future management and decision-making.