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Supplemental material, sj-pdf-1-nnr-10.1177_15459683231166937 for Walking Outcome After Traumatic Paraplegic Spinal Cord Injury: The Function of Which Myotomes Makes a Difference? by Adrian Cathomen, Doris Maier, Jiri Kriz, Rainer Abel, Frank Röhrich, Michael Baumberger, Giorgio Scivoletto, Norbert Weidner, Rüdiger Rupp, Catherine R. Jutzeler, John D. Steeves, Armin Curt and Marc Bolliger in Neurorehabilitation and Neural Repair

Fragestellung: Ziel dieser Studie war es, die Therapiemethode (operativ vs. konservativ) bei Densfrakturenhinsichtlich des Risikos der Entwicklung einer Pseudarthrosezu untersuchen. Methodik: Die Studie basiert auf einer retrospektiv Analyse von routunemäßig erhobenen Daten bei einem [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Ischemic spinal cord injury (SCI) belongs to the heterogeneous group of non-traumatic SCI, while the course of sensorimotor and functional recovery is comparable to traumatic SCI. Recently, we derived from data of patients with traumatic SCI a valid model to predict an independent and reliable bowel management one year after SCI.To evaluate the performance of this model to predict an independent and reliable bowel management one year following ischemic SCI.Prognostic study - observational study.European Multicenter Study about Spinal Cord Injury (EMSCI) ClinicalTrials.gov: NCT01571531.One hundred and forty-two patients with ischemic SCI of various level and severity of injury.The prediction model relied on a single predictor collected within 40 days from injury, the International Standards for Neurological Classification of Spinal Cord Injury total motor score. Bowel outcome one year after SCI derived from the dichotomization of the Spinal Cord Independence Measure (SCIM) item 7 scores. We defined a positive outcome as independent bowel management with regular movements and appropriate timing with no or rare accidents (score of 10 in SCIM version II and score of 8 or 10 in version III).The model showed a fair discrimination with an area under the receiver operating characteristic (ROC) curve of 0.780 (95% confidence interval=0.702-0.860). In addition, the model displayed an acceptable accuracy and calibration.The study extends the validity of our rule to patients with ischemic SCI, thus providing the first model to predict an independent and reliable bowel management in this population.The model may be employed in clinical practice to counsel patients, to define the rehabilitation aims and to estimate the need of assistance after discharge, as well as in the research field for the optimization of patients' allocation in the design of future clinical trials.

Additional file 1: Figure S1. Proportion of missing data in the EMSCI study stratified by the exam stage. Figure S2. Proportion of missing data in the EMSCI study stratified by the injury severity (i.e., AIS grade). Table S1. Outcome variables and number of observations with missing data (EMSCI).

Additional file 2: Figure S1. Annual number of patients enrolled in the EMSCI study. On average 242 patients were included in EMSCI per year across all participating centers. In 2001, EMSCI was founded and only three centers were recruiting patients. Figure S2. Ratio of female and male EMSCI patients with traumatic spinal cord injury between 2001 and 2019. (A) The sex ratio remained constant over time in para- and tetraplegic patients. (B) Similarly, no change over time could be observed when stratifying patients according to injury severity, i.e., AIS grades. Figure S3. Overall annual distribution of age at injury stratified by sex. Over the last two decades, there was a shift in age at injury for both, male and female individuals with spinal cord injury. In comparison to early 2000’s, which were characterized by a unimodal distribution, the proportion of elderly people sustaining a traumatic spinal cord injury increased significantly. Figure S4. Age at injury of EMSCI patients stratified by injury level and severity. Independent of (A) level of injury and (B) injury severity, there was a change in age at injury over the last decade. While in 2001 predominantly young individuals sustained a traumatic spinal cord injury, the proportion of elderly patient significantly increased with time. Figure S5. Proportional distribution of (A) injury severity and (B) injury level of EMSCI patients who sustained a traumatic spinal cord injury between 2001 and 2019. The injury severity remained constant over time in the paraplegic and tetraplegic cohort. More pronounced fluctuations were observed in the injury levels across different AIS grades. Figure S6. Trend estimates of distribution of injury severity in different age groups for male and female EMSCI patients. Positive estimates indicate in an increase in proportion of a specific AIS grade over timeframe between 2001 and 2019, while negative estimates indicate a decrease. In the age groups below 70 years, the proportion of AIS grades remained constant as opposed to the over 70 years of age group that is characterized by a decrease in severe injuries. In the female population, the heterogeneity in terms of injury severities is greater. This has to be interpreted with caution as the number of female patients is relatively small. Figure S7. Sensorimotor recovery between 2001 and 2019. The recovery trajectories of (A) lower and (B) upper extremity, as well as the (C) total motor score, and (D) total sensory score were comparable across the study duration. Less severe injuries (i.e., AIS-C and AIS-D) were associated with a higher sensorimotor recovery. The solid lines represent the fitted models and the shaded areas the standard error. Note: The total sensory score is computed as the sum of the total pin prick score and total light touch score. Figure S8. Time-series of neurological and functional recovery throughout the surveillance period. The sensorimotor recovery, measured as (A) total motor score, (B) and total sensory score, is characterized by an improvement over the course of one year (i.e., transition from the very acute to chronic phase). (C) Similar pattern and rate of recovery can be observed for the functional outcome, measured by the SCIM2/3. However, neither the pattern nor the degree of neurological and functional recovery changed between 2001 and 2019. In other words, the degree a person with spinal cord injury spontaneously recovers sensory and motor function within one-year post-injury is the same now as it was two decades ago. The solid lines represent the fitted models and the shaded areas the standard error. Figure S9. Walking function recovery between 2001 and 2019. The recovery trajectories of the (A) walking endurance, and (B) walking cadence remained comparable throughout the surveillance period. Less severe injuries (i.e., AIS-C and AIS-D) were associated with more functional recovery, including walking. The solid lines represent the fitted models and the shaded areas the standard error. Figure S10. Time-series of recovery of walking function throughout the surveillance period. Dependent on the injury severity, walking function, measured by (A) WISCI, (B) 6-minute walking test, and (C) 10m walking test spontaneously recovers, in part, during the transition from the acute to the chronic phase of injury. Importantly, the increase in different aspects of the walking function, such as endurance (6-minute walking test) and cadence (10m walking test), within one-year post-injury remained comparable throughout the surveillance period. The solid lines represent the fitted models and the shaded areas the standard error. Figure S11. Sensorimotor recovery trajectories stratified by age-groups and injury characteristics. The (A) motor and (B) sensory recovery remained comparable throughout the surveillance period from 2001 and 2019 and across different age groups. Figure S12. Comparison of recovery profiles between female and male patients. The recovery profiles of (A) motor function (i.e., Total motor score), (B) functional independence (i.e., SCIM), and (C) walking function were comparable between patients with traumatic and ischemic spinal cord injuries. Figure S13. Comparison of recovery profiles between patients with traumatic and ischemic injuries. The recovery profiles of (A) motor function (i.e., Total motor score), (B) functional independence (i.e., SCIM), and (C) walking function were comparable between patients with traumatic and ischemic spinal cord injuries. Table S1. Numbers and proportions of patients enrolled in the EMSCI per country (5-year bins). Table S2. Demographics and injury characteristics of included EMSCI cohort stratified by age groups. Table S3. Demographics and injury characteristics of excluded EMSCI cohort. Table S4. Mean and standard deviation of age at injury for the entire EMSCI cohort between 2001 and 2019 stratified by sex. Table S5. Model output of longitudinal analysis of demographics (i.e., sex and age) and baseline injury characteristics (i.e., injury severity and level, plegia). Table S6. Overview of longitudinal sensory and motor recovery. Patients enrolled in the EMSCI had 5 follow-up time points, while the patients participating the Sygen trial had seven. Upper extremity motor scores were computed for paraplegic patients only. We report mean (standard deviation); number of patients. Table S7. Model output of lower extremity motor score (LEMS) stratified by sex, plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Table S8. Model output of upper extremity motor score (UEMS) stratified by sex, plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Note: The model was only run for tetraplegic patients. Table S9. Model output of upper extremity motor score (UEMS) stratified by sex, plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Note: The model was only run for tetraplegic patients. Table S10. Model output of total light touch score (TLT) stratified by sex, plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Table S11. Model output of total pinprick score (TPP) stratified by sex, plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Table S12. Model output of total sensory score (TSS) stratified by sex, plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Table S13. Model output of SCIM Total Score stratified by sex, plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Table S14. Model output of Walking Index for Spinal Cord Injury (WISCI), stratified by sex, plegia, and baseline AIS grades/ Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Table S15. Model output of 6-minute walking test (6-MWT) stratified by sex, plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Note: The model was only run for patients with AIS-C and D injuries. Male and female patients were pooled due to low sample numbers. Table S16. Model output of 10m walking test (10-MWT) stratified by sex, plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Note: The model was only run for patients with AIS-C and D injuries. Table S17. Sensitivity Analysis II: Sex. Model output of total motor score, SCIM2 and 3, and WISCI stratified by plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red. Table S18. Sensitivity Analysis III: Cause of Injury. Model output of total motor score, SCIM2 and 3, and WISCI stratified by plegia, and baseline AIS grades. Patients were enrolled in the EMSCI study. Significant values are highlighted in red.

Supplemental material for Inclusive Trial Designs in Acute Spinal Cord Injuries: Prediction���Based Stratification of Clinical Walking Outcome and Projected Enrolment Frequencies by Adrian Cathomen, MSc, Laura Sirucek, MSc, Tim Killeen, PhD, Rainer Abel, MD, Doris Maier, MD, Norbert Weidner, MD, R��diger Rupp, PhD, Torsten Hothorn, PhD, John D. Steeves, PhD, Armin Curt, MD, and Marc Bolliger, PhD in Neurorehabilitation and Neural Repair

Additional file 3: Figure S1. Flow chart of included and excluded subjects. Figure S2. Proportion of missing data in the Sygen trial stratified by the exam stage. Figure S3. Proportion of missing data in the Sygen trial stratified by the injury severity (i.e., AIS grade). Figure S4. Sensorimotor recovery after spinal cord injury in patients enrolled in the Sygen clinical trial. Recovery of (A) lower and (B) upper extremity motor score as well as (C) total light touch and (D) total pin prick are all dependent on the injury level (tetra- vs. paraplegia) and the injury severity (i.e., AIS grades). Table S1. Details on excluded Sygen cohort. Table S2. Outcome variables and number of observations with missing data (Sygen). Table S3. Model output of longitudinal analysis of demographics (i.e., sex and age) and baseline injury characteristics (i.e., injury severity and level, plegia). Table S4. Model output of lower extremity motor score (LEMS) stratified by sex, plegia, and AIS grades. Patients were enrolled in the Sygen Trial. Note: In case the number of patients per group were too low (n < 3), the model did not converge and thus, the results are not represented in the table. Table S5. Model output of upper extremity motor score (UEMS) stratified by sex and AIS grades. Patients were enrolled in the Sygen Trial. Note: This analysis was only conducted for the tetraplegic patients. Table S7. Model output of total light touch (TLT) stratified by sex, plegia, and AIS grades. Patients were enrolled in the Sygen Trial. Note: In case the number of patients per group were too low (n < 3), the model did not converge and thus, the results are not represented in the table. Table S8. Model output of total pinprick (TPP) stratified by sex, plegia, and AIS grades. Patients were enrolled in the Sygen Trial. Note: In case the number of patients per group were too low (n < 3), the model did not converge and thus, the results are not represented in the table. Table S9. Sensitivity analysis: Surgical timing on total motor score stratified by AIS grades. Patients were enrolled in the Sygen Trial. Note: In case the number of patients per group were too low (n < 3), the model did not converge and thus, the results are not represented in the table.

Additional file 4: Figure S1. Epidemiological tab in Neurosurveillance. The user can interactively explore the changes in the epidemiological landscape in the EMSCI and Sygen data sets. The platform allows the user to customize the selection of patients to visualize. Figure S2. Epidemiological tab in Neurosurveillance. The user can interactively explore the changes in the epidemiological landscape in the EMSCI and Sygen data sets. The platform allows the user to customize the selection of patients to visualize.

Our objective was to track and quantify the natural course of serological markers over the 1st year following spinal cord injury. For that purpose, data on serological markers, demographics, and injury characteristics were extracted from medical records of a clinical trial (Sygen) and an ongoing observational cohort study (Murnau study). The primary outcomes were concentration/levels/amount of commonly collected serological markers at multiple time points. Two-way analysis of variance (ANOVA) and mixed-effects regression techniques were used to account for the longitudinal data and adjust for potential confounders. Trajectories of serological markers contained in both data sources were compared using the slope of progression. Our results show that, at baseline (, Journal of Neurotrauma, 38 (15), ISSN:0897-7151, ISSN:1557-9042