Traumatic spinal cord and cauda equina injuries : a comparison of neurological outcomes achieved by a 75-year-old system of management, and modern care in the USA.

Abstract

The aim of this study was to compare neurological outcomes achieved by two systems of spinal cord injury care: that which was developed by the National Spinal Injuries Centre, Stoke Mandeville Hospital, UK (predominantly conservative, 10% to 15% treated with surgical stabilization, most with gradual mobilization) and that which is practised by USA centres contributing data to the Spinal Cord Injury Model Systems (SCIMS) database (predominantly surgical, often > 80% undergoing surgical stabilization, most with rapid mobilization). Neurological outcomes from 608 patients treated at Stoke Mandeville between 1951 and 1968, and 300 patients treated using the Stoke Mandeville system at Colmar-Mulhouse and Basel (France and Switzerland) between 1968 and 1978, were compared with 804 patients admitted to SCIMS rehabilitation centres between 2011 and 2018. The stratified Mann-Whitney U test was used for overall neurological outcomes; subgroups were tested for differences in proportions. Both Stoke Mandeville system centres achieved significantly better Frankel grade neurological outcomes compared with SCIMS centres (Stoke Mandeville, p < 0.001; Colmar-Mulhouse and Basel, p < 0.001). Had the 804 patients treated at SCIMS centres in the USA achieved the outcomes which were achieved using the Stoke Mandeville system, between 71 and 87 fewer might have deteriorated neurologically, between 195 and 330 more patients might have walked again, and between 129 and 264 more patients might have been completely cured, with no sensory or motor loss and no sphincter disturbance. The Stoke Mandeville system of spinal cord injury care should not have been rejected without clinical trials.