{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T10:06:49Z","timestamp":1771927609197,"version":"3.50.1"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Accurate prediction of functional recovery after thoracolumbar fracture with incomplete spinal cord injury (SCI) remains challenging. We aimed to identify independent predictors and develop a validated model for 12-month functional outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this single-center, retrospective cohort study (January 2018\u2013December 2024), consecutive adults (\u226518\u202fyears) with acute T11-L2 fractures and admission American Spinal Injury Association Impairment Scale (AIS) grade B, C, or D were enrolled. Functional recovery was defined as \u22651 AIS grade improvement plus \u226510-point Spinal Cord Independence Measure version III (SCIM-III) gain at 12\u202fmonths. Candidate predictors (\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f23) were selected\n                      <jats:italic>a priori<\/jats:italic>\n                      based on literature review and expert consensus. Missing data (&amp;lt;8% per variable) were multiply imputed (\n                      <jats:italic>m<\/jats:italic>\n                      \u202f=\u202f20). Multivariable logistic regression with Firth\u2019s correction and backward elimination guided by Akaike Information Criterion was used. Model discrimination [optimism-corrected area under the curve (AUC) 0.87] and calibration (Hosmer-Lemeshow test) were assessed by 1,000 bootstrap resamples. Pre-specified subgroup analyses examined age, AIS grade, surgical timing and lesion length.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,032 eligible patients, 206 (20.0%) achieved functional recovery. Eight predictors were independently associated: admission AIS grade (OR 4.5 per grade, 95% CI 3.5\u20135.8), motor score (OR 1.05 per point, 1.03\u20131.07), intact posterior ligamentous complex (OR 2.3, 1.6\u20133.2), decompression \u2264 24\u202fh (OR 1.9, 1.4\u20132.7), non-smoking (OR 1.7, 1.2\u20132.4), Charlson Comorbidity Index\u202f=\u202f0 (OR 1.5, 1.1\u20132.1), shorter intramedullary T2 lesion length (OR 0.96 per mm, 0.95\u20130.97) and rehabilitation intensity \u22653\u202fh\/day (OR 1.4, 1.0\u20131.9). The final model demonstrated an optimism\u2014corrected AUC of 0.87 (95% CI: 0.85\u20130.89) and calibration characteristics with a calibration slope of 1.02, an intercept of 0.01, and a Hosmer\u2013Lemeshow\n                      <jats:italic>p<\/jats:italic>\n                      -value of 0.18 during internal validation. Predictive effects were stronger in younger, AIS B\/C patients and when surgery was performed early.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A parsimonious eight-factor model showed robust discrimination and satisfactory calibration in internal validation for 12-month functional recovery after thoracolumbar incomplete SCI, enabling individualized prognostication. External validation in independent multicenter cohorts is required before clinical implementation and treatment decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1697322","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T06:43:34Z","timestamp":1769582614000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Identification of clinical predictors for functional recovery in patients with thoracolumbar fractures and incomplete spinal cord injury: an internally validated prediction model"],"prefix":"10.3389","volume":"17","author":[{"given":"Zongyang","family":"Li","sequence":"first","affiliation":[{"name":"Changchun University of Chinese Medicine","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yudan","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Third Affiliated Hospital of Changchun University of Chinese Medicine","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, The Third Affiliated Hospital of Changchun University of Chinese Medicine","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Zhang","sequence":"additional","affiliation":[{"name":"Fujian Vocational College of Bioengineering","place":["Fuzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Yu","sequence":"additional","affiliation":[{"name":"College of Traditional Chinese Medicine, Changchun University of Chinese Medicine","place":["Changchun, Jilin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanpeng","family":"Jiang","sequence":"additional","affiliation":[{"name":"College of Traditional Chinese Medicine, Changchun University of Chinese Medicine","place":["Changchun, Jilin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuhang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, China-Japan Union Hospital of Jilin University","place":["Changchun, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"5628","DOI":"10.1038\/s41598-021-85167-9","article-title":"A modified MRI protocol for the increased detection of sacrococcygeal fractures in patients with thoracolumbar junction fractures","volume":"11","author":"Khil","year":"2021","journal-title":"Sci Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"181","DOI":"10.29252\/beat-060301","article-title":"Mortality rate and predicting factors of traumatic thoracolumbar spinal cord injury; a systematic review and Meta-analysis","volume":"6","author":"Azarhomayoun","year":"2018","journal-title":"Bull Emerg Trauma"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e64458","DOI":"10.7759\/cureus.64458","article-title":"The recovered independent ambulation rate and prognostic factors of non-ambulatory patients after metastatic spinal cord compression surgery","volume":"16","author":"Iida","year":"2024","journal-title":"Cureus"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1814","DOI":"10.3390\/diagnostics13101814","article-title":"Association between cerebrospinal fluid and serum biomarker levels and diagnosis, injury severity, and short-term outcomes in patients with acute traumatic spinal cord injury","volume":"13","author":"Yang","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1007\/s00586-012-2483-9","article-title":"Does the type of T2-weighted hyperintensity influence surgical outcome in patients with cervical spondylotic myelopathy? A review","volume":"22","author":"Vedantam","year":"2012","journal-title":"Eur Spine J"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"285","DOI":"10.4103\/0028-3886.375382","article-title":"Does MR signal intensity change have prognostic value in multilevel cervical myelopathy? A single-center, prospective study","volume":"71","author":"Dave","year":"2023","journal-title":"Neurol India"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1038\/sc.2013.99","article-title":"MRI evidence that glibenclamide reduces acute lesion expansion in a rat model of spinal cord injury","volume":"51","author":"Simard","year":"2013","journal-title":"Spinal Cord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1007\/s11547-025-02029-4","article-title":"Emerging MRI-based spine scoring techniques targeting bone quality to assess osteoporosis, vertebral fracture risk, other spinal degenerative diseases, and post-surgical outcomes","volume":"130","author":"Din","year":"2025","journal-title":"Radiol Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"102787","DOI":"10.1016\/j.bas.2024.102787","article-title":"Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: conceptual framework and proposed methodology","volume":"4","author":"Aly","year":"2024","journal-title":"Brain Spine"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.46292\/sci22-00036","article-title":"The international standards for neurological classification of spinal cord injury: classification accuracy and challenges","volume":"29","author":"Snider","year":"2023","journal-title":"Top Spinal Cord Inj"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.3109\/09638288.2012.756942","article-title":"The spinal cord independence measure: how much change is clinically significant for spinal cord injury subjects","volume":"35","author":"Scivoletto","year":"2013","journal-title":"Disabil Rehabil"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.jor.2023.05.007","article-title":"Current insights into the management of spinal cord injury","volume":"41","author":"Srikandarajah","year":"2023","journal-title":"J Orthop"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.47363\/jpmrs\/2023(5)166","article-title":"Ambulatory outcomes of traumatic cauda Equina syndrome and Conus medullaris syndrome: a systematic review","volume":"5","author":"Chen","year":"2023","journal-title":"J PhyMed Rehab Stud Rep"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"683","DOI":"10.3171\/2018.10.SPINE18802","article-title":"Neurological recovery following traumatic spinal cord injury: a systematic review and meta-analysis","volume":"30","author":"Khorasanizadeh","year":"2019","journal-title":"J Neurosurg-Spine"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.rcl.2018.09.004","article-title":"MR imaging for assessing injury severity and prognosis in acute traumatic spinal cord injury","volume":"57","author":"Talbott","year":"2018","journal-title":"Radiol Clin North Am"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1089\/neu.2017.5357","article-title":"Predicting injury severity and neurological recovery after acute cervical spinal cord injury: a comparison of cerebrospinal fluid and magnetic resonance imaging biomarkers","volume":"35","author":"Dalkilic","year":"2017","journal-title":"J Neurotraum"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"282","DOI":"10.3389\/fneur.2019.00282","article-title":"Traumatic spinal cord injury: an overview of pathophysiology, models and acute injury mechanisms","volume":"10","author":"Alizadeh","year":"2019","journal-title":"Front Neurol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"88 166-174","DOI":"10.1016\/j.wneu.2015.12.072","article-title":"Early versus delayed surgical decompression of spinal cord after traumatic cervical spinal cord injury: a cost-utility analysis","author":"Furlan","year":"2016","journal-title":"World Neurosurg"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"5692","DOI":"10.1038\/s41467-021-25960-2","article-title":"Confronting false discoveries in single-cell differential expression","volume":"12","author":"Squair","year":"2021","journal-title":"Nat Commun"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1089\/neu.2009.1063","article-title":"Diffusion tensor imaging at 3 hours after traumatic spinal cord injury predicts long-term locomotor recovery","volume":"27","author":"Kim","year":"2010","journal-title":"J Neurotraum"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1097\/00001756-200501190-00017","article-title":"MRI diffusion coefficients in spinal cord correlate with axon morphometry","volume":"16","author":"Schwartz","year":"2005","journal-title":"Neuroreport"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"179","DOI":"10.14444\/8411","article-title":"Effect of smoking on motor recovery after cervical American spinal injury association grade D traumatic spinal cord injury","volume":"17","author":"Moon","year":"2023","journal-title":"Int J Spine Surg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"2036","DOI":"10.1089\/neu.2018.5900","article-title":"Kinematic and neuromuscular adaptations in incomplete spinal cord injury after high- versus low-intensity locomotor training","volume":"36","author":"Ardestani","year":"2019","journal-title":"J Neurotraum"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1007\/978-3-7091-0603-7_9","article-title":"The role of inflammatory processes in the pathophysiology and treatment of brain and spinal cord trauma","volume":"89","author":"Dietrich","year":"2004","journal-title":"Acta Neurochir Suppl"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1212\/CPJ.0000000000000460","article-title":"Exercise for cognitive brain health in aging: a systematic review for an evaluation of dose","volume":"8","author":"Gomes-Osman","year":"2018","journal-title":"Neurol Clin Pract"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"77 194-206","DOI":"10.1016\/j.neurobiolaging.2019.02.010","article-title":"Old age increases microglial senescence, exacerbates secondary neuroinflammation, and worsens neurological outcomes after acute traumatic brain injury in mice","author":"Ritzel","year":"2019","journal-title":"Neurobiol Aging"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1089\/neu.2014.3632","article-title":"The influence of time from injury to surgery on motor recovery and length of hospital stay in acute traumatic spinal cord injury: an observational Canadian cohort study","volume":"32","author":"Dvorak","year":"2014","journal-title":"J Neurotraum"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1016\/j.apmr.2004.02.010","article-title":"Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests","volume":"86","author":"van Hedel","year":"2005","journal-title":"Arch Phys Med Rehab"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1697322\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:14:09Z","timestamp":1771924449000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1697322\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":28,"alternative-id":["10.3389\/fneur.2026.1697322"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1697322","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,28]]},"article-number":"1697322"}}