{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T21:04:21Z","timestamp":1768251861723,"version":"3.49.0"},"reference-count":55,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2021,10,18]],"date-time":"2021-10-18T00:00:00Z","timestamp":1634515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Prognostic factors for clinical outcome after spinal cord (SC) injury (SCI) are limited but important in patient management and education. There is a lack of evidence regarding magnetic resonance imaging (MRI) and clinical outcomes in SCI patients. Therefore, we aimed to investigate whether baseline MRI features predicted the clinical course of the disease. This study is an ancillary to the prospective North American Clinical Trials Network (NACTN) registry. Patients were enrolled from 2005\u20132017. MRI within 72 h of injury and a minimum follow-up of one year were available for 459 patients. Patients with American Spinal Injury Association impairment scale (AIS) E were excluded. Patients were grouped into those with (n = 354) versus without (n = 105) SC signal change on MRI T2-weighted images. Logistic regression analysis adjusted for commonly known a priori confounders (age and baseline AIS). Main outcomes and measures: The primary outcome was any adverse event. Secondary outcomes were AIS at the baseline and final follow-up, length of hospital stay (LOS), and mortality. A regression model adjusted for age and baseline AIS. Patients with intrinsic SC signal change were younger (46.0 (interquartile range (IQR) 29.0 vs. 50.0 (IQR 20.5) years, p = 0.039). There were no significant differences in the other baseline variables, gender, body mass index, comorbidities, and injury location. There were more adverse events in patients with SC signal change (230 (65.0%) vs. 47 (44.8%), p &lt; 0.001; odds ratio (OR) = 2.09 (95% confidence interval (CI) 1.31\u20133.35), p = 0.002). The most common adverse event was cardiopulmonary (186 (40.5%)). Patients were less likely to be in the AIS D category with SC signal change at baseline (OR = 0.45 (95% CI 0.28\u20130.72), p = 0.001) and in the AIS D or E category at the final follow-up (OR = 0.36 (95% CI 0.16\u20130.82), p = 0.015). The length of stay was longer in patients with SC signal change (13.0 (IQR 17.0) vs. 11.0 (IQR 14.0), p = 0.049). There was no difference between the groups in mortality (11 (3.2%) vs. 4 (3.9%)). MRI SC signal change may predict adverse events and overall LOS in the SCI population. If present, patients are more likely to have a worse baseline clinical presentation (i.e., AIS) and in- or outpatient clinical outcome after one year. Patients with SC signal change may benefit from earlier, more aggressive treatment strategies and need to be educated about an unfavorable prognosis.<\/jats:p>","DOI":"10.3390\/jcm10204778","type":"journal-article","created":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T22:52:47Z","timestamp":1634683967000},"page":"4778","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Spinal Cord Signal Change on Magnetic Resonance Imaging May Predict Worse Clinical In- and Outpatient Outcomes in Patients with Spinal Cord Injury: A Prospective Multicenter Study in 459 Patients"],"prefix":"10.3390","volume":"10","author":[{"given":"Thorsten","family":"Jentzsch","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada"},{"name":"Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Cadotte","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary Combined Spine Program, Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jefferson R.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurosurgery, St. Michael\u2019s Hospital, University Health Network, Toronto, ON M5T 2S8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jetan H.","family":"Badhiwala","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad A.","family":"Akbar","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett","family":"Rocos","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert G.","family":"Grossman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bizhan","family":"Aarabi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James S.","family":"Harrop","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5722-6364","authenticated-orcid":false,"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5T 2S8, Canada"},{"name":"Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON M5G 2C4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1038\/sc.2010.146","article-title":"A global map for traumatic spinal cord injury epidemiology: Towards a living data repository for injury prevention","volume":"49","author":"Cripps","year":"2010","journal-title":"Spinal Cord"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1159\/000110305","article-title":"Epidemiology of Spinal Cord Injury in New Zealand","volume":"12","author":"Dixon","year":"1993","journal-title":"Neuroepidemiology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1038\/sc.1990.13","article-title":"Epidemiology of spinal cord lesions in Denmark","volume":"28","author":"Pedersen","year":"1990","journal-title":"Spinal Cord"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1179\/204577211X13207446293695","article-title":"International standards for neurological classification of spinal cord injury (Revised 2011)","volume":"34","author":"Kirshblum","year":"2011","journal-title":"J. Spinal Cord Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2324","DOI":"10.1007\/s00586-017-5097-4","article-title":"A prospective serial MRI study following acute traumatic cervical spinal cord injury","volume":"26","author":"Rutges","year":"2017","journal-title":"Eur. Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.wneu.2017.02.034","article-title":"MRI Prognostication Factors in the Setting of Cervical Spinal Cord Injury Secondary to Trauma","volume":"101","author":"Cepeda","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.wneu.2016.03.005","article-title":"Predictors of Surgical Outcome in Acute Spinal Cord Injury Patients with Cervical Ossification of the Posterior Longitudinal Ligament","volume":"90","author":"Gu","year":"2016","journal-title":"World Neurosurg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13018-015-0235-3","article-title":"Prognostic factors for surgical outcome in spinal cord injury associated with ossification of the posterior longitudinal ligament (OPLL)","volume":"10","author":"Kwon","year":"2015","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/S1474-4422(13)70146-7","article-title":"MRI investigation of the sensorimotor cortex and the corticospinal tract after acute spinal cord injury: A prospective longitudinal study","volume":"12","author":"Freund","year":"2013","journal-title":"Lancet Neurol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"E1560","DOI":"10.1097\/BRS.0b013e318272f345","article-title":"Soft-Tissue Damage and Segmental Instability in Adult Patients With Cervical Spinal Cord Injury Without Major Bone Injury","volume":"37","author":"Maeda","year":"2012","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"E1568","DOI":"10.1097\/BRS.0b013e31821273c0","article-title":"Can magnetic resonance imaging reflect the prognosis in patients of cervical spinal cord injury without radiographic abnormality?","volume":"36","author":"Machino","year":"2011","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1148\/radiol.2433060583","article-title":"Acute Cervical Traumatic Spinal Cord Injury: MR Imaging Findings Correlated with Neurologic Outcome\u2014Prospective Study with 100 Consecutive Patients1","volume":"243","author":"Miyanji","year":"2007","journal-title":"Radiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1097\/01.brs.0000201274.59427.a4","article-title":"Predicting Neurologic Recovery in Cervical Spinal Cord Injury With Postoperative MR Imaging","volume":"31","author":"Boldin","year":"2006","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1227\/01.NEU.0000083590.84053.CC","article-title":"Acute Cervical Cord Injury Associated with Ossification of the Posterior Longitudinal Ligament","volume":"53","author":"Koyanagi","year":"2003","journal-title":"Neurosurgery"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1177\/230949900201000205","article-title":"Traumatic cervical cord injury at C3-4 without radiographic abnormalities: Correlation of magnetic resonance findings with clinical features and outcome","volume":"10","author":"Takahashi","year":"2002","journal-title":"J. Orthop. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1652","DOI":"10.1097\/00007632-200208010-00011","article-title":"Predictors of Neurologic Recovery in Acute Central Cervical Cord Injury with Only Upper Extremity Impairment","volume":"27","author":"Ishida","year":"2002","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"15","DOI":"10.3171\/spi.2000.93.1.0015","article-title":"Acute cervical cord injury without fracture or dislocation of the spinal column","volume":"93","author":"Koyanagi","year":"2000","journal-title":"J. Neurosurg. Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1038\/sj.sc.3100858","article-title":"Sequential MR studies of cervical cord injury: Correlation with neurological damage and clinical outcome","volume":"37","author":"Shimada","year":"1999","journal-title":"Spinal Cord"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1093\/neuros\/nyw053","article-title":"Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury","volume":"80","author":"Aarabi","year":"2016","journal-title":"Neurosurgery"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"6","DOI":"10.3171\/2012.4.AOSPINE1294","article-title":"North American Clinical Trials Network for the Treatment of Spinal Cord Injury: Goals and progress","volume":"17","author":"Grossman","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"119","DOI":"10.3171\/2012.5.AOSPINE12127","article-title":"Incidence and severity of acute complications after spinal cord injury","volume":"17","author":"Grossman","year":"2012","journal-title":"J. Neurosurg. Spine"},{"key":"ref_22","unstructured":"ClinicalTrials.gov (2021, October 13). Spinal Cord Injury Registry\u2014NACTN (NACTN), Available online: http:\/\/clinicaltrials.gov\/ct2\/show\/NCT00178724?term=NACTN&recr=Open&cond=spinal+cord+injury&rank=1."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"35S","DOI":"10.1177\/2192568217703083","article-title":"Nonoperative Versus Operative Management for the Treatment Degenerative Cervical Myelopathy: An Updated Systematic Review","volume":"7","author":"Rhee","year":"2017","journal-title":"Glob. Spine J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e854","DOI":"10.1097\/CCM.0000000000003937","article-title":"Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury","volume":"47","author":"Jiang","year":"2019","journal-title":"Crit. Care Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.juro.2014.02.048","article-title":"Functional Multiparametric Magnetic Resonance Imaging of the Kidneys Using Blood Oxygen Level Dependent and Diffusion-Weighted Sequences","volume":"192","author":"Giannarini","year":"2014","journal-title":"J. Urol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1097\/BRS.0b013e3182326957","article-title":"Can Prophylactic Bilateral C4\/C5 Foraminotomy Prevent Postoperative C5 Palsy After Open-Door Laminoplasty?","volume":"37","author":"Katsumi","year":"2012","journal-title":"Spine"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1007\/s00776-009-1378-z","article-title":"Longitudinal magnetic resonance imaging study on whiplash injury patients: Minimum 10-year follow-up","volume":"14","author":"Ichihara","year":"2009","journal-title":"J. Orthop. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1007\/s00701-009-0408-0","article-title":"Significance of serial S100b and NSE serum measurements in surgically treated patients with spondylotic cervical myelopathy","volume":"151","author":"Marquardt","year":"2009","journal-title":"Acta Neurochir."},{"key":"ref_29","first-page":"544","article-title":"Is magnetic resonance imaging essential in clearing the cervical spine in obtunded patients with blunt trauma?","volume":"63","author":"Como","year":"2007","journal-title":"J. Trauma"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1097\/01.brs.0000152378.93868.c8","article-title":"Low back pain on passive straight leg raising: The anterior theca as a source of pain","volume":"30","author":"Summers","year":"2005","journal-title":"Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1097\/00007632-200210150-00010","article-title":"Respiratory Dysfunction in Patients with Chronic-Onset Cervical Myelopathy","volume":"27","author":"Ishibe","year":"2002","journal-title":"Spine"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"443","DOI":"10.2214\/ajr.164.2.7839986","article-title":"Vertebral artery injury after acute cervical spine trauma: Rate of occurrence as detected by MR angiography and assessment of clinical consequences","volume":"164","author":"Friedman","year":"1995","journal-title":"Am. J. Roentgenol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1038\/sc.1993.117","article-title":"Atypical syndromes caudal to the injury site in patients following spinal cord injury. A clinical, neurophysiological and MRI study","volume":"31","author":"Tosi","year":"1993","journal-title":"Spinal Cord"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1001\/jamasurg.2016.1248","article-title":"Evaluation of Cervical Spine Clearance by Computed Tomographic Scan Alone in Intoxicated Patients with Blunt Trauma","volume":"151","author":"Bush","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_35","first-page":"299","article-title":"Effects of electromyostimulation on muscle and bone in men with acute traumatic spinal cord injury: A randomized clinical trial","volume":"37","author":"Martin","year":"2013","journal-title":"J. Spinal Cord Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1038\/sc.2013.41","article-title":"Brain activation in the acute phase of traumatic spinal cord injury","volume":"51","author":"Sabre","year":"2013","journal-title":"Spinal Cord"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1016\/j.jocn.2012.07.009","article-title":"Ketamine for acute neuropathic pain in patients with spinal cord injury","volume":"20","author":"Kim","year":"2013","journal-title":"J. Clin. Neurosci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.surge.2011.01.007","article-title":"Imaging the spine for tumour and trauma\u2014A national audit of practice in Irish hospitals","volume":"10","author":"Kelly","year":"2012","journal-title":"Surgeon"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1574","DOI":"10.1212\/WNL.54.8.1574","article-title":"From spinal shock to spasticity: Neuronal adaptations to a spinal cord injury","volume":"54","author":"Hiersemenzel","year":"2000","journal-title":"Neurology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1108","DOI":"10.1038\/sc.2017.83","article-title":"Spontaneous acute and chronic spinal cord injuries in paraplegic dogs: A comparative study of in vivo diffusion tensor imaging","volume":"55","author":"Hobert","year":"2017","journal-title":"Spinal Cord"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1111\/jvim.14715","article-title":"Comparison of Preoperative Quantitative Magnetic Resonance Imaging and Clinical Assessment of Deep Pain Perception as Prognostic Tools for Early Recovery of Motor Function in Paraplegic Dogs with Intervertebral Disk Herniations","volume":"31","author":"Siedenburg","year":"2017","journal-title":"J. Veter Intern. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/j.1532-950X.2009.00633.x","article-title":"Incidence of spinal compressive lesions in chondrodystrophic dogs with abnormal recovery after hemilaminectomy for treatment of thoracolumbar disc disease: A prospective magnetic resonance imaging study","volume":"39","author":"Dickomeit","year":"2010","journal-title":"Vet. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2160","DOI":"10.1097\/CCM.0b013e3181a05d41","article-title":"Hypertonic saline attenuates cord swelling and edema in experimental spinal cord injury: A study utilizing magnetic resonance imaging","volume":"37","author":"Nout","year":"2009","journal-title":"Crit. Care Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e7958","DOI":"10.1097\/MD.0000000000007958","article-title":"Clinical and imaging features of spinal cord type of neuro Beh\u00e7et disease: A case report and systematic review","volume":"96","author":"Liu","year":"2017","journal-title":"Medicine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"401","DOI":"10.3928\/01477447-20080401-37","article-title":"Quadriparesis due to acute collapse of a seemingly stabilized C5\/6 segment in a patient with rheumatoid arthritis\u2014A case report","volume":"31","author":"Takahata","year":"2008","journal-title":"Orthopedics"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"622","DOI":"10.2340\/16501977-0101","article-title":"Traumatic brain injury is under-diagnosed in patients with spinal cord injury","volume":"39","author":"Tolonen","year":"2007","journal-title":"Acta Derm. Venereol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1302\/0301-620X.89B4.18121","article-title":"Balloon kyphoplasty as a single or as an adjunct procedure for the management of symptomatic vertebral haemangiomas","volume":"89","author":"Hadjipavlou","year":"2007","journal-title":"J. Bone Jt. Surgery. Br. Vol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.wneu.2015.02.029","article-title":"Adjacent Level Ligamentous Injury Associated with Traumatic Cervical Spine Fractures: Indications for Imaging and Implications for Treatment","volume":"84","author":"Awad","year":"2015","journal-title":"World Neurosurg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.clon.2014.04.032","article-title":"A Royal College of Radiologists National Audit of Radiotherapy in the Treatment of Metastatic Spinal Cord Compression and Implications for the Development of Acute Oncology Services","volume":"26","author":"McGivern","year":"2014","journal-title":"Clin. Oncol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1016\/j.mri.2013.05.006","article-title":"Acute and chronic MRI changes in the spine and spinal cord after surgical stem cell grafting in patients with definite amyotrophic lateral sclerosis: Post-infusion injuries are unrelated with clinical impairment","volume":"31","author":"Santos","year":"2013","journal-title":"Magn. Reson. Imaging"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.rehab.2011.02.003","article-title":"Evolution of spinal cord injuries due to cervical canal stenosis without radiographic evidence of trauma (SCIWORET): A prospective study","volume":"54","author":"Lamothe","year":"2011","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1001\/archneur.1990.00530060101026","article-title":"The Influence of Age at Time of Spinal Cord Injury on Rehabilitation Outcome","volume":"47","author":"DeVivo","year":"1990","journal-title":"Arch. Neurol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2027","DOI":"10.1089\/neu.2016.4955","article-title":"Functional Outcome Prediction after Traumatic Spinal Cord Injury Based on Acute Clinical Factors","volume":"34","author":"Kaminski","year":"2017","journal-title":"J. Neurotrauma"},{"key":"ref_54","doi-asserted-by":"crossref","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":"ref_55","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1136\/jnnp-2020-323150","article-title":"Tissue bridges predict neuropathic pain emergence after spinal cord injury","volume":"91","author":"Pfyffer","year":"2020","journal-title":"J. Neurol. Neurosurg. Psychiatry"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/20\/4778\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:17:35Z","timestamp":1760167055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/20\/4778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,18]]},"references-count":55,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2021,10]]}},"alternative-id":["jcm10204778"],"URL":"https:\/\/doi.org\/10.3390\/jcm10204778","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,18]]}}}