Age-Related Trends in Cervical Spinal Cord Injury Outcomes: An Analysis of AIS Grade Transitions and Motor Score Improvements in Pediatric Versus Adult Patients

Introduction: Spinal cord injury (SCI) outcomes differ between pediatric and adult patients due to potential physiological and recovery-related variations. This study aims to identify discrepancies between pediatric and adult patients in motor score improvements following SCI.

Methods: Using the National Spinal Cord Injury Model Systems (SCIMS) Database, patients were divided by age (pediatric ≤21 years, adult >21 years). Descriptive statistics were performed on demographics, injury severity, and traumatic etiology. American Spinal Injury Association Impairment Scale (AIS) grades were assessed at admission, discharge, and 1-year follow-up to evaluate neurological recovery patterns, with adult versus pediatric comparisons performed using chi-square tests.

Results: The study cohort included 3,967 pediatric patients (median age 18 years [IQR = 17-20], 83% male, 79% White, 60% AIS A) and 13,488 adult patients (median age 43 years [IQR = 29-57], 80% male, 71% White, 35% AIS A), with primary causes being vehicular (46%) and recreational (32%) injuries in pediatrics versus vehicular (43%) and falls (33%) in adults. In AIS A patients, pediatrics showed lower improvement at discharge (14.7% vs 24.4%, p< 0.001) and 1-year (23.4% vs 33.7%, p=0.002), while AIS B pediatric patients demonstrated higher B to C conversion rates at discharge (43.3% vs 26.9%, p=0.002) but similar rates at 1-year (32.2% vs 33.7%, p=0.78); AIS C pediatric patients showed similar improvement but higher decline rates at discharge (improved: 62.7% vs 65.4%, p=0.78; declined: 11.8% vs 4.1%, p=0.014) and maintained this pattern through 1-year (discharge to 1-year improvement: 37.2% vs 39.7%, p=0.66; declined: 17.4% vs 9.9%, p=0.044), while AIS D patients in both groups showed comparable decline rates throughout (discharge: 1.6% vs 1.9%, p=0.88; 1-year: 2.7% vs 2.7%, p=0.99).

Conclusion : Pediatric patients with complete (AIS A) injuries demonstrate poorer neurological recovery compared to adults, while those with incomplete injuries show more rapid initial improvement but similar long-term outcomes, underscoring the need for injury severity-specific rehabilitation strategies in pediatric SCI.