A study of prognostic value of ASIA score in post operative outcome assessment in spine trauma in a tertiary care centre

Abstract

Background: Spinal cord injury (SCI) remains a major cause of long-term disability and reduced quality of life, with significant socioeconomic and healthcare implications. The American Spinal Injury Association Impairment Scale (AIS) is a widely accepted tool for assessing the severity of SCI and predicting neurological recovery. While existing studies have examined AIS grade changes in Western populations, limited data are available from resource-limited settings such as India.

Objectives: (A) To determine the percentage of individuals with complete spinal cord injury (AIS A) who convert to incomplete status within the first post-injury year (B) To evaluate the extent of improvement in AIS grade from baseline to one-year follow-up among patients with initial AIS B injuries.

Methodology: This was a prospective observational study conducted at the Trauma Centre, Department of Neurosurgery, SMS Medical College, Jaipur, from December 2022 to December 2023. A total of 400 patients aged ?16 years with traumatic SCI admitted within 30 days of injury were enrolled. Baseline AIS grades were recorded at admission, and neurological recovery was assessed at a one-year follow-up using the AIS classification. Statistical analysis involved chi-square tests to assess the significance of AIS grade changes.

Results: Of the 146 patients with initial AIS A injury, 38 (26.0%) improved to an incomplete status (AIS B, C, or D), while 108 (74.0%) remained unchanged. Among 66 patients with initial AIS B injuries, 26 (39.4%) showed improvement to a higher AIS grade, while 33 (50.0%) remained unchanged and 7 (10.6%) worsened to AIS A. AIS C and D patients demonstrated higher rates of recovery (56.5% and 54.4%, respectively), while no significant change was observed among AIS E patients. Statistical analysis confirmed a significant association between baseline AIS grade and post-operative outcomes (p < 0.001).

Conclusion: The study demonstrates that AIS scores are valuable in predicting post-operative neurological recovery in SCI patients. While AIS A patients exhibit limited potential for improvement, AIS B–D patients show higher recovery rates, reinforcing the importance of early intervention and targeted rehabilitative strategies. The findings underscore the need for tailored clinical management based on initial AIS grades to optimise patient outcomes in resource-limited settings.