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1263 - Level of the Lesion Risk Stratification of Autonomic Dysreflexia Prevalence in Incomplete Cervical Spinal Cord Injuries

Friday, February 23, 2024
5:00 PM – 6:30 PM EDT

    Presenting Author(s)

  • CN

    Clever M. Nguyen, BS

    Medical Student
    Penn State College of Medicine
    Harrisburg, Pennsylvania, United States

  • JC

    Justin Ceasar, BS (he/him/his)

    Medical Student
    Penn State College of Medicine
    Hershey, Pennsylvania, United States

    • Co-Author(s)

  • CT

    Corey Tooke, BS

    Medical Student
    Penn State College of Medicine
    Hershey, Pennsylvania, United States

  • Natasha Romanoski, DO

    Associate Professor Physical Medicine & Rehabilitation
    Penn State Milton S. Hershey Medical Center
    Hershey, Pennsylvania, United States

  • Michael A. Kryger, MD

    Program Director, Spinal Cord Fellowship, Penn State Physical Medicine and Rehabilitation
    Penn State Milton S. Hershey Medical Center
    Hershey, Pennsylvania, United States

Objectives: To evaluate the prevalence of autonomic dysreflexia (AD) as a complication of incomplete cervical spinal cord injuries (SCIs) and stratify AD prevalence by lesion level.

Design: A comparative, retrospective cohort study using the TriNetX Research Network registry, aggregating electronic health records from 70+ USA-based Healthcare Organizations with 100+ million patients on network was performed on July 6th, 2023. ICD-10 billing codes were used to identify categorized incomplete cervical SCIs (S14.15) and subcategorized incomplete cervical SCIs at the levels of C1-C8 (S14.151-S14.158) from January 1st, 2010-2020. The primary outcome was the newly diagnosed occurrence of AD (G90.4) as a complication. Risk difference analysis between overall incomplete cervical SCIs as a reference group to each C1-C8 level of SCI was performed for AD.

Results: 6,489 incomplete cervical SCI patients were identified, with 6.09% (395) diagnosed with AD. Compared to this group, AD prevalence for incomplete cervical SCI levels are as follows: C1 (81 of 1,629 patients (4.97%); RD, -1.12%, p=0.0868; odds ratio [OR], 0.807), C2 (76 of 1,652 patients (4.60%); RD, -1.49%, p< 0.05; OR, 0.744), C3 (89 of 1782 patients (4.99%); RD, -1.09%, p=0.0817; OR, 0.811), C4 (107 of 2,069 patients (5.17%); RD, -0.916%, p=0.123; OR, 0.841), C5 (200 of 2,712 patients (7.38%); RD, 1.29%, p< 0.05; OR, 1.23), C6 (184 of 2,343 patients (7.85%); RD, 1.77%, p< 0.005; OR, 1.32), C7 (163 of 2,079 patients (7.84%); RD, 1.75%, p< 0.005; OR, 1.31), C8 (68 of 871 patients (7.84%); RD, 1.72%, p< 0.05; OR, 1.306). Statistically significant RD and OR were observed in C2, C5, C6, C7, and C8.

Conclusions: Relative to overall incomplete cervical SCIs, injuries involving C5-C8 levels may have a higher likelihood of experiencing AD while injuries involving C2 may have less likelihood of AD occurrence. This finding may suggest the significance of an injury involving the superior cervical postganglionic fibers.