Associations between Acute Treatments for Spinal Cord Strokes and Functional Outcomes

Background: Acute treatments for patients with spinal cord strokes (SCS), including lumbar drain, blood pressure augmentation, corticosteroids, antiplatelets, and anticoagulants, are largely extrapolated from literature on cerebral infarcts or based on suspected SCS physiology. This study adds to the knowledge of symptomatology and management of SCS. Methods: This retrospective cohort study included patients from one medical system from 2000-2025. Multivariate ordinal logistic regressions were performed to evaluate associations of SCS treatments with the primary outcome of ambulatory status (independently ambulatory, ambulatory with assistance, non-ambulatory) at first follow-up, as well as secondary outcomes of modified Rankin Scale (mRS) and modified Japanese Orthopedic Association (mJOA) scores. SCS severity by American Spinal Injury Association impairment scale (AIS) with grade A as the comparator, age, sex, and whether SCS was spontaneous/periprocedural were covariates. Odds ratios (OR) greater than 1 were associated with better ambulatory status, lower mRS, and higher mJOA. Results: 130 SCS patients were included. Median age at SCS onset was 62 years, 42% were female, and 39% were periprocedural. Median first follow-up was 57 days. AIS grade was A for 28%, B for 25%, C for 28%, and D for 26%. SCS severity had significant associations with outcomes. For ambulatory status, AIS B OR 2.78, 95% CI 1.03-7.69, p-value 0.045; AIS C OR 16.7, 95% CI 5.56-50.0, p-value <0.01; AIS D OR 125, 95% CI 33.3-500, p-value <0.01. Corticosteroids were associated with improved ambulatory status and mJOA at follow-up (OR 2.38, 95% CI 1.15-5, p-value 0.023 and OR 2.27, 95% CI 1.09-4.76, p-value 0.030, respectively). No treatment had a significant association with mRS. Conclusion: Initial SCS severity had the strongest association with outcomes. Corticosteroids were associated with a better ambulatory status and mJOA. This study can help guide clinician management of patients with SCS.