1229 - Early Conversion from Complete C4 Tetraplegia to Motor Incomplete in a Young Male: Implications for Prognosis and Recovery

Case Diagnosis: Complete C4 ASIA-A tetraplegia after motorcycle collision with early conversion to motor incomplete

Case Description: 22-year-old male presented as a level 1 trauma after a motorcycle collision with flaccid paralysis of bilateral lower limbs, neurogenic bowel and bladder. GCS of three obtained at the scene. He was found to have sustained multiple traumatic injuries including C5-C6 dislocation with three column ligamentous injury, cord signal changes on MRI requiring urgent C5-C6 anterior decompression and instrumented fusion. Physiatry was consulted for formal American Spinal Injury Association Impairment Scale (ASIA) scoring and rehabilitative recommendations which revealed a complete C4 ASIA-A tetraplegia. Surprisingly, repeat examination performed thirty days after initial ASIA scoring revealed incomplete C4 ASIA-C tetraplegia. Patient showed gradual improvement in function during acute rehabilitation, requiring maximal assistance for bed mobility and transfers, minimal assistance for wheelchair propulsion.

Discussions: This case highlights the unpredictable nature of recovery following traumatic spinal cord injury (SCI). Recent data from the National Spinal Cord Injury Statistical Center (NSCISC) shows an increasing trend in conversion of ASIA A injuries to motor incomplete, from 5.8% (1995–1997) to 16.4% (2013–2015). Individuals with cervical injuries, such as our patient, show the greatest potential for early conversion, with repeated ASIA exams revealing recovery as early as 30 days post-injury. Proposed mechanisms include maintaining optimal mean arterial blood pressure and early decompression. Effects of newer treatments on recovery remain unclear. Interestingly, older patients often show better odds of conversion, which contrasts our young patient's trajectory.

Conclusions: Increasing rates of conversion from complete to incomplete tetraplegia have significant implications for prognosis and early intervention in SCI patients. Clinicians should discuss potential motor recovery with patients and families, even in the acute phase of injury. Further research, including the development of biomarkers, is essential to enhance our ability to predict recovery and tailor early rehabilitation strategies for SCI patients.