Two measures were reported as independent predictors of six-month neurological recovery after acute cervical spinal cord injury: the preoperative IHL measure based on hemorrhage seen inside the spinal cord on MRI, and the rate at which the AMS motor score recovered soon after surgery. The finding comes from a retrospective review of 93 patients whose MRI showed intramedullary hemorrhage and edema and who underwent surgery. The authors said the pair had prognostic value when considered together.
Recovery was measured at six months
Among the 93 patients, 67, or 72.0%, improved at six months, while 26, or 28.0%, did not. The study defined neurological recovery as an improvement of at least one AIS grade at the six-month assessment. In other words, the outcome was based on a recorded change in neurological grade over the follow-up period.
The fuller model narrowed the field
Researchers collected clinical and radiological variables, including IEL, IHL, MSCC, preoperative AMS, postoperative AMS and the early postoperative AMS recovery rate. They first used univariate analysis, which examines each factor's relationship with the outcome separately. They then used multivariable binary logistic regression, a statistical model that considers several factors together, to identify which associations remained independent.
Two associations went in different directions
In the multivariable model, preoperative IHL was reported as a negative predictor of recovery. Its odds ratio was 0.664, with a 95% confidence interval from 0.475 to 0.929. In plain language, the model linked preoperative IHL with lower odds of the study's defined recovery outcome. This was a statistical association in a retrospective cohort, not a guarantee about what would happen to any individual patient.
Early postoperative AMS recovery rate showed the opposite pattern. It was reported as a positive independent predictor, with an odds ratio of 1.269 and a 95% confidence interval from 1.014 to 1.588. The result means that a higher reported recovery rate was associated with greater odds of neurological improvement at six months in this sample. It does not show that making early motor recovery happen faster would cause later neurological improvement.
Other measures did not hold independently
Several measures appeared relevant in the individual-factor analysis. IEL, IHL, MSCC, postoperative AMS and the early AMS recovery rate were all associated with neurological recovery in the univariate results. But IEL and MSCC were not independently associated with recovery once the multivariable analysis considered predictors together. The study therefore does not show that those MRI measures are universally uninformative; it reports no independent association in the analysis presented.
Age, sex and injury mechanism did not differ significantly between the recovery and non-recovery groups. Those comparisons describe the groups in this cohort, but they do not by themselves establish that the identified predictors caused the outcome.
A useful lead, not a clinical rule
The authors concluded that preoperative IHL and early postoperative AMS recovery rate had prognostic value when combined. That conclusion is about prediction in this cohort, not proof that either measure causes recovery or that changing treatment to influence one of them would improve outcomes. The study evaluated prognostic variables in records from patients who underwent surgery; it did not test an assigned intervention.
The population was specific: patients with acute cervical spinal cord injury, MRI-detected intramedullary hemorrhage and edema, and surgical treatment. The findings therefore cannot automatically be extended to patients without those MRI findings or to patients who do not undergo surgery. Whether the predictors hold in larger, prospective or multicenter cohorts remains an open question.
What the paper reports
The study data came from the hospital electronic medical-record system and are not openly available because of sensitivity, although they can be requested from the corresponding author. The work was supported by the Gusu Medical Talent Program of Suzhou, China, under grant GSWS2023087. The authors reported no relevant financial or non-financial interests. Ethical approval was waived because the study was retrospective and the procedures were part of routine care. The article was published on 21 August 2026.
Paper data and sources
Original title: Intramedullary hemorrhage and early motor recovery as predictors of neurological recovery after acute cervical spinal cord injury.
Authors: Jile Xie, Zhidong Wang, Genlin Wang et al.
Journal/Repository: Acta neurologica Belgica
Status: Peer-reviewed
First online: 2026-08-21
DOI: 10.1007/s13760-026-03132-7
Original paper · Full text