Trends in Bowel and Bladder Function Recovery in Cervical Versus Thoracic Level Spinal Cord Injury

Introduction: Bowel and bladder (BB)-related deficits significantly impact quality-of-life following spinal cord injury (SCI). The relationship between level of injury and long-term BB function recovery remains poorly understood. We evaluated differences in BB function recovery following cervical SCI (cSCI) versus thoracic SCI (tSCI).

Methods: We studied patients ≥ 15 years old presenting with SCI between 1990-2016 using the National
SCI Model Systems (SCIMS) Database. BB function was assessed by the “Frequency of Accidents” item of the Functional-Independence-Measure (FIM). Level of BB care independence was measured with the FIM’s BB items. Accidents and independence were measured at rehab admit, discharge, and follow-up exam at 1 and 5 years, respectively. SCI severity was assessed using the American Spinal Injury Association grading system: Grades A-B: severe; Grades C-D: moderate.

Results: There were 6382 patients who met inclusion criteria: 3616 were cSCI and 2766 were tSCI. There were no significant differences in age, sex, race, and education level between the two groups. tSCI patients had improved bowel (p < 0.0001) and bladder (p < 0.001) function from rehab admission to 5-year follow-up. cSCI patients improved from rehab admission to 1-year follow-up, but experienced a decline in bowel (p < 0.001) and bladder (p < 0.001) functional scores, as measured by frequency of accidents, from 1-year to 5-year follow-up. Standard least squares regression demonstrated no clinically significant predictors of change in BB function when controlling for age, sex, race, education level, and ASIA grade, suggesting that the level of injury was the primary determinant of functional change.

Conclusion : These novel findings demonstrate a decline of BB function in cSCI patients at 5-year follow-up from rehab. Additionally, cSCI patients showed slower improvement while in rehab, as compared to tSCI patients. These findings demonstrate that cSCI patients may require diligent monitoring of their BB function and ability to achieve independence in their management routines.