New grading system for the clinical evaluation of patients with spinal vascular lesions

• Published in: Neuroradiology 2018-10, Vol.60 (10), p.1035-1041
• Main Authors: Suh, Dae Chul, Song, Yunsun, Park, Danbi, Han, Minkyu, Lim, Young-Min, Park, Ji Eun, Lee, Sang Hun, Jeon, Sang Ryong, Kim, Kwang-Kuk
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Angiography, Digital Subtraction; Cardiovascular system; Central nervous system diseases; Central Nervous System Vascular Malformations - complications; Disability Evaluation; Disease Progression; Embolization, Therapeutic - methods; Evaluation; Female; Fistulae; Gait; Grading; Humans; Imaging; Lesions; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Pain; Pain Measurement; Patients; Radiology; Severity of Illness Index; Sphincter; Spinal cord; Spinal Cord Diseases - classification; Spinal Cord Diseases - diagnostic imaging; Spinal Cord Diseases - physiopathology; Spinal Cord Vascular Diseases - classification; Spinal Cord Vascular Diseases - diagnostic imaging; Spinal Cord Vascular Diseases - physiopathology; Spinal Neuroradiology; Surgery; Surgical instruments; Systems analysis; Urination
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-018-2076-3

Purpose Neurointerventional approaches have improved myelopathy in patients with spinal vascular lesions by providing effective management, particularly when surgical approaches are difficult. However, there have been challenges in describing and comparing recovery status during the post-treatment period. Methods We evaluated 43 patients with venous congestive myelopathy (VCM) using Aminoff–Logue Disability Scale for gait (AL-G) and micturition (AL-M) scores. These results were compared with our new PSMS grading system that evaluates four categories (grades 0–3): p ain, s ensory symptoms, m otor deficit, and s phincter change. Simple linear regression was used to identify the association or trend among the scales. We also calculated an overall area under the receiver operating characteristic curve to compare the predictive ability of the PSMS system with that of the previous grading system (AL-G and AL-M). Results Compared with other grading system, the PSMS system was more sensitively correlated with patient status and the results were easy to compare with previous clinical statuses during follow-up. The PSMS system also measured pain, which is commonly associated with spinal dural arteriovenous fistula and not precisely evaluated by other grading system. Conclusions The new PSMS grading system for patients with VCM correlated well with the previously used systems and included pain evaluation. This new grading system is an easy tool for the evaluation and comparison of outcomes before and after endovascular treatment.