Key result
Higher intraspinal pressure multi-scale entropy (OR 6.10) and more frequent edge of chaos dynamics independently predicted long-term functional improvement after severe traumatic spinal cord injury.
Why the study?
Does non-linear dynamical analysis of intraspinal pressure predict functional improvement in patients with severe traumatic spinal cord injuries?
Observational (n=49)
No
Does non-linear dynamical analysis of intraspinal pressure predict functional improvement in patients with severe traumatic spinal cord injuries?
Odds Ratio: 6.1 (95% CI 1.96–39.61)
p-value: p=<0.0005
Non-linear dynamical analysis of intraspinal pressure signals reveals that higher complexity and edge-of-chaos dynamics independently predict long-term functional improvement after severe traumatic spinal cord injury.
May aid prognostication after severe spinal cord injury; hypothesis-generating and requires prospective validation before clinical use.
The injured spinal cord is a complex system influenced by many local and systemic factors that interact over many timescales. To help guide clinical management, we developed a technique that monitors intraspinal pressure from the injury site in patients with acute, severe traumatic spinal cord injuries. Here, we hypothesize that spinal cord injury alters the complex dynamics of the intraspinal pressure signal quantified by computing hourly the detrended fluctuation exponent alpha, multiscale entropy, and maximal Lyapunov exponent lambda. 49 patients with severe traumatic spinal cord injuries were monitored within 72 h of injury for 5 days on average to produce 5,941 h of intraspinal pressure data. We computed the spinal cord perfusion pressure as mean arterial pressure minus intraspinal pressure and the vascular pressure reactivity index as the running correlation coefficient between intraspinal pressure and arterial blood pressure. Mean patient follow-up was 17 months. We show that alpha values are greater than 0.5, which indicates that the intraspinal pressure signal is fractal. As alpha increases, intraspinal pressure decreases and spinal cord perfusion pressure increases with negative correlation between the vascular pressure reactivity index vs. alpha. Thus, secondary insults to the injured cord disrupt intraspinal pressure fractality. Our analysis shows that high intraspinal pressure, low spinal cord perfusion pressure, and impaired pressure reactivity strongly correlate with reduced multi-scale entropy, supporting the notion that secondary insults to the injured cord cause de-complexification of the intraspinal pressure signal, which may render the cord less adaptable to external changes. Healthy physiological systems are characterized by edge of chaos dynamics. We found negative correlations between the percentage of hours with edge of chaos dynamics (-0.01 ≤ lambda ≤ 0.01) vs. high intraspinal pressure and vs. low spinal cord perfusion pressure; these findings suggest that secondary insults render the intraspinal pressure more regular or chaotic. In a multivariate logistic regression model, better neurological status on admission, higher intraspinal pressure multi-scale entropy and more frequent edge of chaos intraspinal pressure dynamics predict long-term functional improvement. We conclude that spinal cord injury is associated with marked changes in non-linear intraspinal pressure metrics that carry prognostic information.
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Chen et al. (2018) conducted an observational in Severe traumatic spinal cord injury (n=49). Non-linear dynamical analysis of intraspinal pressure (MSE and edge of chaos dynamics) was evaluated on Improvement by at least one AIS grade at follow-up (OR 6.10, 95% CI 1.96-39.61, p=<0.0005). Higher intraspinal pressure multi-scale entropy (OR 6.10) and more frequent edge of chaos dynamics independently predicted long-term functional improvement after severe traumatic spinal cord injury.
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