300 Section - The Determinant Neurologic Level for Ambulation in Patients with Spinal Cord Injury: A Retrospective Odds Ratio Study

Spinal cord injury (SCI) frequently results in ambulatory impairments, and in clinical settings, the most pressing question patients ask is: “Will I ever walk again?” Although several predictive models have been proposed, most rely on early comprehensive neurological assessments, which are often unavailable in real-life scenarios. Addressing this limitation, the study aims to identify neurologic levels most strongly associated with regaining ambulatory function, providing clinicians with a readily applicable prognostic reference for walking.

Design:

We retrospectively analyzed patients with cervical, thoracic, and lumbar SCI admitted to Taipei Veterans General Hospital between 1990 and 2025. Institutional Review Board approval was obtained. Enrollments underwent at least one month of comprehensive inpatient rehabilitation. Ambulation was evaluated using the Walking Index for Spinal Cord Injury II (WISCI II), and the highest score achieved was recorded with the corresponding neurologic level. Odds ratios (ORs) for ambulation were calculated using the univariate chi-square test and multivariate logistic regression, adjusting for age, gender, American Spinal Injury Association Impairment Scale(AIS), mechanism of injury, and injury chronicity.


Results:

Among 200 SCI patients (C1-L5), 98 (49.0%) regained ambulation (WISCI II≠0). Lower neurologic levels (thoracic and lumbar) and motor-incomplete status (AIS-C/D) were significant predictors (p< 0.05). Univariate analysis showed that patients with injury at or below C6 had higher odds of walking recovery (OR: 2.096, p=0.012). ORs remain around 2 to 4 until the T11 level (OR=8.5, p< 0.001), where another escalation was identified. Multivariate analysis indicated similar results that C5 and T11 (both p< 0.001) were independent inflection points associated with ambulation.

Conclusion:

Neurologic levels at or below C5 to C6 and T11 represent critical thresholds for predicting ambulation after SCI, regardless of age, gender, mechanism of injury, and injury chronicity. The finding provides clinicians with an accessible, examination-based reference, guiding discussion about prognosis and personalized rehabilitation strategies for SCI patients.