Furlan Julio C, Shen Tian, Kurban Dilnur
Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Ontario, Canada.
KITE Research Institute, University Health Network, Toronto, Ontario, Canada.
Neurology. 2025 Sep 9;105(5):e213996. doi: 10.1212/WNL.0000000000213996. Epub 2025 Aug 19.
While preclinical studies documented potential neuroprotective effects of estrogen/progesterone, the impact of biological sex on outcomes after traumatic spinal cord injury (tSCI) remains incompletely understood. The aim of this study was to compare male and female age-stratified subgroups, which presumably correspond to premenopausal, perimenopausal, and postmenopausal states, concerning access to optimal care and their outcomes after tSCI.
A series of propensity score-matched cohort studies was performed, comparing female individuals with male individuals in the younger (age≤ 40 years), middle-aged (41-50 years), and older (>50 years) subgroups regarding baseline data; management strategies; access to optimal care; and hospital, neurologic, and functional outcomes after tSCI. Data were selected from 5,571 individuals with tSCI at C1-L2 who were enrolled in the Rick Hansen Spinal Cord Injury Registry from July 2004 to September 2019. Outcome measures included in-hospital mortality and motor and sensory score changes from admission to an acute care hospital to discharge from a rehabilitation center.
In the younger subgroups, female individuals (n = 320, mean age: 26 years) were more often White and had a greater proportion of tSCIs due to falls or transportation-related accidents than male individuals (n = 320, mean age: 26.5 years). Younger female and male subgroups had similar in-hospital mortality rates (0.6% vs 0.6%, = 1) and motor (4 vs 5, = 0.8919) and sensory (2 vs 5, = 0.5) score changes after tSCI. In the middle-aged subgroups, female individuals (n = 133, mean age: 46 years) and male individuals (n = 113, mean age: 46 years) had statistically comparable baseline data, in-hospital mortality rates (2.3% vs 3.0%, = 1), and motor (12 vs 5, = 0.8766) and sensory (0 vs 2, = 0.4918) score changes. In the older subgroups, female individuals (n = 531, mean age: 68 years) showed a higher frequency of fall-related tSCI but they had similar in-hospital mortality rates (7.7% vs 9.8%, = 0.2324) and motor (9 vs 8, = 0.7594) and sensory (5 vs 0, = 0.7204) score changes after tSCI compared with male individuals (n = 531, mean age: 68 years).
The results of this study suggest that biological sex does not significantly affect in-hospital mortality and neurologic recovery after tSCI when optimal care is applied, according to data from a Canadian registry. Those findings support the notion that sex equity in management strategies promotes equal outcomes after tSCI.
虽然临床前研究证明了雌激素/孕激素具有潜在的神经保护作用，但生物性别对创伤性脊髓损伤（tSCI）后预后的影响仍未完全明确。本研究的目的是比较男性和女性按年龄分层的亚组（大致对应绝经前、围绝经期和绝经后状态）在获得最佳治疗方面的情况以及tSCI后的预后。
进行了一系列倾向评分匹配队列研究，比较年轻（年龄≤40岁）、中年（41 - 50岁）和老年（>50岁）亚组中的女性个体与男性个体的基线数据、管理策略、获得最佳治疗的情况以及tSCI后的医院、神经学和功能预后。数据选自2004年7月至2019年9月纳入里克·汉森脊髓损伤登记处的5571例C1 - L2节段tSCI患者。结局指标包括住院死亡率以及从急性护理医院入院到康复中心出院时运动和感觉评分的变化。
在较年轻的亚组中，女性个体（n = 320，平均年龄：26岁）比男性个体（n = 320，平均年龄：26.5岁）更常为白人，且因跌倒或交通相关事故导致的tSCI比例更高。较年轻的女性和男性亚组的住院死亡率相似（0.6%对0.6%，P = 1），tSCI后的运动评分变化（4对5，P = 0.8919）和感觉评分变化（2对5，P = 0.5）也相似。在中年亚组中，女性个体（n = 133，平均年龄：46岁）和男性个体（n = 113，平均年龄：46岁）在统计学上具有可比的基线数据、住院死亡率（2.3%对3.0%，P = 1）以及运动评分变化（12对5，P = 0.8766）和感觉评分变化（0对2，P = 0.4918）。在老年亚组中
