The Italian spine trauma registry: design and rationale of a prospective nationwide multicenter study on surgically treated spinal trauma

The Italian spine trauma registry: design and rationale of a prospective nationwide multicenter study on surgically treated spinal trauma | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Italian spine trauma registry: design and rationale of a prospective nationwide multicenter study on surgically treated spinal trauma Rossella Rispoli, Simona Bistazzoni, Fabio Savoldi, Francesco Certo, and 16 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9031435/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Study Design: Prospective multicenter observational cohort study Objectives : To describe the design, rationale, and methodology of the first nationwide Italian registry dedicated to surgically treated spinal trauma, enabling standardized data collection and long-term outcome assessment. Setting : 48 neurosurgical centers across Italy Methods : Adult patients undergoing surgical treatment for traumatic spinal injuries are prospectively enrolled from 2025 to 2034. Data are collected via a secure digital platform, including demographics, injury characteristics, neurological status, surgical timing and technique, perioperative management, complications, rehabilitation, and Patient Reported Outcome for Spine Trauma (PROST). Follow-up occurs at 3, 12, and 24 months. Statistical analyses will include descriptive statistics, regression, multivariate, and time-to-event models. Results : This manuscript outlines the registry’s design, data collection infrastructure, variables, outcomes, and planned analyses. The first-year enrollment included 673 patients, with the majority presenting lumbar injuries and preserved neurological function. Early surgery (<48 h) was most frequent in subaxial cervical injuries. Surgical approaches and discharge pathways are described. Conclusion : TVMit represents the first nationwide Italian registry for surgically treated spinal trauma, integrating standardized multicenter data collection with longitudinal follow-up and patient-reported outcomes. It provides a platform to inform clinical decision-making, support guideline development, optimize trauma networks, and enable predictive modeling. Health sciences/Diseases/Trauma Health sciences/Health care/Quality of life Figures Figure 1 Introduction Traumatic injuries of the spinal column and spinal cord remain among the most challenging emergencies in neurosurgery. Spinal cord injury (SCI) carries high morbidity and mortality, frequently resulting in permanent neurological deficits, long-term disability, and a substantial socioeconomic burden on patients, families, and healthcare systems [1,2]. Although advances in surgical techniques, neurocritical care, and rehabilitation have improved outcomes, several aspects of spinal trauma management, including timing of surgery, decompression strategies, and perioperative interventions, remain controversial [3,4]. These clinical uncertainties are compounded by the limited availability of high-quality, prospective, multicenter data, resulting in reliance on local practices or retrospective studies [3,8]. Over the past two decades, national and international spine registries have provided valuable insights into elective spinal surgery, implant performance, and perioperative complications [5–7]. However, trauma-specific registries remain scarce, and existing datasets often fail to capture detailed neurological recovery, rehabilitation outcomes, or long-term functional reintegration [8,9]. Moreover, follow-up beyond hospital discharge is frequently incomplete, limiting understanding of recovery trajectories over time. Italy, despite a well-developed neurosurgical network, currently lacks a nationwide coordinated registry dedicated specifically to surgically treated spinal trauma and spinal cord injury. The absence of standardized national data prevents benchmarking between centers, limits the evaluation of trauma system performance, and hinders the development of evidence-based guidelines tailored to real clinical practice [6,7]. To address these limitations, the Spine and Spinal Cord Surgery Department of the University Hospital of Udine, in collaboration with the Spine Section of the Italian Society of Neurosurgery (Società Italiana di Neurochirurgia, SINch), established the Italian National Registry for Surgical Spinal Trauma (TVMit). This nationwide, prospective initiative aims to systematically collect standardized, practice-based data on patients undergoing surgical treatment for traumatic spinal injuries, providing a robust foundation for clinical practice, research, and health policy development [5–7]. Alignment with the International Spinal Cord Injury (SCI) Core Data Set ensures methodological comparability with international registries, enabling cross-country analyses and contributing to global benchmarking and best practice development in spinal trauma care. Methods Study Design The Italian Spine Trauma Registry (TVMit) is a prospective, multicenter, observational cohort study designed to provide a comprehensive, longitudinal evaluation of adult patients undergoing surgical treatment for traumatic spinal column and/or spinal cord injuries. This initiative is coordinated by the Spine and Spinal Cord Surgery Department of the University Hospital of Udine in collaboration with the Spine Section of the Italian Society of Neurosurgery (SINch). By involving 48 neurosurgical centers across Italy, the registry captures a broad spectrum of clinical practice, from highly specialized academic referral centers to regional hospitals, reflecting routine clinical variability in patient management. Enrollment is planned from January 2025 to December 2034, with interim analyses every three years to allow early identification of trends, facilitate timely feedback to participating centers, and support rapid dissemination of findings. Data are collected through a secure, centralized digital platform, designed to support standardized entry, real-time validation, and longitudinal follow-up. This infrastructure ensures consistent, high-quality data capture and allows integration of clinical, surgical, imaging, and patient-reported outcomes. Prior to study initiation, the coordinating center undertook an extensive preparatory phase dedicated to the development of the full study protocol, regulatory documentation, data protection procedures, and standardized data collection tools required for ethical submission. The study protocol was submitted to the Regional Centralized Ethics Committee (Comitato Etico Unico Regionale, CEUR), which conducted a formal review and granted approval following clarification of specific methodological and organizational aspects. After resolution of these comments, final authorization was obtained and the study was formally initiated. Study Population Inclusion criteria comprise adults (≥16 years) presenting with traumatic spinal column and/or spinal cord injuries who undergo surgical intervention, either urgent or delayed, at a participating center. Participants must be available for structured follow-up assessments; patients who die prior to postoperative evaluation are also included to ensure comprehensive assessment of perioperative mortality and outcome patterns. Exclusion criteria include non-operative management, neoplastic fractures, insufficient baseline or perioperative data, and refusal or withdrawal of informed consent. This comprehensive approach ensures that the registry captures the full spectrum of surgically treated patients, including those at high risk, thereby enhancing the generalizability and clinical relevance of the findings. Data Collection The registry collects detailed, standardized data across multiple domains to enable comprehensive analyses of patient characteristics, interventions, and outcomes. Baseline variables include demographics, comorbidities, injury mechanism, anatomical level, and radiological severity, forming the basis for risk stratification and comparative analyses. Neurological status is assessed pre- and postoperatively using the ASIA Impairment Scale (AIS) and Medical Research Council (MRC) scale at baseline and predefined follow-up intervals, allowing longitudinal evaluation of motor and sensory recovery. Surgical details include timing of intervention, surgical approach, and stabilization techniques, enabling comparison of operative strategies and functional outcomes. Perioperative variables include ICU admission, corticosteroid therapy, and rehabilitation planning to assess their influence on recovery. Follow-up at 3, 12, and 24 months records neurological status, complications, reoperations, imaging findings, Patient Reported Outcome for Spine Trauma (PROST), functional independence, and return-to-work. Retention is supported through structured reminders, telemedicine consultations, and centralized coordination to ensure long-term follow-up. Study Phases The registry is implemented in four sequential but overlapping phases: Preparatory Phase (2022–2024): standardization of definitions, pilot testing of electronic forms, platform deployment, governance structure setup, and preparation and submission of regulatory documentation required to obtain approval from the Regional Centralized Ethics Committee (CEUR). Enrollment and Data Collection Phase (2025–2034): prospective recruitment, standardized data capture, and interim analyses every three years. Follow-Up Continuation Phase (2034–2036): completion of 24-month outcomes for all enrolled patients. Analysis and Dissemination Phase (2025–2036): comprehensive analyses, preparation of peer-reviewed publications, presentations at national and international conferences, and institutional reporting. A schematic diagram (Fig. 1) illustrates the conceptual framework of the registry, the patient pathway, data flow, and feedback cycle from clinical care to benchmarking and guideline development. Outcomes The primary outcome is the proportion of patients achieving neurological improvement at 24 months, defined as at least a one-grade improvement on the ASIA Impairment Scale (AIS) or the Medical Research Council (MRC) scale. Secondary outcomes include neurological recovery at 3 and 12 months, perioperative complications and reoperation rates, functional independence, return to work, mortality, and the influence of surgical timing and perioperative management on clinical outcomes. This comprehensive outcome framework enables evaluation of both functional recovery and safety across diverse patient populations. Statistical Methods and Control of Confounding Factors Continuous variables will be summarized as means ± standard deviations or medians with interquartile ranges, and categorical variables as frequencies. Normality will be assessed using the Shapiro–Wilk test. Group comparisons will be performed using the chi-square or Fisher’s exact test for categorical variables and the independent samples t-test or Wilcoxon–Mann–Whitney test for continuous variables, as appropriate. Univariable and multivariable logistic regression analyses will identify factors associated with clinically relevant neurological or functional improvement at T3, T12, and T24. Statistical significance will be set at p < 0.05. Analyses will be conducted using SAS Enterprise Guide 7.1, with alternative models applied if required by data distribution or regression assumptions. Governance, Ethics, and Data Protection To enhance the global relevance of findings, the registry aligns with the International SCI Core Data Set [8, 9], allowing standardized reporting of AIS conversion, complication rates, functional recovery, and mortality. This framework supports cross-country benchmarking, international collaboration, and identification of best practices in spinal trauma care. The registry ensures data quality through continuous local verification and centralized oversight by the Principal Investigator, supported by regular audits and standardized assessment protocols to maintain consistency across centers. Communication among investigators is facilitated through a dedicated group platform. The registry complies with General Data Protection Regulations (GDPR), with pseudo-anonymized data securely stored and accessible only to authorized personnel. Written informed consent is obtained from all participants, and participation does not modify standard clinical care. Funding This is a physician-initiated and investigator-led study conducted without external funding. It is supported by the professional commitment of participating centers and embedded within routine clinical practice. First-year population characteristics During the first year, 673 patients were enrolled (Tables 1 and 2). Lumbar injuries (L1–L5) were the most frequent (46.2%), followed by thoracic (T1–T12, 30.6%), subaxial cervical (C3–C7, 15.0%), and upper cervical (C0–C2, 8.0%) levels. Overall, most patients presented with preserved neurological function (AIS E); however, patients with subaxial cervical injuries (C3–C7) showed a higher proportion of severe neurological impairment (AIS A–B, 25.7%) compared with thoracic (12.1%), lumbar (2.9%), and upper cervical injuries (1.9%). Regarding surgical timing, early intervention within 48 hours was more frequent in subaxial cervical injuries (46.5%) compared with upper cervical (9.3%), thoracic (16.5%), and lumbar cases (19.6%). Planned procedures, performed after 72 hours, were more common in thoracic (73.8%) and lumbar injuries (68.8%), as well as in upper cervical trauma (74.1%), whereas they accounted for 38.6% of subaxial cervical cases. The posterior approach was predominant in upper cervical (85.2%), thoracic (91.3%), and lumbar injuries (88.1%). In contrast, in subaxial cervical trauma, anterior (41.6%), posterior (29.7%), and combined approaches (28.7%) were distributed in nearly equivalent proportions. Most patients were discharged home, while a minority required rehabilitation or extended care facilities. Discussion A principal strength of TVMit is its prospective, nationwide, multicenter design, which enhances both methodological rigor and external validity. In spinal cord injury (SCI), much of the existing evidence derives from retrospective cohorts or single-center experiences, frequently limited by incomplete data capture, selection bias, and heterogeneous follow-up intervals [1–3]. Prospective registries have been recognized as essential tools in conditions where randomized controlled trials are challenging due to ethical constraints and injury heterogeneity [4]. By enrolling patients consecutively across 48 centers, TVMit reduces referral bias and reflects contemporary surgical practice, thereby improving generalizability while preserving standardized data collection. Another major strength is the focus on surgically treated spinal trauma, allowing detailed evaluation of operative strategies in a population where decision-making remains controversial. Although early decompression is widely advocated following the STASCIS study [5] and subsequent meta-analyses [6], important uncertainties persist regarding optimal timing thresholds, patient selection in incomplete injuries, and the influence of surgical approach. Furthermore, debates continue regarding the role of adjunctive therapies such as high-dose methylprednisolone, whose benefit-risk profile remains contested despite historical NASCIS trials [10, 11,12]. A prospective national registry capturing granular surgical and perioperative data offers a unique opportunity to evaluate these issues in a routine clinical setting beyond the constraints of randomized protocols. The integration of standardized neurological assessment with Patient Reported Outcome for Spine Trauma (PROST) [13, 14] represents a further methodological advancement. Neurological grading using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and AIS remains fundamental for impairment quantification [15]. However, neurological recovery does not fully correlate with functional independence or quality of life [16]. Contemporary SCI research increasingly emphasizes multidimensional outcome frameworks that incorporate autonomy, participation, and psychosocial recovery [17]. By combining objective neurological scales with patient-centered outcomes (PROST), TVMit aligns with value-based healthcare principles and provides a more comprehensive evaluation of long-term recovery. The longitudinal follow-up structure (3, 12, and 24 months) constitutes another critical strength. Neurological and functional recovery after SCI is dynamic, with early improvements often occurring within the first months and later gains associated with rehabilitation and neuroplastic adaptation [18,19,20]. Many existing studies report short-term outcomes, limiting understanding of sustained functional trajectories. Serial assessments enable characterization of recovery patterns, differentiation between transient and durable improvements, and identification of early prognostic indicators. Such longitudinal data are essential for developing robust outcome prediction models and refining patient counseling strategies. From an analytical perspective, TVMit provides a foundation for predictive modeling and data-driven clinical decision support. Recent work has demonstrated the potential of multivariable and machine-learning models to predict neurological and functional outcomes after SCI using clinical and imaging variables [21,22]. However, the reliability of such models depends heavily on large, high-quality prospective datasets. The structured architecture of TVMit — incorporating baseline injury characteristics, surgical parameters, complications, and longitudinal outcomes — creates a suitable infrastructure for precision-medicine approaches in spinal trauma care. TVMit also strengthens the national and international research landscape. Established registries such as the Rick Hansen Spinal Cord Injury Registry (RHSCIR) [23] and the European Multicenter Study about Spinal Cord Injury (EMSCI) [24] have demonstrated the scientific value of harmonized data collection and multicenter collaboration. By adopting standardized outcome measures and prospective methodology, TVMit positions Italy within this international framework, enabling cross-country benchmarking and contributing to the global harmonization of SCI research. Finally, the registry has significant implications for health system governance and quality improvement [25]. Nationwide benchmarking allows identification of practice variation in surgical timing, approach selection, complication rates, and rehabilitation referral patterns. Reducing unwarranted variation is a recognized pathway toward improving healthcare quality and cost-effectiveness [26]. In this context, TVMit functions not only as a research instrument but also as a structured quality-assurance platform capable of informing national guidelines and optimizing resource allocation. Collectively, these strengths - prospective design, surgical specificity, multidimensional outcome integration, longitudinal follow-up, analytical scalability, and system-level impact - position TVMit as a transformative initiative in spinal trauma research. By bridging clinical practice, epidemiology, and predictive analytics, the registry has the potential to advance evidence generation and support more individualized, data-driven care for patients with spinal cord injury. Nevertheless, registry-based studies inherently carry potential methodological limitations. Selection bias may occur because only surgically treated patients admitted to neurosurgical centers are included, potentially underrepresenting milder injuries or patients managed conservatively. However, this design reflects the registry’s specific aim of evaluating surgical decision-making and operative outcomes in spinal trauma [27]. Inter-center heterogeneity in surgical techniques, perioperative protocols, and rehabilitation pathways represents another limitation. Rather than a weakness, this variability also constitutes a strength of real-world registries, as it allows comparative effectiveness analyses across different clinical strategies. To mitigate this issue, standardized variable definitions, mandatory investigator training, and predefined outcome measures are implemented across all centers. Missing data and loss to follow-up are recognized challenges in longitudinal registries. Multiple mitigation strategies have been incorporated, including reminders, centralized follow-up coordination, and telemedicine visits. In addition, real-time validation checks and centralized discrepancy queries aim to ensure data completeness and reliability. Variability in neurological grading between evaluators and in fracture classification may introduce misclassification bias, affecting data consistency as well as the reproducibility of the study findings. Finally, as an observational study, causal relationships between treatments and outcomes cannot be definitively established. However, multivariate analyses and large sample size will allow identification of independent predictors and generation of robust hypotheses for future clinical trials [28]. Conclusion The Italian Spine Trauma Registry (TVMit) is the first nationwide prospective multicenter initiative in Italy dedicated to surgically treated spinal trauma and spinal cord injury. By combining standardized neurological assessments, longitudinal follow-up, and patient-centered outcomes, the registry provides a structured platform for real-world evidence generation. Beyond descriptive epidemiology, TVMit enables benchmarking across centers, evaluation of clinical strategies, and identification of predictors of recovery and complications. Through alignment with international data standards, the registry also supports global collaboration and comparative analyses. Ultimately, TVMit aims to inform clinical decision-making, improve quality of care, and guide health policy in spinal trauma management. Declarations Sponsorship: Physician-initiated and investigator-led study, supported by the Italian Society of Neurosurgery (SINch) and embedded in routine clinical practice. CONFLICT OF INTEREST The authors declare no conflicts of interest related to this work. References Gliklich RE, Dreyer NA, Leavy MB, editors. Registries for Evaluating Patient Outcomes: A User's Guide [Internet]. 3rd ed. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Apr. Report No.: 13(14)-EHC111 Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. 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Baseline characteristics of the study population during the first year of enrollment (n = 673) Variable n % Age Median (years) 60 Range (min–max) 16–88 Sex Male 402 59.7% Female 271 40.3% Mechanism of Injury Road traffic accident 198 29.4% Domestic accident 218 32.4% Fall from height 143 21.2% Sports injury 38 5.6% Suicide attempt 16 2.4% Other 60 8.9% Polytrauma No 452 67.2% Yes 221 32.8% ICU Admission No 564 83.8% Yes 109 16.2% Spinal Level C0–C2 54 8.0% C3–C7 101 15.0% T1–T12 206 30.6% L1–L5 311 46.2% Sacrum 1 0.1% Table 2 . Clinical, surgical, and discharge characteristics by spinal level in the study population during the first year of enrollment (n = 673). C0–C2 (n=54) C3–C7 (n=101) T1–T12 (n=206) L1–L5 (n=311) Sacrum (n=1) AIS Grade AIS A 15 23 5 AIS B 1 11 2 4 AIS C 2 15 8 10 AIS D 3 18 13 23 AIS E 48 42 160 269 1 NASCIS Yes 3 21 11 7 No 51 80 195 304 1 Surg. Timing 0–24 hours 1 30 18 21 25–48 hours 4 17 16 40 49–72 hours 9 15 20 36 Planned (>72h) 40 39 152 214 1 Surg. Approach Anterior 7 42 2 Posterior 46 30 188 274 1 Combined 29 1 5 Other 1 17 30 Discharge Home 41 35 145 228 1 Rehab. facility 7 37 42 53 Nursing home 3 2 1 4 To other ward 1 14 13 21 Other 1 9 5 5 Deceased 1 4 Additional Declarations There is no duality of interest Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: revise 07 Apr, 2026 Review # 1 received at journal 04 Apr, 2026 Review # 2 received at journal 29 Mar, 2026 Reviewer # 2 agreed at journal 23 Mar, 2026 Reviewer # 1 agreed at journal 16 Mar, 2026 Reviewers invited by journal 16 Mar, 2026 Editor assigned by journal 11 Mar, 2026 Submission checks completed at journal 11 Mar, 2026 First submitted to journal 05 Mar, 2026 Unknown event 04 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9031435","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":604365529,"identity":"690c5895-81ee-4630-a130-94925c88e317","order_by":0,"name":"Rossella 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14:36:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9031435/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9031435/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105031758,"identity":"6a535ae0-5051-4876-bbcb-3e56c7e6272a","added_by":"auto","created_at":"2026-03-20 06:51:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":228892,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual framework of the Italian Spine Trauma Registry (TVMit), illustrating the patient pathway, data flow, and feedback cycle from clinical care to benchmarking and guideline development.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9031435/v1/ca73c8530bac87f9cbd599c3.png"},{"id":105035934,"identity":"40402913-926c-490c-b1cf-4f6d8f9bb54c","added_by":"auto","created_at":"2026-03-20 07:27:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":766070,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9031435/v1/71bc3152-f762-43bc-b539-cc2c06eec93d.pdf"}],"financialInterests":"There is no duality of interest","formattedTitle":"The Italian spine trauma registry: design and rationale of a prospective nationwide multicenter study on surgically treated spinal trauma","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraumatic injuries of the spinal column and spinal cord remain among the most challenging emergencies in neurosurgery. Spinal cord injury (SCI) carries high morbidity and mortality, frequently resulting in permanent neurological deficits, long-term disability, and a substantial socioeconomic burden on patients, families, and healthcare systems [1,2]. Although advances in surgical techniques, neurocritical care, and rehabilitation have improved outcomes, several aspects of spinal trauma management, including timing of surgery, decompression strategies, and perioperative interventions, remain controversial [3,4]. These clinical uncertainties are compounded by the limited availability of high-quality, prospective, multicenter data, resulting in reliance on local practices or retrospective studies [3,8].\u003c/p\u003e \u003cp\u003eOver the past two decades, national and international spine registries have provided valuable insights into elective spinal surgery, implant performance, and perioperative complications [5\u0026ndash;7]. However, trauma-specific registries remain scarce, and existing datasets often fail to capture detailed neurological recovery, rehabilitation outcomes, or long-term functional reintegration [8,9]. Moreover, follow-up beyond hospital discharge is frequently incomplete, limiting understanding of recovery trajectories over time.\u003c/p\u003e \u003cp\u003eItaly, despite a well-developed neurosurgical network, currently lacks a nationwide coordinated registry dedicated specifically to surgically treated spinal trauma and spinal cord injury. The absence of standardized national data prevents benchmarking between centers, limits the evaluation of trauma system performance, and hinders the development of evidence-based guidelines tailored to real clinical practice [6,7].\u003c/p\u003e \u003cp\u003eTo address these limitations, the Spine and Spinal Cord Surgery Department of the University Hospital of Udine, in collaboration with the Spine Section of the Italian Society of Neurosurgery (Societ\u0026agrave; Italiana di Neurochirurgia, SINch), established the Italian National Registry for Surgical Spinal Trauma (TVMit). This nationwide, prospective initiative aims to systematically collect standardized, practice-based data on patients undergoing surgical treatment for traumatic spinal injuries, providing a robust foundation for clinical practice, research, and health policy development [5\u0026ndash;7].\u003c/p\u003e \u003cp\u003eAlignment with the International Spinal Cord Injury (SCI) Core Data Set ensures methodological comparability with international registries, enabling cross-country analyses and contributing to global benchmarking and best practice development in spinal trauma care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cem\u003eStudy Design\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Italian Spine Trauma Registry (TVMit) is a prospective, multicenter, observational cohort study designed to provide a comprehensive, longitudinal evaluation of adult patients undergoing surgical treatment for traumatic spinal column and/or spinal cord injuries. This initiative is coordinated by the Spine and Spinal Cord Surgery Department of the University Hospital of Udine in collaboration with the Spine Section of the Italian Society of Neurosurgery (SINch). By involving 48 neurosurgical centers across Italy, the registry captures a broad spectrum of clinical practice, from highly specialized academic referral centers to regional hospitals, reflecting routine clinical variability in patient management.\u003c/p\u003e\n\u003cp\u003eEnrollment is planned from January 2025 to December 2034, with interim analyses every three years to allow early identification of trends, facilitate timely feedback to participating centers, and support rapid dissemination of findings. Data are collected through a secure, centralized digital platform, designed to support standardized entry, real-time validation, and longitudinal follow-up. This infrastructure ensures consistent, high-quality data capture and allows integration of clinical, surgical, imaging, and patient-reported outcomes.\u003c/p\u003e\n\u003cp\u003ePrior to study initiation, the coordinating center undertook an extensive preparatory phase dedicated to the development of the full study protocol, regulatory documentation, data protection procedures, and standardized data collection tools required for ethical submission. The study protocol was submitted to the Regional Centralized Ethics Committee (Comitato Etico Unico Regionale, CEUR), which conducted a formal review and granted approval following clarification of specific methodological and organizational aspects. After resolution of these comments, final authorization was obtained and the study was formally initiated.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudy Population\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria comprise adults (\u0026ge;16\u0026nbsp;years) presenting with traumatic spinal column and/or spinal cord injuries who undergo surgical intervention, either urgent or delayed, at a participating center. Participants must be available for structured follow-up assessments; patients who die prior to postoperative evaluation are also included to ensure comprehensive assessment of perioperative mortality and outcome patterns.\u003c/p\u003e\n\u003cp\u003eExclusion criteria include non-operative management, neoplastic fractures, insufficient baseline or perioperative data, and refusal or withdrawal of informed consent.\u003c/p\u003e\n\u003cp\u003eThis comprehensive approach ensures that the registry captures the full spectrum of surgically treated patients, including those at high risk, thereby enhancing the generalizability and clinical relevance of the findings.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData Collection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe registry collects detailed, standardized data across multiple domains to enable comprehensive analyses of patient characteristics, interventions, and outcomes.\u003c/p\u003e\n\u003cp\u003eBaseline variables include demographics, comorbidities, injury mechanism, anatomical level, and radiological severity, forming the basis for risk stratification and comparative analyses. Neurological status is assessed pre- and postoperatively using the ASIA Impairment Scale (AIS) and Medical Research Council (MRC) scale at baseline and predefined follow-up intervals, allowing longitudinal evaluation of motor and sensory recovery.\u003c/p\u003e\n\u003cp\u003eSurgical details include timing of intervention, surgical approach, and stabilization techniques, enabling comparison of operative strategies and functional outcomes. Perioperative variables include ICU admission, corticosteroid therapy, and rehabilitation planning to assess their influence on recovery.\u003c/p\u003e\n\u003cp\u003eFollow-up at 3, 12, and 24 months records neurological status, complications, reoperations, imaging findings, Patient Reported Outcome for Spine Trauma (PROST), functional independence, and return-to-work. Retention is supported through structured reminders, telemedicine consultations, and centralized coordination to ensure long-term follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStudy Phases\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe registry is implemented in four sequential but overlapping phases:\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003ePreparatory Phase (2022\u0026ndash;2024): standardization of definitions, pilot testing of electronic forms, platform deployment, governance structure setup, and preparation and submission of regulatory documentation required to obtain approval from the Regional Centralized Ethics Committee (CEUR).\u003c/li\u003e\n \u003cli\u003eEnrollment and Data Collection Phase (2025\u0026ndash;2034): prospective recruitment, standardized data capture, and interim analyses every three years.\u003c/li\u003e\n \u003cli\u003eFollow-Up Continuation Phase (2034\u0026ndash;2036): completion of 24-month outcomes for all enrolled patients.\u003c/li\u003e\n \u003cli\u003eAnalysis and Dissemination Phase (2025\u0026ndash;2036): comprehensive analyses, preparation of peer-reviewed publications, presentations at national and international conferences, and institutional reporting.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eA schematic diagram (Fig. 1) illustrates the conceptual framework of the registry, the patient pathway, data flow, and feedback cycle from clinical care to benchmarking and guideline development.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOutcomes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe primary outcome is the proportion of patients achieving neurological improvement at 24 months, defined as at least a one-grade improvement on the ASIA Impairment Scale (AIS) or the Medical Research Council (MRC) scale. Secondary outcomes include neurological recovery at 3 and 12 months, perioperative complications and reoperation rates, functional independence, return to work, mortality, and the influence of surgical timing and perioperative management on clinical outcomes.\u003c/p\u003e\n\u003cp\u003eThis comprehensive outcome framework enables evaluation of both functional recovery and safety across diverse patient populations.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Methods and Control of Confounding Factors\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables will be summarized as means \u0026plusmn; standard deviations or medians with interquartile ranges, and categorical variables as frequencies. Normality will be assessed using the Shapiro\u0026ndash;Wilk test. Group comparisons will be performed using the chi-square or Fisher\u0026rsquo;s exact test for categorical variables and the independent samples t-test or Wilcoxon\u0026ndash;Mann\u0026ndash;Whitney test for continuous variables, as appropriate. Univariable and multivariable logistic regression analyses will identify factors associated with clinically relevant neurological or functional improvement at T3, T12, and T24. Statistical significance will be set at p \u0026lt; 0.05. Analyses will be conducted using SAS Enterprise Guide 7.1, with alternative models applied if required by data distribution or regression assumptions.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGovernance, Ethics, and Data Protection\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo enhance the global relevance of findings, the registry aligns with the International SCI Core Data Set [8, 9], allowing standardized reporting of AIS conversion, complication rates, functional recovery, and mortality. This framework supports cross-country benchmarking, international collaboration, and identification of best practices in spinal trauma care.\u003c/p\u003e\n\u003cp\u003eThe registry ensures data quality through continuous local verification and centralized oversight by the Principal Investigator, supported by regular audits and standardized assessment protocols to maintain consistency across centers. Communication among investigators is facilitated through a dedicated group platform. The registry complies with General Data Protection Regulations (GDPR), with pseudo-anonymized data securely stored and accessible only to authorized personnel. Written informed consent is obtained from all participants, and participation does not modify standard clinical care.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis is a physician-initiated and investigator-led study conducted without external funding. It is supported by the professional commitment of participating centers and embedded within routine clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFirst-year population characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDuring the first year, 673 patients were enrolled (Tables 1 and 2).\u003c/p\u003e\n\u003cp\u003eLumbar injuries (L1\u0026ndash;L5) were the most frequent (46.2%), followed by thoracic (T1\u0026ndash;T12, 30.6%), subaxial cervical (C3\u0026ndash;C7, 15.0%), and upper cervical (C0\u0026ndash;C2, 8.0%) levels. Overall, most patients presented with preserved neurological function (AIS E); however, patients with subaxial cervical injuries (C3\u0026ndash;C7) showed a higher proportion of severe neurological impairment (AIS A\u0026ndash;B, 25.7%) compared with thoracic (12.1%), lumbar (2.9%), and upper cervical injuries (1.9%).\u003c/p\u003e\n\u003cp\u003eRegarding surgical timing, early intervention within 48 hours was more frequent in subaxial cervical injuries (46.5%) compared with upper cervical (9.3%), thoracic (16.5%), and lumbar cases (19.6%). Planned procedures, performed after 72 hours, were more common in thoracic (73.8%) and lumbar injuries (68.8%), as well as in upper cervical trauma (74.1%), whereas they accounted for 38.6% of subaxial cervical cases.\u003c/p\u003e\n\u003cp\u003eThe posterior approach was predominant in upper cervical (85.2%), thoracic (91.3%), and lumbar injuries (88.1%). In contrast, in subaxial cervical trauma, anterior (41.6%), posterior (29.7%), and combined approaches (28.7%) were distributed in nearly equivalent proportions.\u003c/p\u003e\n\u003cp\u003eMost patients were discharged home, while a minority required rehabilitation or extended care facilities.\u003c/p\u003e"},{"header":"Discussion ","content":"\u003cp\u003eA principal strength of TVMit is its prospective, nationwide, multicenter design, which enhances both methodological rigor and external validity. In spinal cord injury (SCI), much of the existing evidence derives from retrospective cohorts or single-center experiences, frequently limited by incomplete data capture, selection bias, and heterogeneous follow-up intervals [1\u0026ndash;3]. Prospective registries have been recognized as essential tools in conditions where randomized controlled trials are challenging due to ethical constraints and injury heterogeneity [4]. By enrolling patients consecutively across 48 centers, TVMit reduces referral bias and reflects contemporary surgical practice, thereby improving generalizability while preserving standardized data collection.\u003c/p\u003e\n\u003cp\u003eAnother major strength is the focus on surgically treated spinal trauma, allowing detailed evaluation of operative strategies in a population where decision-making remains controversial. Although early decompression is widely advocated following the STASCIS study [5] and subsequent meta-analyses [6], important uncertainties persist regarding optimal timing thresholds, patient selection in incomplete injuries, and the influence of surgical approach. Furthermore, debates continue regarding the role of adjunctive therapies such as high-dose methylprednisolone, whose benefit-risk profile remains contested despite historical NASCIS trials [10, 11,12]. A prospective national registry capturing granular surgical and perioperative data offers a unique opportunity to evaluate these issues in a routine clinical setting beyond the constraints of randomized protocols.\u003c/p\u003e\n\u003cp\u003eThe integration of standardized neurological assessment with Patient Reported Outcome for Spine Trauma (PROST) [13, 14] represents a further methodological advancement. Neurological grading using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and AIS remains fundamental for impairment quantification [15]. However, neurological recovery does not fully correlate with functional independence or quality of life [16]. Contemporary SCI research increasingly emphasizes multidimensional outcome frameworks that incorporate autonomy, participation, and psychosocial recovery [17]. By combining objective neurological scales with patient-centered outcomes (PROST), TVMit aligns with value-based healthcare principles and provides a more comprehensive evaluation of long-term recovery.\u003c/p\u003e\n\u003cp\u003eThe longitudinal follow-up structure (3, 12, and 24 months) constitutes another critical strength. Neurological and functional recovery after SCI is dynamic, with early improvements often occurring within the first months and later gains associated with rehabilitation and neuroplastic adaptation [18,19,20]. Many existing studies report short-term outcomes, limiting understanding of sustained functional trajectories. Serial assessments enable characterization of recovery patterns, differentiation between transient and durable improvements, and identification of early prognostic indicators. Such longitudinal data are essential for developing robust outcome prediction models and refining patient counseling strategies.\u003c/p\u003e\n\u003cp\u003eFrom an analytical perspective, TVMit provides a foundation for predictive modeling and data-driven clinical decision support. Recent work has demonstrated the potential of multivariable and machine-learning models to predict neurological and functional outcomes after SCI using clinical and imaging variables [21,22]. However, the reliability of such models depends heavily on large, high-quality prospective datasets. The structured architecture of TVMit \u0026mdash; incorporating baseline injury characteristics, surgical parameters, complications, and longitudinal outcomes \u0026mdash; creates a suitable infrastructure for precision-medicine approaches in spinal trauma care.\u003c/p\u003e\n\u003cp\u003eTVMit also strengthens the national and international research landscape. Established registries such as the Rick Hansen Spinal Cord Injury Registry (RHSCIR) [23] and the European Multicenter Study about Spinal Cord Injury (EMSCI) [24] have demonstrated the scientific value of harmonized data collection and multicenter collaboration. By adopting standardized outcome measures and prospective methodology, TVMit positions Italy within this international framework, enabling cross-country benchmarking and contributing to the global harmonization of SCI research.\u003c/p\u003e\n\u003cp\u003eFinally, the registry has significant implications for health system governance and quality improvement [25]. Nationwide benchmarking allows identification of practice variation in surgical timing, approach selection, complication rates, and rehabilitation referral patterns. Reducing unwarranted variation is a recognized pathway toward improving healthcare quality and cost-effectiveness [26]. In this context, TVMit functions not only as a research instrument but also as a structured quality-assurance platform capable of informing national guidelines and optimizing resource allocation. Collectively, these strengths - prospective design, surgical specificity, multidimensional outcome integration, longitudinal follow-up, analytical scalability, and system-level impact - position TVMit as a transformative initiative in spinal trauma research. By bridging clinical practice, epidemiology, and predictive analytics, the registry has the potential to advance evidence generation and support more individualized, data-driven care for patients with spinal cord injury.\u003c/p\u003e\n\u003cp\u003eNevertheless, registry-based studies inherently carry potential methodological limitations.\u003c/p\u003e\n\u003cp\u003eSelection bias may occur because only surgically treated patients admitted to neurosurgical centers are included, potentially underrepresenting milder injuries or patients managed conservatively. However, this design reflects the registry\u0026rsquo;s specific aim of evaluating surgical decision-making and operative outcomes in spinal trauma [27].\u003c/p\u003e\n\u003cp\u003eInter-center heterogeneity in surgical techniques, perioperative protocols, and rehabilitation pathways represents another limitation. Rather than a weakness, this variability also constitutes a strength of real-world registries, as it allows comparative effectiveness analyses across different clinical strategies. To mitigate this issue, standardized variable definitions, mandatory investigator training, and predefined outcome measures are implemented across all centers.\u003c/p\u003e\n\u003cp\u003eMissing data and loss to follow-up are recognized challenges in longitudinal registries. Multiple mitigation strategies have been incorporated, including reminders, centralized follow-up coordination, and telemedicine visits. In addition, real-time validation checks and centralized discrepancy queries aim to ensure data completeness and reliability.\u003c/p\u003e\n\u003cp\u003eVariability in neurological grading between evaluators and in fracture classification may introduce misclassification bias, affecting data consistency as well as the reproducibility of the study findings.\u003c/p\u003e\n\u003cp\u003eFinally, as an observational study, causal relationships between treatments and outcomes cannot be definitively established. However, multivariate analyses and large sample size will allow identification of independent predictors and generation of robust hypotheses for future clinical trials [28].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe Italian Spine Trauma Registry (TVMit) is the first nationwide prospective multicenter initiative in Italy dedicated to surgically treated spinal trauma and spinal cord injury. By combining standardized neurological assessments, longitudinal follow-up, and patient-centered outcomes, the registry provides a structured platform for real-world evidence generation.\u003c/p\u003e\n\u003cp\u003eBeyond descriptive epidemiology, TVMit enables benchmarking across centers, evaluation of clinical strategies, and identification of predictors of recovery and complications. Through alignment with international data standards, the registry also supports global collaboration and comparative analyses.\u003c/p\u003e\n\u003cp\u003eUltimately, TVMit aims to inform clinical decision-making, improve quality of care, and guide health policy in spinal trauma management.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eSponsorship: Physician-initiated and investigator-led study, supported by the Italian Society of Neurosurgery (SINch) and embedded in routine clinical practice.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCONFLICT OF INTEREST\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest related to this work.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGliklich RE, Dreyer NA, Leavy MB, editors. Registries for Evaluating Patient Outcomes: A User\u0026apos;s Guide [Internet]. 3rd ed. Rockville (MD): Agency for Healthcare Research and Quality (US); 2014 Apr. Report No.: 13(14)-EHC111\u003c/li\u003e\n \u003cli\u003eSingh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol. 2014 Sep 23;6:309-31.\u003c/li\u003e\n \u003cli\u003eFehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(2):e32037.\u003c/li\u003e\n \u003cli\u003eAarabi B, Alexander M, Mirvis SE, Shanmuganathan K, Chesler D, Maulucci C, Iguchi M, Aresco C, Blacklock T. Predictors of outcome in acute traumatic central cord syndrome due to spinal stenosis. J Neurosurg Spine. 2011 Jan;14(1):122-30.\u003c/li\u003e\n \u003cli\u003ePascucci S, Langella F, Franz\u0026ograve; M, Tesse MG, Ciminello E, Biondi A, Carrani E, Sampaolo L, Zanoli G, Berjano P, Torre M. National spine surgery registries\u0026apos; characteristics and aims: globally accepted standards have yet to be met. Results of a scoping review and a complementary survey. J Orthop Traumatol. 2023 Sep 16;24(1):49.\u003c/li\u003e\n \u003cli\u003evan Hooff ML, Jacobs WC, Willems PC, Wouters MW, de Kleuver M, Peul WC, Ostelo RW, Fritzell P. Evidence and practice in spine registries. Acta Orthop. 2015;86(5):534-44.\u003c/li\u003e\n \u003cli\u003eO\u0026apos;Reilly GM, Cameron PA, Joshipura M. Global trauma registry mapping: a scoping review. Injury. 2012 Jul;43(7):1148-53.\u003c/li\u003e\n \u003cli\u003eDeVivo M, Biering-S\u0026oslash;rensen F, Charlifue S, Noonan V, Post M, Stripling T, Wing P; Executive Committee for the International SCI Data Sets Committees. International Spinal Cord Injury Core Data Set. Spinal Cord. 2006 Sep;44(9):535-40.\u003c/li\u003e\n \u003cli\u003eBiering-S\u0026oslash;rensen F, Charlifue S, DeVivo M, Noonan V, Post M, Stripling T, Wing P. International Spinal Cord Injury Data Sets. Spinal Cord. 2006 Sep;44(9):530-4.\u003c/li\u003e\n \u003cli\u003eBracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, Eisenberg HM, Flamm E, Leo-Summers L, Maroon J, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990 May 17;322(20):1405-11.\u003c/li\u003e\n \u003cli\u003eHurlbert RJ. The role of steroids in acute spinal cord injury: an evidence-based analysis. Spine (Phila Pa 1976). 2001 Dec 15;26(24 Suppl):S39-46.\u003c/li\u003e\n \u003cli\u003eRispoli R, Cappelletto B. Unraveling the controversy: high-dose steroids in spinal cord injury. Forty years of inquiry. J Neurosurg Sci. 2024 Jun;68(3):251-253.\u003c/li\u003e\n \u003cli\u003eBeighley A, Zhang A, Huang B, Carr C, Mathkour M, Werner C, Scullen T, Kilgore M, Maulucci C, Dallapiazza R, Kalyvas J. Patient-reported outcome measures in spine surgery: A systematic review. J Craniovertebr Junction Spine. 2022;13(4):378-389.\u003c/li\u003e\n \u003cli\u003eSadiqi S, Post MW, Hosman AJ, Dvorak MF, Chapman JR, Benneker LM, Kandziora F, Rajasekaran S, Schnake KJ, Vaccaro AR, Oner FC. Reliability, validity and responsiveness of the Dutch version of the AOSpine PROST (Patient Reported Outcome Spine Trauma). Eur Spine J. 2021;30(9):2631-2644.\u003c/li\u003e\n \u003cli\u003eKirshblum SC, Biering-S\u0026oslash;rensen F, Betz R, Burns S, Donovan W, Graves DE, Johansen M, Jones L, Mulcahey MJ, Rodriguez GM, Schmidt-Read M, Steeves JD, Tansey K, Waring W. International standards for neurological classification of spinal cord injury: cases with classification challenges. Top Spinal Cord Inj Rehabil. 2014 Spring;20(2):81-9.\u003c/li\u003e\n \u003cli\u003eSteeves JD, Lammertse D, Curt A, Fawcett JW, Tuszynski MH, Ditunno JF, Ellaway PH, Fehlings MG, Guest JD, Kleitman N, Bartlett PF, Blight AR, Dietz V, Dobkin BH, Grossman R, Short D, Nakamura M, Coleman WP, Gaviria M, Privat A. Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures. Spinal Cord. 2007 Mar;45(3):206-21.\u003c/li\u003e\n \u003cli\u003eTulsky DS, Kisala PA, Victorson D, Tate DG, Heinemann AW, Charlifue S, Kirshblum SC, Fyffe D, Gershon R, Spungen AM, Bombardier CH, Dyson-Hudson TA, Amtmann D, Kalpakjian CZ, Choi SW, Jette AM, Forchheimer M. Overview of the Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system. J Spinal Cord Med. 2015 May;38(3):257-69.\u003c/li\u003e\n \u003cli\u003eCurt A, Van Hedel HJ, Klaus D, Dietz V; EM-SCI Study Group. Recovery from a spinal cord injury: significance of compensation, neural plasticity, and repair. J Neurotrauma. 2008 Jun;25(6):677-85.\u003c/li\u003e\n \u003cli\u003eSteeves JD, Lammertse D, Curt A, Fawcett JW, Tuszynski MH, Ditunno JF, Ellaway PH, Fehlings MG, Guest JD, Kleitman N, Bartlett PF, Blight AR, Dietz V, Dobkin BH, Grossman R, Short D, Nakamura M, Coleman WP, Gaviria M, Privat A. Guidelines for the conduct of clinical trials for spinal cord injury (SCI) as developed by the ICCP panel: clinical trial outcome measures. Spinal Cord. 2007 Mar;45(3):206-21.\u003c/li\u003e\n \u003cli\u003eRispoli R, Abousayed M, Hamed AA, Cappelletto B. Long versus short segment with intermediate screw fixation for burst fractures of thoracolumbar junction: radiological and clinical results. J Neurosurg Sci. 2024 Oct;68(5):567-573.\u003c/li\u003e\n \u003cli\u003eJaveed S, Greenberg JK, Zhang JK, Dibble CF, Khalifeh JM, Liu Y, Wilson TJ, Yang LJ, Park Y, Ray WZ. Derivation and Validation of a Clinical Prediction Rule for Upper Limb Functional Outcomes After Traumatic Cervical Spinal Cord Injury. JAMA Netw Open. 2022 Dec 1;5(12):e2247949.\u003c/li\u003e\n \u003cli\u003eZhang T, Nikouline A, Lightfoot D, Nolan B. Machine Learning in the Prediction of Trauma Outcomes: A Systematic Review. Ann Emerg Med. 2022 Nov;80(5):440-455.\u003c/li\u003e\n \u003cli\u003eNoonan VK, Kwon BK, Soril L, Fehlings MG, Hurlbert RJ, Townson A, Johnson M, Dvorak MF. The Rick Hansen Spinal Cord Injury Registry (RHSCIR): a national patient-registry. Spinal Cord. 2012 Jan;50(1):22-7.\u003c/li\u003e\n \u003cli\u003eCurt A, Schwab ME, Dietz V. Providing the clinical basis for new interventional therapies: refined diagnosis and assessment of recovery after spinal cord injury. Spinal Cord. 2004 Jan;42(1):1-6.\u003c/li\u003e\n \u003cli\u003eRispoli R, Cappelletto B. The Complex Landscape of Privacy in Spine Research. Neurospine. 2025 Sep;22(3):870-872.\u003c/li\u003e\n \u003cli\u003eWennberg JE. Unwarranted variations in healthcare delivery: implications for academic medical centres. BMJ. 2002 Oct 26;325(7370):961-4.\u003c/li\u003e\n \u003cli\u003eKelly-Hedrik M, Abd-El-Barr MM, Aarabi B, Curt A, Howley SP, Harrop JS, Kirshblum S, Neal CJ, Noonan V, Park C, Ugiliweneza B, Tator C, Toups EG, Fehlings MG, Williamson T, Guest JD. Importance of Prospective Registries and Clinical Research Networks in the Evolution of Spinal Cord Injury Care. J Neurotrauma. 2023 Sep;40(17-18):1834-1848.\u003c/li\u003e\n \u003cli\u003eRispoli R, Cappelletto B. A landmark study on spine and spinal cord injuries treated surgically in Italy. J Neurosurg Sci. 2025 Apr;69(2):141-143\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Baseline characteristics of the study population during the first year of enrollment (n = 673)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"584\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eMedian (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eRange (min\u0026ndash;max)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e16\u0026ndash;88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e402\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e59.7%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e40.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eMechanism of Injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eRoad traffic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e29.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eDomestic accident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e32.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eFall from height\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e21.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eSports injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e5.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eSuicide attempt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e2.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e8.9%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003ePolytrauma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e452\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e67.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e32.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eICU Admission\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e564\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e83.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e16.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\n \u003cp\u003eSpinal Level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eC0\u0026ndash;C2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e8.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eC3\u0026ndash;C7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e15.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eT1\u0026ndash;T12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e30.6%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eL1\u0026ndash;L5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e46.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 202px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eSacrum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e0.1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e. Clinical, surgical, and discharge characteristics by spinal level in the study population during the first year of enrollment (n = 673).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"627\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC0\u0026ndash;C2 (n=54)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eC3\u0026ndash;C7 (n=101)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT1\u0026ndash;T12 (n=206)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eL1\u0026ndash;L5 (n=311)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSacrum\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAIS Grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAIS A\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAIS B\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAIS C\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAIS D\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAIS E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e269\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eNASCIS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e304\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eSurg.\u0026nbsp;Timing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e0\u0026ndash;24\u0026nbsp;hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e25\u0026ndash;48\u0026nbsp;hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e49\u0026ndash;72\u0026nbsp;hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003ePlanned (\u0026gt;72h)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e214\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eSurg.\u0026nbsp;Approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eAnterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003ePosterior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e188\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eCombined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eDischarge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eRehab.\u0026nbsp;facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eNursing home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eTo other ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003eDeceased\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9031435/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9031435/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eStudy Design: \u003c/strong\u003eProspective multicenter observational cohort study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjectives\u003c/strong\u003e: To describe the design, rationale, and methodology of the first nationwide Italian registry dedicated to surgically treated spinal trauma, enabling standardized data collection and long-term outcome assessment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e: 48 neurosurgical centers across Italy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Adult patients undergoing surgical treatment for traumatic spinal injuries are prospectively enrolled from 2025 to 2034. Data are collected via a secure digital platform, including demographics, injury characteristics, neurological status, surgical timing and technique, perioperative management, complications, rehabilitation, and Patient Reported Outcome for Spine Trauma (PROST). Follow-up occurs at 3, 12, and 24 months. Statistical analyses will include descriptive statistics, regression, multivariate, and time-to-event models.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: This manuscript outlines the registry’s design, data collection infrastructure, variables, outcomes, and planned analyses. The first-year enrollment included 673 patients, with the majority presenting lumbar injuries and preserved neurological function. Early surgery (\u0026lt;48 h) was most frequent in subaxial cervical injuries. Surgical approaches and discharge pathways are described.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: TVMit represents the first nationwide Italian registry for surgically treated spinal trauma, integrating standardized multicenter data collection with longitudinal follow-up and patient-reported outcomes. It provides a platform to inform clinical decision-making, support guideline development, optimize trauma networks, and enable predictive modeling.\u003c/p\u003e","manuscriptTitle":"The Italian spine trauma registry: design and rationale of a prospective nationwide multicenter study on surgically treated spinal trauma","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-20 06:51:42","doi":"10.21203/rs.3.rs-9031435/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-04-07T13:18:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-04-04T12:37:58+00:00","index":1,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-03-29T13:01:48+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-03-23T15:47:06+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-03-16T20:19:47+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2026-03-16T16:12:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-11T10:39:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-11T10:38:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Spinal Cord","date":"2026-03-05T15:07:21+00:00","index":"","fulltext":""},{"type":"checksFailed","content":"","date":"2026-03-04T18:30:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"spinal-cord","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"sc","sideBox":"Learn more about [Spinal Cord](http://www.nature.com/sc/)","snPcode":"41393","submissionUrl":"https://mts-sc.nature.com/cgi-bin/main.plex","title":"Spinal Cord","twitterHandle":"@journalsci","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"adbf122d-9b8e-4203-8418-a6b119f98b2f","owner":[],"postedDate":"March 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":64311834,"name":"Health sciences/Diseases/Trauma"},{"id":64311835,"name":"Health sciences/Health care/Quality of life"}],"tags":[],"updatedAt":"2026-04-07T13:22:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-20 06:51:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9031435","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9031435","identity":"rs-9031435","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}