The ‘Minneapolis Score': A Pre-Operative Scoring System for Spinal Cord Injury Pressure Ulcer Treatment – An Outcome Analysis

Introduction:

The short and long-term outcome of pressure ulcer (PU) treatment with tissue flaps in spinal cord injury (SCI) patients has been very variable in the literature. Overall complication rates are reported from 4-50%, and PU recurrence rates are reported from 3-82%^1-3. We describe a scoring system that stratifies SCI patients pre-operatively based on Medical, Nutritional, Psychological, Physical, Local, Surgical, Social, and Surface variables (The MNPPLSSS: ‘Minneapolis Score’) and assists in determining candidacy for surgical treatment to improve outcome.

Methods and Materials:

The ‘Minneapolis Score’ system was implemented in 2011, and was used as a guide to determine surgical candidacy (Score < 15 and no ‘auto-fail’ factors were deemed ideal surgical candidates). A retrospective study of SCI patients who underwent PU flap surgery from 2008-2013 was performed. The ‘Minneapolis Score’, and outcome data were collected and analyzed using logistic regression. A p-value of <0.05 was considered significant.

Results:

A total of 53 flaps were performed on 43 patients (all males, Mean age: 66 years). All patients had at least 3-month follow up (Range: 3 months – 54 months). There were 20 (37.7%) flaps performed between 2008-2010 (Group A); and 33 (62.3%) flaps performed between 2011-2013 (Group B). The mean ‘Minneapolis Score’ of Group A was 15.35 (Range: 5-27) with 12 (60%) cases scoring ≥15. The mean ‘Minneapolis Score’ of Group B was 11.72 (Range: 5-29) with 6 (18%) cases scoring ≥15 . In Group A, there were 50% (n=10) minor wound complications and 10% (n=2) major complications; whereas, in Group B, there were 36% (n=12) minor wound complications, and 6% (n=2) major complications. A higher ‘Minneapolis Score’ was associated with a higher risk of long-term flap failure and pressure ulcer recurrence (OR: 1.15, p=0.04). All 4 flap failures and ulcer recurrences occurred in patients with ‘Minneapolis Score’ >20 (21,23,27,29).

Conclusions:

The ‘Minneapolis Score’ may help determine which SCI patients are potentially better candidates for flap surgery and may have an impact on decreasing flap failure and recurrent pressure ulcer rates.