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Spine J. 2018 Jan;18(1):88-98. doi: 10.1016/j.spinee.2017.06.032. Epub 2017 Jul 1.

The impact of spine stability on cervical spinal cord injury with respect to demographics, management, and outcome: a prospective cohort from a national spinal cord injury registry.

Author information

1
Laval University, 1401, 18e Rue, Sciences Neurologiques, Québec, QC G1J 1Z4, Canada. Electronic address: jerome_paquet@yahoo.ca.
2
Rick Hansen Institute, 6400-818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.
3
Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Room MG 361, Toronto, ON M4N 3M5, Canada.
4
Department of Neurosurgery, National Trauma Research Institute (NTRI), The Alfred Hospital, 55 Commercial Rd, Melbourne, VIC 3004, Australia.
5
Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, International Collaboration on Repair Discoveries (ICORD), UBC, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.
6
Department of Clinical Neurosciences, University of Calgary, 12th Floor Foothills Hospital, 1403 29 St NW, Calgary, AB T2N 2T9, Canada.
7
Research Division of Neurosurgery, Dalhousie University, 1796 Summer St, Rm 3814, Halifax, NS B3H 3A7, Canada.
8
Department of Surgery, Division of Surgery, University of Ottawa, C2-1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada.
9
University of Toronto Spine Program, 55 Queen St East, Suite 1008, Toronto, ON M5C1R6 Canada.
10
Department of Orthopaedic Surgery, McMaster University, 237 Barton St West, Hamilton, ON L8L 2X2, Canada.
11
Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, Room E4, 800 Commissioners Rd East, London, ON N6A 5W9, Canada.
12
Division of Neurosurgery, University of Saskatchewan, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W8, Canada.
13
Dalhousie University, Horizon Health Network, Division of Neurosurgery Saint John Regional Hospital, P.O. Box 2100, Saint John, NB E2L4L2, Canada.
14
University of Manitoba, Department of Surgery, Orthopaedics and Neurosurgery, AD4-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.
15
Department of Surgery, University of Toronto, 399 Bathurst St, Suite 4ww-449, Toronto, ON M5T 2S8, Canada.
16
Professeur-Agrégé Département de Chirurgie Chaire Académique sur les Déformations de la Colonne, 5400 boul. Western Gouin, Montréal, QC H4L 1C5, Canada.
17
Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, 818 West 10th Ave, Vancouver, BC V5Z 1M9, Canada.

Abstract

BACKGROUND CONTEXT:

Emergent surgery for patients with a traumatic spinal cord injury (SCI) is seen as the gold standard in acute management. However, optimal treatment for those with the clinical diagnosis of central cord syndrome (CCS) is less clear, and classic definitions of CCS do not identify a unique population of patients.

PURPOSE:

The study aimed to test the authors' hypothesis that spine stability can identify a unique group of patients with regard to demographics, management, and outcomes, which classic CCS definitions do not.

STUDY DESIGN/SETTING:

This is a prospective observational study.

PATIENT SAMPLE:

The sample included participants with cervical SCI included in a prospective Canadian registry.

OUTCOME MEASURES:

The outcome measures were initial hospitalization length of stay, change in total motor score from admission to discharge, and in-hospital mortality.

METHODS:

Patients with cervical SCI from a prospective Canadian SCI registry were grouped into stable and unstable spine cohorts. Bivariate analyses were used to identify differences in demographic, injury, management, and outcomes. Multivariate analysis was used to better understand the impact of spine stability on motor score improvement. No conflicts of interest were identified.

RESULTS:

Compared with those with an unstable spine, patients with cervical SCI and a stable spine were older (58.8 vs. 44.1 years, p<.0001), more likely male (86.4% vs. 76.1%, p=.0059), and have more medical comorbidities. Patients with stable spine cervical SCI were more likely to have sustained their injury by a fall (67.4% vs. 34.9%, p<.0001), and have high cervical (C1-C4; 58.5% vs. 43.3%, p=.0009) and less severe neurologic injuries (ASIA Impairment Scale C or D; 81.3% vs. 47.5%, p<.0001). Those with stable spine injuries were less likely to have surgery (67.6% vs. 92.6%, p<.0001), had shorter in-hospital lengths of stay (median 84.0 vs. 100.5 days, p=.0062), and higher total motor score change (20.7 vs. 19.4 points, p=.0014). Multivariate modeling revealed that neurologic severity of injury and spine stability were significantly related to motor score improvement; patients with stable spine injuries had more motor score improvement.

CONCLUSIONS:

We propose that classification of stable cervical SCI is more clinically relevant than classic CCS classification as this group was found to be unique with regard to demographics, neurologic injury, management, and outcome, whereas classic CCS classifications do not . This classification can be used to assess optimal management in patients where it is less clear if and when surgery should be performed.

KEYWORDS:

Central cord syndrome; Cervical spinal cord injury; Decompressive surgery; Incomplete spinal cord injury; Spinal cord injury; Spine stability; Spondylosis

PMID:
28673827
DOI:
10.1016/j.spinee.2017.06.032
[Indexed for MEDLINE]

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