Department of Neurosurgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
J Neurosurg Spine. 2011 Jan;14(1):122-30. doi: 10.3171/2010.9.SPINE09922. Epub 2010 Dec 17.
the objective of this study was to elucidate the relationship between admission demographic data, validated injury severity measures on imaging studies, and clinical indicators on the American Spinal Injury Association (ASIA) motor score, Functional Independence Measure (FIM), manual dexterity, and dysesthetic pain at least 12 months after surgery for acute traumatic central cord syndrome (ATCCS) due to spinal stenosis.
over a 100-month period (January 2000 to April 2008), of 211 patients treated for ATCCS, 59 cases were due to spinal stenosis, and these patients underwent surgical decompression. Five of these patients died, 2 were lost to follow-up, 10 were not eligible for the study, and the remaining 42 were followed for at least 12 months.
in the cohort of 42 patients, mean age was 58.3 years, 83% of the patients were men, and 52.4% of the accidents were due to falls. Mean admission ASIA motor score was 63.8 (upper extremities score, 25.8 and lower extremities score, 39.8), the spinal cord was most frequently compressed at skeletal segments C3-4 and C4-5 (71%), mean midsagittal diameter at the point of maximum compression was 5.6 mm, maximum canal compromise (MCC) was 50.5%, maximum spinal cord compression was 16.5%, and length of parenchymal damage on T2-weighted MR imaging was 29.4 mm. Time after injury until surgery was within 24 hours in 9 patients, 24-48 hours in 10 patients, and more than 48 hours in 23 patients. At the 1-year follow-up, the mean ASIA motor score was 94.1 (upper extremities score, 45.7 and lower extremities score, 47.6), FIM was 111.1, manual dexterity was 64.4% of baseline, and pain level was 3.5. Stepwise regression analysis of 10 independent variables indicated significant relationships between ASIA motor score at follow-up and admission ASIA motor score (p = 0.003), MCC (p = 0.02), and midsagittal diameter (p = 0.02); FIM and admission ASIA motor score (p = 0.03), MCC (p = 0.02), and age (p = 0.02); manual dexterity and admission ASIA motor score (p = 0.0002) and length of parenchymal damage on T2-weighted MR imaging (p = 0.002); and pain level and age (p = 0.02) and length of parenchymal lesion on T2-weighted MR imaging (p = 0.04).
the main indicators of long-term ASIA motor score, FIM, manual dexterity, and dysesthetic pain were admission ASIA motor score, midsagittal diameter, MCC, length of parenchymal damage on T2-weighted MR imaging, and age, but different domains of outcome were determined by different predictors.
本研究旨在阐明入院人口统计学数据、影像学研究中经过验证的损伤严重程度指标，以及美国脊髓损伤协会（ASIA）运动评分、功能独立性测量（FIM）、手灵巧度和感觉异常疼痛等临床指标与因椎管狭窄导致的急性创伤性中央脊髓综合征（ATCCS）患者术后至少 12 个月的关系。
在 100 个月的时间内（2000 年 1 月至 2008 年 4 月），对 211 例 ATCCS 患者进行治疗，其中 59 例由脊髓狭窄引起，这些患者接受了手术减压。其中 5 例死亡，2 例失访，10 例不符合研究条件，其余 42 例至少随访 12 个月。
在这 42 例患者的队列中，平均年龄为 58.3 岁，83%的患者为男性，52.4%的事故是由跌倒引起的。入院时 ASIA 运动评分平均为 63.8（上肢评分 25.8，下肢评分 39.8），脊髓最常受压于 C3-4 和 C4-5 节段（71%），矢状位最大压迫处的平均中矢径为 5.6mm，最大椎管狭窄（MCC）为 50.5%，最大脊髓压迫为 16.5%，T2 加权磁共振成像上的实质损伤长度为 29.4mm。受伤后至手术时间在 24 小时内的有 9 例，24-48 小时内的有 10 例，超过 48 小时的有 23 例。在 1 年随访时，平均 ASIA 运动评分 94.1（上肢评分 45.7，下肢评分 47.6），FIM 为 111.1，手灵巧度为基线的 64.4%，疼痛程度为 3.5。10 个独立变量的逐步回归分析表明，随访时的 ASIA 运动评分与入院时的 ASIA 运动评分（p=0.003）、MCC（p=0.02）和中矢径（p=0.02）呈显著相关；FIM 与入院时的 ASIA 运动评分（p=0.03）、MCC（p=0.02）和年龄（p=0.02）呈显著相关；手灵巧度与入院时的 ASIA 运动评分（p=0.0002）和 T2 加权磁共振成像上的实质损伤长度（p=0.002）呈显著相关；疼痛程度与年龄（p=0.02）和 T2 加权磁共振成像上的实质损伤长度（p=0.04）呈显著相关。
长期 ASIA 运动评分、FIM、手灵巧度和感觉异常疼痛的主要指标是入院时的 ASIA 运动评分、中矢径、MCC、T2 加权磁共振成像上的实质损伤长度和年龄，但不同领域的结果由不同的预测因素决定。
