Department of Orthopedic Surgery, Chubu Rosai Hospital, Nagoya, Japan.
Spine (Phila Pa 1976). 2011 Mar 15;36(6):E441-6. doi: 10.1097/BRS.0b013e3181d99e8c.
Retrospective clinical case study.
To evaluate whether spinal column injury severity influences neurological outcome after cervical spine injury patterns of Allen's classification.
Allen's classification is commonly used in cervical fracture/dislocation. Cervical spine injuries are classified into 6 common patterns by their mechanism. Each pattern is divided into stages according to spinal column damage severity, and these stages have been closely correlated with the neurological damage at injury. However, the validity of the relationship has not been adequately discussed. Moreover, only a few reports have assessed whether the injury pattern influences the neurological outcome.
We selected 155 patients with unstable subaxial cervical spine injuries. Only 146 patients having more than 12-month postoperative follow-up were included. All were treated with posterior spinal arthrodesis. Supplemental anterior surgery was added in four patients. The injury patterns were graded using Allen's classification. The neurological status at injury and final follow-up was evaluated using the American Spinal Injury Association (ASIA) impairment scale.
Patients were categorized by using Allen's classification as follows: distractive flexion, 82; compressive flexion, 29; compressive extension, 21; vertical compression, 8; and distractive extension, 6. In distractive flexion cases, the ratios of ASIA A cases at final follow-up increased with advancing stage (27%, 18%, 63%, and 100% in stages 1-4; P < 0.001). Furthermore, in similar cases with neurological deficit, the ratio of postoperative improvement on the ASIA impairment scale (>1 level) decreased with advancing stage (62%, 67%, 27%, and 0% in stages 1-4; P < 0.01). With other patterns, neurological outcome was likely to be influenced by spinal column injury severity.
Injury patterns based on Allen's classification well-correlated with the neurological outcome and recovery rate. This was especially evident distractive flexion cases. Thus, Allen's classification can be a predictor of neurological outcome after cervical spine injury.
回顾性临床病例研究。
评估脊柱损伤严重程度是否会影响 Allen 分类法颈椎损伤模式后的神经功能预后。
Allen 分类法常用于颈椎骨折/脱位。颈椎损伤根据其机制分为 6 种常见类型。根据脊柱损伤严重程度，每种类型分为不同阶段，这些阶段与损伤时的神经损伤密切相关。然而，这种关系的有效性尚未得到充分讨论。此外，只有少数报告评估了损伤模式是否会影响神经功能预后。
我们选择了 155 例不稳定下颈椎脊柱损伤患者。只有 146 例患者术后随访超过 12 个月，均接受后路脊柱融合术治疗。4 例患者加行前路辅助手术。使用 Allen 分类法对损伤模式进行分级。使用美国脊柱损伤协会（ASIA）损伤量表评估损伤时和最终随访时的神经状态。
患者根据 Allen 分类法分为以下几类：牵张性屈曲，82 例；压缩性屈曲，29 例；压缩性伸展，21 例；垂直压缩，8 例；牵张性伸展，6 例。在牵张性屈曲病例中，终末随访时 ASIA A 型病例的比例随阶段进展而增加（1-4 级分别为 27%、18%、63%和 100%；P<0.001）。此外，在具有神经功能缺损的类似病例中，术后 ASIA 损伤量表改善（>1 级）的比例随阶段进展而降低（1-4 级分别为 62%、67%、27%和 0%；P<0.01）。对于其他类型，神经功能预后可能受脊柱损伤严重程度的影响。
基于 Allen 分类法的损伤模式与神经功能预后和恢复率密切相关。牵张性屈曲病例尤其明显。因此，Allen 分类法可以预测颈椎损伤后的神经功能预后。
