Department of Surgery, Divisions of Neurosurgery and Orthopedic Surgery, Spinal Program, University of Toronto, Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 2013 Jan 15;38(2):97-103. doi: 10.1097/BRS.0b013e31826e2b91.
A multicenter prospective cohort study.
To define differences in baseline characteristics and long-term clinical outcomes in patients with cervical spinal cord injury (SCI) with and without facet dislocation (FD).
Reports of dramatic neurological improvement in patients with FD and cervical SCI, treated with rapid reduction have led to the hypothesis that this represents a subgroup of patients with significant recovery potential. However, without a large systematic comparative analysis, this hypothesis remains untested.
Patients were classified into FD and non-FD groups based on imaging investigations at admission. The primary outcome was change in American Spinal Injury Association (ASIA) motor score (AMS) at 1-year follow-up. Secondary outcome measures included ASIA impairment scale (AIS) grade conversion and functional independence measure score at 1-year postinjury, as well as length of acute hospitalization. Baseline characteristics and long-term outcomes were also compared for patients with unilateral and bilateral FD.
Of 421 patients who enrolled, 135 (32.1%) had FD and 286 (67.9%) had no FD. Patients in the FD group presented with a significantly worse AIS grade and higher energy injury mechanisms (P < 0.01). Patients with bilateral FD had a greater severity of baseline neurological deficit compared with those with unilateral FD, measured by AIS grade and AMS. The mean length of acute hospitalization was 41.2 days among patients with FD and 30 days among patients without FD (P = 0.04). At 1-year follow-up, patients with FD experienced a mean AMS improvement of 18.0 points, whereas patients without FD experienced an improvement of 27.9 points (P < 0.01). In the adjusted analysis, patients with FD continued to demonstrate less AMS recovery compared with the patients without FD (P = 0.04).
Compared with patients without FD, cervical SCI patients with FD tended to present with a more severe degree of initial injury and displayed less potential for motor recovery at 1-year follow-up.
一项多中心前瞻性队列研究。
定义伴有和不伴有小关节突脱位（FD）的颈椎脊髓损伤（SCI）患者在基线特征和长期临床结局方面的差异。
快速复位治疗 FD 和颈椎 SCI 患者后出现显著神经改善的报道，导致了一个假设，即这代表了一组具有显著恢复潜力的患者亚组。然而，由于没有大规模的系统比较分析，这一假设仍未得到验证。
根据入院时的影像学检查，将患者分为 FD 和非 FD 组。主要结局是 1 年随访时美国脊髓损伤协会（ASIA）运动评分（AMS）的变化。次要结局测量包括 1 年后的 ASIA 损伤量表（AIS）分级转换和功能独立性测量评分，以及急性住院时间。还比较了单侧和双侧 FD 患者的基线特征和长期结局。
在纳入的 421 名患者中，135 名（32.1%）有 FD，286 名（67.9%）无 FD。FD 组患者的 AIS 分级和能量损伤机制明显较差（P < 0.01）。与单侧 FD 患者相比，双侧 FD 患者的基线神经功能缺损程度更严重，表现为 AIS 分级和 AMS。FD 患者的急性住院时间平均为 41.2 天，无 FD 患者为 30 天（P = 0.04）。在 1 年随访时，FD 组患者的 AMS 平均改善 18.0 分，而无 FD 组患者的改善 27.9 分（P < 0.01）。在调整分析中，FD 组患者的 AMS 恢复程度仍低于无 FD 组（P = 0.04）。
与无 FD 的患者相比，伴有 FD 的颈椎 SCI 患者在初始损伤程度上往往更严重，在 1 年随访时运动恢复的潜力较小。
