Song Kyung-Jin, Choi Byung-Wan, Park Chan-Il, Lee Kwang-Bok
Department of Orthopedic Surgery, Chonbuk National University Hospital, Jeonju, Korea.
Eur J Orthop Surg Traumatol. 2015 Jul;25 Suppl 1:S101-6. doi: 10.1007/s00590-014-1479-z. Epub 2014 May 22.
The subaxial spine has high risk of fatal damage by trauma and thereby requires more accurate and aggressive treatment. For the proper treatment and predicting the prognosis, the evaluation to reveal the risk factors for the prognosis is important. We analyzed the various factors contributing to the prognosis in distractive extension injuries of the subaxial cervical spine.
The study included 103 patients who were diagnosed as distractive extension injury of subaxial cervical spine. We evaluate the patient age, sex, cause of injury, initial neurological impairment, number and portion of injured segment, spinal stenosis, extent of soft tissue damage, ossification of the posterior longitudinal ligament, and degenerative spondylosis as a prognostic factor. To analyze the factor related with prognosis, the subjects were divided into group A, in which patients had neurological recovery ≥grade 2 on the ASIA scale or showed normal in final follow-up and group B, in which patients have no neurological recovery.
Prognosis was not associated with age, sex, and cause of injury (P = 0.677, 0.541, and 0.965, respectively). Prognosis was poor in cases with spinal stenosis (P = 0.009), soft tissue damage ≥grade 3 on magnetic resonance imaging (MRI) (P = 0.002), or severe neurological impairment (P ≤ 0.001). Logistic regression analysis also showed that prognosis was poor in cases with spinal stenosis (OR 5.03; 95% CI 1.20-16.93), soft tissue damage ≥grade 3 on MRI (OR 7.63; 95% CI 1.86-31.34), or severe neurological impairment (ASIA C, D, OR 0.59, 95% CI 0.14-2.41; ASIA A, B, OR 18.43, 95% CI 1.64-207.69).
The prognosis of patients with distractive extension injury of the subaxial cervical spine was poor in cases with spinal stenosis, severe soft tissue damage in MRI findings or severe initial neurological impairment.
下颈椎有因创伤导致致命损伤的高风险，因此需要更准确且积极的治疗。为了进行恰当的治疗并预测预后，揭示预后危险因素的评估很重要。我们分析了下颈椎牵张性伸展损伤中影响预后的各种因素。
该研究纳入了103例被诊断为下颈椎牵张性伸展损伤的患者。我们评估患者的年龄、性别、损伤原因、初始神经功能损害、损伤节段的数量和部位、椎管狭窄、软组织损伤程度、后纵韧带骨化以及退变性脊柱病作为预后因素。为了分析与预后相关的因素，将受试者分为A组（患者在ASIA量表上神经功能恢复≥2级或在最终随访时显示正常）和B组（患者无神经功能恢复）。
预后与年龄、性别和损伤原因无关（P分别为0.677、0.541和0.965）。在存在椎管狭窄（P = 0.009）、磁共振成像（MRI）显示软组织损伤≥3级（P = 0.002）或严重神经功能损害（P≤0.001）的情况下，预后较差。逻辑回归分析还显示，存在椎管狭窄（比值比5.03；95%置信区间1.20 - 16.93）、MRI显示软组织损伤≥3级（比值比7.63；95%置信区间1.86 - 31.34）或严重神经功能损害（ASIA C、D，比值比0.59，95%置信区间0.14 - 2.41；ASIA A、B，比值比18.43，95%置信区间1.64 - 207.69）时，预后较差。
在下颈椎牵张性伸展损伤患者中，存在椎管狭窄、MRI表现为严重软组织损伤或严重初始神经功能损害时，预后较差。
