Aarabi Bizhan, Sansur Charles A, Ibrahimi David M, Simard J Marc, Hersh David S, Le Elizabeth, Diaz Cara, Massetti Jennifer, Akhtar-Danesh Noori
Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.
R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland.
Neurosurgery. 2017 Apr 1;80(4):610-620. doi: 10.1093/neuros/nyw053.
Evidence indicates that, over time, patients with spinal cord injury (SCI) improve neurologically in various degrees. We sought to further investigate indicators of grade conversion in cervical SCI.
To detect predictors of ASIA impairment scale (AIS) grade conversion in SCI following surgical decompression.
In a retrospective study, demographics, clinical, imaging, and surgical data from 100 consecutive patients were assessed for predictors of AIS grade conversion.
American Spinal Injury Association motor score was 17.1. AIS grade was A in 52%, B in 29%, and C in 19% of patients. Surgical decompression took place on an average of 17.6 h following trauma (≤12 h in 51 and >12 h in 49). Complete decompression was verified by magnetic resonance imaging (MRI) in 73 patients. Intramedullary lesion length (IMLL) on postoperative MRI measured 72.8 mm, and hemorrhage at the injury epicenter was noted in 71 patients. Grade conversion took place in 26.9% of AIS grade A patients, 65.5% of AIS grade B, and 78.9% of AIS grade C. AIS grade conversion had statistical relationship with injury severity score, admission AIS grade, extent of decompression, presence of intramedullary hemorrhage, American Spinal Injury Association motor score, and IMLL. A stepwise multiple logistic regression analysis indicated IMLL was the sole and strongest indicator of AIS grade conversion (odds ratio 0.950, 95% CI 0.931-0.969). For 1- and 10-mm increases in IMLL, the model indicates 4% and 40% decreases, respectively, in the odds of AIS grade conversion.
Compared with other surrogates, IMLL remained as the only predictor of AIS grade conversion.
有证据表明，随着时间推移，脊髓损伤（SCI）患者在神经功能方面会有不同程度的改善。我们试图进一步研究颈髓损伤分级转换的指标。
检测手术减压后脊髓损伤患者美国脊髓损伤协会（ASIA）损伤分级转换的预测因素。
在一项回顾性研究中，对100例连续患者的人口统计学、临床、影像学和手术数据进行评估，以寻找ASIA分级转换的预测因素。
美国脊髓损伤协会运动评分为17.1。52%的患者ASIA分级为A，29%为B，19%为C。手术减压平均在创伤后17.6小时进行（51例≤12小时，49例>12小时）。73例患者通过磁共振成像（MRI）证实为完全减压。术后MRI测量的脊髓内病变长度（IMLL）为72.8毫米，71例患者在损伤中心有出血。26.9%的ASIA A级患者、65.5%的ASIA B级患者和78.9%的ASIA C级患者发生了分级转换。ASIA分级转换与损伤严重程度评分、入院时ASIA分级、减压范围、脊髓内出血的存在、美国脊髓损伤协会运动评分和IMLL有统计学关系。逐步多因素逻辑回归分析表明，IMLL是ASIA分级转换的唯一且最强指标（比值比0.950，95%可信区间0.931-0.969）。IMLL每增加1毫米和10毫米，模型显示ASIA分级转换的几率分别降低4%和40%。
与其他替代指标相比，IMLL仍然是ASIA分级转换的唯一预测因素。
