Motiei-Langroudi Rouzbeh, Sadeghian Homa
Division of Neurosurgery, Department of Surgery, Pastor Hospital, Bam University of Medical Sciences, Bam, Iran.
Neurosurgery Service, Department of Surgery, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
Asian Spine J. 2017 Jun;11(3):412-418. doi: 10.4184/asj.2017.11.3.412. Epub 2017 Jun 15.
Retrospective study.
To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term.
SCI is a potentially disabling and devastating neurological outcome that can occur because of spinal column fractures. Most studies have not evaluated or have failed to show the influence of different surgical approaches and other parameters on neurological recovery.
A thorough history regarding sensory, motor, and urinary complaints was taken from 103 patients with SCI due to vertebral fracture; patients were followed by a thorough neurological examination. Subsequently, all medical records of patients, including neurological state after trauma, trauma mechanism, treatment protocol, surgical protocol, and imaging findings, were evaluated.
Of the 103 patients, 73.8% were survivors of a major earthquake and 26.2% were victims of vehicle accidents; 92.2% patients were surgically treated, while 7.8% underwent conservative management. The mean follow-up duration was 10.3 years. In follow-up visits, 67.0%, 12.6%, 13.6%, and 6.8% patients showed no, partial, substantial, and complete motor improvement, respectively; 68.0%, 26.2%, and 5.8% showed no, mild, and substantial sensory improvement, respectively; and 73.8%, 17.5%, and 8.7% showed no, substantial, and complete urinary improvement, respectively. Logistic regression analysis showed that sex, age at injury time, follow-up duration, trauma mechanism, and stem cell therapy had no effect on motor, sensory, and urinary improvement. Higher initial scores on the American Spinal Injury Association (ASIA) classification, lumbar fracture level, and performance of laminectomy improved motor outcome; higher initial ASIA scores improved urinary and sensory outcomes.
The initial ASIA score is the most important factor for prognosticating motor, sensory, and urinary improvement in SCI patients. Lumbar (L3-L5) and thoracic (T1-T10) fractures have the best and worst prognosis, respectively, in terms of motor recovery. Laminectomy during surgery improves motor function.
回顾性研究。
评估脊髓损伤（SCI）患者的运动、感觉及泌尿功能长期预后情况。
SCI是一种因脊柱骨折可能导致残疾和严重损害神经功能的后果。大多数研究未评估或未能显示不同手术方式及其他参数对神经功能恢复的影响。
对103例因椎体骨折导致SCI的患者进行了关于感觉、运动及泌尿功能主诉的详尽病史采集；随后对患者进行全面的神经学检查。接着，评估了所有患者的病历，包括创伤后的神经状态、创伤机制、治疗方案、手术方案及影像学检查结果。
103例患者中，73.8%是一次大地震的幸存者，26.2%是车祸受害者；92.2%的患者接受了手术治疗，7.8%接受了保守治疗。平均随访时间为10.3年。随访时，分别有67.0%、12.6%、13.6%和6.8%的患者运动功能无改善、部分改善、显著改善和完全改善；分别有68.0%、26.2%和5.8%的患者感觉功能无改善、轻度改善和显著改善；分别有73.8%、17.5%和8.7%的患者泌尿功能无改善、显著改善和完全改善。逻辑回归分析显示，性别、受伤时年龄、随访时间、创伤机制及干细胞治疗对运动、感觉及泌尿功能改善无影响。美国脊髓损伤协会（ASIA）分类初始评分较高、腰椎骨折节段及椎板切除术的实施改善了运动功能预后；较高的初始ASIA评分改善了泌尿及感觉功能预后。
初始ASIA评分是预测SCI患者运动、感觉及泌尿功能改善的最重要因素。就运动功能恢复而言，腰椎（L3 - L5）和胸椎（T1 - T10）骨折的预后分别最佳和最差。手术中进行椎板切除术可改善运动功能。
