Mori Eiji, Ueta Takayoshi, Maeda Takeshi, Ideta Ryousuke, Yugué Itaru, Kawano Osamu, Shiba Keiichiro
Departments of1Orthopaedic Surgery and.
2Rehabilitation Medicine, Japan Organization of Occupational Health and Safety, Spinal Injuries Center, Igisu, Iizuka, Fukuoka, Japan.
J Neurosurg Spine. 2018 Jul;29(1):1-9. doi: 10.3171/2017.10.SPINE17844. Epub 2018 Apr 20.
OBJECTIVE This study investigated neurological improvements after conservative treatment in patients with complete motor paralysis caused by acute cervical spinal cord injury (SCI) without bone and disc injury. METHODS This study was retrospective. The authors evaluated neurological outcomes after conservative treatment of 62 patients with complete motor paralysis caused by cervical SCI without bone and disc injury within 72 hours after trauma. The sequential changes in their American Spinal Injury Association Impairment Scale (AIS) grades were reviewed at follow-up 24-72 hours, 1 week, and 1, 3, and 6 months after treatment. RESULTS Of the 31 patients with a baseline AIS grade of A, 2 (6.5%) patients improved to grade B, 5 (16.1%) improved to grade C, and 2 (6.5%) improved to grade D by the 6-month follow-up. The 22 (71.0%) patients who remained at AIS grade A 1 month after injury showed no neurological improvement at the 6-month follow-up. Of the 31 patients with a baseline AIS grade of B, 12 (38.7%) patients showed at least a 1-grade improvement at the 1-month follow-up; 11 (35.5%) patients improved to grade C and 16 (51.6%) patients improved to grade D at the 6-month follow-up. CONCLUSIONS Even in patients with complete motor paralysis caused by cervical SCI without bone and disc injury within 72 hours after trauma, approximately 30% of the patients with an AIS grade of A and 85% of the patients with an AIS grade B improved neurologically after conservative treatment. It is very important to recognize the extent of neurological improvement possible with conservative treatment, even for severe complete motor paralysis.
目的 本研究调查了急性颈脊髓损伤（SCI）且无骨骼和椎间盘损伤导致完全性运动麻痹的患者经保守治疗后的神经功能改善情况。方法 本研究为回顾性研究。作者评估了62例创伤后72小时内由无骨骼和椎间盘损伤的颈脊髓损伤导致完全性运动麻痹的患者经保守治疗后的神经功能结局。在治疗后24 - 72小时、1周以及1、3和6个月的随访中，回顾了他们美国脊髓损伤协会损伤分级（AIS）等级的连续变化。结果 在基线AIS等级为A的31例患者中，到6个月随访时，2例（6.5%）患者改善至B级，5例（16.1%）改善至C级，2例（6.5%）改善至D级。伤后1个月仍处于AIS A级的22例（71.0%）患者在6个月随访时神经功能无改善。在基线AIS等级为B的31例患者中，12例（38.7%）患者在1个月随访时至少有1级改善；在6个月随访时，11例（35.5%）患者改善至C级，16例（51.6%）患者改善至D级。结论 即使是创伤后72小时内由无骨骼和椎间盘损伤的颈脊髓损伤导致完全性运动麻痹的患者，经保守治疗后，约30%的AIS A级患者和85%的AIS B级患者神经功能得到改善。认识到即使对于严重的完全性运动麻痹，保守治疗可能实现的神经功能改善程度非常重要。
