Deparment of Neurological Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA.
Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
World Neurosurg. 2020 Oct;142:246-254. doi: 10.1016/j.wneu.2020.07.035. Epub 2020 Jul 12.
We assessed the hypothesis that nonoperative management would be a viable treatment option for patients with underlying degenerative disease who have traumatic cervical spinal cord injury (TCSI) without neurological deterioration and/or spinal instability during hospitalization.
Data were collected prospectively from 2011 to 2016. All the patients had been treated nonoperatively with hard cervical collar immobilization. The clinical parameters assessed included the Frankel grade at presentation and discharge, the occurrence of deep vein thrombosis, urinary tract infection, sphincter dysfunction, and pressure sores. The radiographic data collected included magnetic resonance imaging signal cord changes. P ≤ 0.05 represented a significant association between the Frankel grade at presentation and the outcome parameters.
A total of 28 patients were included in the present study. Of the patients who had presented with Frankel grade B, 85.71% had improved to a higher grade, 90.91% of the patients with Frankel grade C had improved to a higher grade, and 14.29% of the patients with Frankel grade D had improved to Frankel grade E. All the patients had satisfactory spinal stability, as evidenced by dynamic radiographs, after treatment.
The findings from the present study have shown that nonoperative management can result in improved neurological outcomes for patients with underlying degenerative disease who have experienced TCSI without evidence of neurological deterioration and spinal instability. The Frankel grade at presentation was significantly associated with outcome parameters such as the neurological outcome on discharge and the occurrence of urinary tract infection. The results from the present study could be helpful to neurological surgeons in rural and other low-resource settings because the cost savings realized by nonoperative treatment will not sacrifice the provision of adequate care to their patients.
我们评估了这样一种假说，即对于在住院期间没有神经恶化和/或脊柱不稳定的、患有创伤性颈脊髓损伤（TCSI）且存在潜在退行性疾病的患者，非手术治疗可能是一种可行的治疗选择。
数据是从 2011 年至 2016 年期间前瞻性收集的。所有患者均接受过硬颈圈固定的非手术治疗。评估的临床参数包括入院时和出院时的 Frankel 分级、深静脉血栓形成、尿路感染、括约肌功能障碍和压疮的发生情况。收集的影像学数据包括磁共振成像信号脊髓变化。P≤0.05 表示入院时的 Frankel 分级与结局参数之间存在显著相关性。
本研究共纳入 28 例患者。入院时 Frankel 分级为 B 的患者中，85.71%的患者神经功能改善至更高的分级，C 级患者中有 90.91%的患者神经功能改善至更高的分级，D 级患者中有 14.29%的患者改善至 E 级。所有患者经治疗后动态影像学检查均显示脊柱稳定性良好。
本研究结果表明，对于患有潜在退行性疾病且 TCSI 无神经恶化和脊柱不稳定证据的患者，非手术治疗可改善神经功能预后。入院时的 Frankel 分级与出院时的神经功能结局和尿路感染的发生等结局参数显著相关。本研究结果可能有助于农村和其他资源匮乏地区的神经外科医生，因为非手术治疗所节省的成本不会牺牲为患者提供足够护理的机会。
