Na Bo-Ram, Seo Hyoung-Yeon
Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, 42 Jebongro, Donggu, Gwangju 61469, Korea.
J Clin Med. 2021 Mar 6;10(5):1106. doi: 10.3390/jcm10051106.
The cervical spine can be injured even in the absence of radiographic abnormality, and the best surgical treatment for adult spinal cord injury without bone injury is debated. The aim of this study was to retrospectively investigate the effect of surgical decompression for severe adult spinal cord injury without major bone injury and to establish predictors of good neurological outcome. We analyzed 11 patients who underwent surgical decompression in severe adult spinal cord injury without major bone injury patients classified as American Spinal Injury Association Impairment Scale (AIS) grade A, B, or C. Neurological assessments were performed using AIS at preoperative and postoperative 1-year follow-up. Radiological evaluations were performed using cervical magnetic resonance imaging (MRI) at preoperative. Seven cases were classified as AIS grade A; two cases as AIS grade B; and two cases as AIS grade C. Five of 11 (45.5%) patients showed improved neurological grade 1-year postoperatively. Intramedullary lesion length (IMLL) ( = 0.047) and compression rate ( = 0.045) had the most powerful effect on AIS grade conversion. This study shows that the fate of the injured spinal cord is determined at the time of the injury, but adequate decompression may have limited contribution to the recovery of neurological function. Compression rate and IMLL on MRI can be used as a predictor of neurological recovery.
即使在影像学无异常的情况下，颈椎也可能受伤，而对于无骨损伤的成人脊髓损伤的最佳手术治疗方法仍存在争议。本研究的目的是回顾性调查对无重大骨损伤的严重成人脊髓损伤进行手术减压的效果，并确定神经功能良好预后的预测因素。我们分析了11例接受手术减压的无重大骨损伤的严重成人脊髓损伤患者，这些患者被分类为美国脊髓损伤协会损伤量表（AIS）A级、B级或C级。术前和术后1年随访时使用AIS进行神经学评估。术前使用颈椎磁共振成像（MRI）进行影像学评估。7例为AIS A级；2例为AIS B级；2例为AIS C级。11例患者中有5例（45.5%）术后1年神经学分级有所改善。脊髓内病变长度（IMLL）（=0.047）和压迫率（=0.045）对AIS分级转换的影响最大。本研究表明，受伤脊髓的转归在损伤时即已确定，但充分减压对神经功能恢复的贡献可能有限。MRI上的压迫率和IMLL可作为神经功能恢复的预测指标。
