Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
J Orthop Sci. 2024 Mar;29(2):480-485. doi: 10.1016/j.jos.2023.01.004. Epub 2023 Jan 29.
Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury.
In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery.
The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement.
Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.
虽然先前的研究已经证明了外伤性脊髓损伤（SCI）早期手术的优势，但对于无骨损伤的颈段脊髓损伤（CSCI）的适当手术时机仍存在争议。在这里，我们研究了伤后 48 小时内进行相对较早手术对无骨损伤的老年 CSCI 患者神经功能恢复的影响。
在这项回顾性多中心研究中，我们回顾了 2010 年至 2020 年间在参与中心接受手术治疗的 159 例年龄≥65 岁的 CSCI 无骨损伤的连续患者的数据。患者在 CSCI 后至少随访 6 个月。我们将患者分为相对较早（CSCI 后≤48 小时，n=24）和较晚手术（CSCI 后>48 小时，n=135）组，并比较两组间的基线特征和神经功能结局。进行多变量分析以确定与神经恢复相关的因素。
与较晚手术组相比，相对较早手术组的心脏病患病率较低，基线美国脊髓损伤协会（ASIA）损伤量表评分较差，基线 ASIA 运动评分（AMS）较低（P<0.030、P<0.001 和 P<0.001）。尽管受伤后 6 个月时相对较早手术组的 AMS 较低（P=0.001），但从基线到受伤后 6 个月的 AMS 改善更大（P=0.010）。多元线性回归分析显示，相对较早的手术不会影响术后 AMS 的改善，而是较低的基线 AMS 与更好的 AMS 改善相关（P<0.001）。谵妄（P=0.006）、肺炎（P=0.030）和糖尿病（P=0.039）对术后改善有负面影响。
尽管需要进一步的研究来验证，但相对较早的手术并没有显示出对老年无骨损伤 CSCI 神经功能恢复的积极影响。
