Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan.
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Spinal Cord. 2024 Apr;62(4):149-155. doi: 10.1038/s41393-024-00963-0. Epub 2024 Feb 12.
Retrospective cohort study.
To define the prognosis and predictive factors for neurological improvement in older patients with incomplete spinal cord injury (SCI) of American Spinal Injury Association Impairment Scale grade C (AIS-C).
Multi-institutions in Japan.
We included patients aged ≥65 years with traumatic SCI of AIS-C who were treated conservatively or surgically with >3 follow-up months. To identify factors related to neurological improvement, patients were divided into three groups according to their neurological status at the final follow-up, with univariate among-group comparisons of demographics, radiographic, and therapeutic factors. Significant variables were included in the multivariate logistic regression analysis.
Overall, 296 older patients with SCI of AIS-C on admission were identified (average age: 75.2 years, average follow-up: 18.7 months). Among them, 190 (64.2%) patients improved to AIS-D and 21 (7.1%) patients improved to AIS-E at final follow-up. There were significant among-group differences in age (p = 0.026), body mass index (p = 0.007), status of pre-traumatic activities of daily living (ADL) (p = 0.037), and serum albumin concentrations (p = 0.011). Logistic regression analysis showed no significant differences in variables in the stratified group of patients who improved to AIS-D. Meanwhile, serum albumin was a significant variable in patients who improved to AIS-E (p = 0.026; OR: 6.20, pre-traumatic ADL was omitted due to data skewness).
Most older patients with incomplete AIS-C SCI demonstrated at least 1 grade of neurological improvement. However, <10% of patients achieved complete recovery. Key predictors of complete recovery were high serum albumin levels on admission and independent pre-traumatic ADL.
No funding was received for this study.
回顾性队列研究。
明确美国脊髓损伤协会损伤分级（AIS）C 级（AIS-C）不完全性脊髓损伤（SCI）老年患者的预后和预测因素。
日本多机构。
纳入≥65 岁的创伤性 AIS-C 患者，接受保守或手术治疗，随访时间≥3 个月。为了明确与神经功能改善相关的因素，根据最终随访时的神经状态将患者分为三组，对各组间的人口统计学、影像学和治疗因素进行单变量比较。将有统计学意义的变量纳入多变量逻辑回归分析。
共纳入 296 例 AIS-C 老年 SCI 患者（平均年龄 75.2 岁，平均随访 18.7 个月）。其中 190 例（64.2%）患者在最终随访时改善至 AIS-D，21 例（7.1%）患者改善至 AIS-E。组间在年龄（p=0.026）、体质指数（p=0.007）、受伤前日常生活活动（ADL）状态（p=0.037）和血清白蛋白浓度（p=0.011）方面有显著差异。Logistic 回归分析显示，在改善至 AIS-D 的分层组中，各变量无统计学差异。而血清白蛋白是改善至 AIS-E 的显著变量（p=0.026；OR：6.20，因数据偏态，受伤前 ADL 被排除）。
大多数 AIS-C 不完全性 SCI 的老年患者至少有 1 级神经功能改善。然而，<10%的患者完全恢复。完全恢复的关键预测因素是入院时高血清白蛋白水平和受伤前独立 ADL。
本研究无资金支持。
