Department of Orthopedics, First People's Hospital of Xianyang, No. 10, Biyuan Road, Qindu District, Xianyang, Shaanxi, 712099, PR China.
BMC Musculoskelet Disord. 2024 Oct 25;25(1):847. doi: 10.1186/s12891-024-07918-9.
To analyze the influencing factors and treatment options of cervical spondylotic myelopathy (CSM) complicated with traumatic central cord syndrome (TCCS).
A total of 243 patients with CSM admitted to our hospital from January 2021 to September 2022 were retrospectively analyzed, and then divided into the control group (n = 152) and the observation group (n = 91) according to the presence or absence of concurrent TCCS. The clinical data and imaging data of the two groups were compared, and multivariate logistic regression was used to analyze the influencing factors of CSM complicated with TCCS. Patients in the observation group were further divided into the zero notch anterior cervical interbody fusion device (Zero-P) group (n = 45) and the cervical spine locking plate (CSLP) group (n = 46) according to the treatment mode, and the perioperative indexes of the two groups were compared. The treatment effects were evaluated by the American Spinal Injury Association (ASIA) and the Japanese Orthopedic Association (JOA) before surgery, 1 week after surgery and 6 months after surgery. The height of intervertebral space and the cervical lordosis angle were measured.
Multivariate logistic regression analysis showed that the injury mechanism (hyperextension injury), hand muscle weakness, cervical instability, age, degree of cervical spinal stenosis, degree of cervical spinal cord compression, and changes in intramedullary high signal were the risk factors, while the type of compression (soft), ASIA score and JOA score were the protective factor for CSM complicated with TCCS (P < 0.05). Patients in Zero-P group had much shorter operation time and hospitalization time than these in CSLP group (P < 0.05). The cervical lordosis angle and intervertebral space height at 1 week and 6 months after operation in the two groups were both largely higher than these before operation, and the cervical lordosis angle and intervertebral space height in the Zero-P group were significantly higher than these in the CSLP group one week after surgery (P < 0.05). The ASIA score and JOA score were obviously increased in the two groups 1 week and 6 months after surgery, and the ASIA score and JOA score in the Zero-P group were significantly higher than these in the CSLP group at 1 week after surgery (P < 0.05).
The mechanism of TCCS in CSM is still controversial, which it is generally believed to be caused by cervical hyperextension injury. The clinical symptoms are diverse, and the treatment methods are also different. This study shows that the mechanism of injury, type of compression, hand muscle weakness, cervical instability, age, cervical stenosis compression, and intramedullary high signal changes are all risk factors for CSM complicated with TCCS. Early identification of risk factors and targeted interventions can effectively reduce the complicated rate of TCCS. Zero-P and CSLP surgical fixation have good efficacy in the treatment of TCCS, and there is little difference in efficacy between the two. However, Zero-P fixation surgery has the advantages of short operation time and fast postoperative recovery.
分析颈椎脊髓病（CSM）并发创伤性中央脊髓综合征（TCCS）的影响因素及治疗选择。
回顾性分析 2021 年 1 月至 2022 年 9 月我院收治的 243 例 CSM 患者，根据是否合并并发 TCCS 将患者分为对照组（n=152）和观察组（n=91）。比较两组患者的临床资料和影像学资料，采用多因素 logistic 回归分析 CSM 并发 TCCS 的影响因素。观察组患者根据治疗方式进一步分为零切迹颈椎前路椎间融合器（Zero-P）组（n=45）和颈椎锁定钢板（CSLP）组（n=46），比较两组患者的围手术期指标。分别于术前、术后 1 周及术后 6 个月采用美国脊髓损伤协会（ASIA）和日本矫形协会（JOA）评分评估治疗效果。测量椎间间隙高度和颈椎曲度角。
多因素 logistic 回归分析显示，损伤机制（过伸损伤）、手部肌肉无力、颈椎不稳、年龄、颈椎管狭窄程度、颈椎脊髓压迫程度、髓内高信号改变是 CSM 并发 TCCS 的危险因素，而压迫类型（软性）、ASIA 评分和 JOA 评分是其保护因素（P<0.05）。Zero-P 组患者的手术时间和住院时间明显短于 CSLP 组（P<0.05）。两组患者术后 1 周和 6 个月的颈椎曲度角和椎间间隙高度均明显高于术前，且 Zero-P 组术后 1 周的颈椎曲度角和椎间间隙高度明显高于 CSLP 组（P<0.05）。两组患者术后 1 周和 6 个月的 ASIA 评分和 JOA 评分均明显升高，且 Zero-P 组术后 1 周的 ASIA 评分和 JOA 评分明显高于 CSLP 组（P<0.05）。
CSM 并发 TCCS 的发病机制仍存在争议，一般认为是由颈椎过伸损伤引起。临床表现多样，治疗方法也不同。本研究表明，损伤机制、压迫类型、手部肌肉无力、颈椎不稳、年龄、颈椎管狭窄压迫、髓内高信号改变均为 CSM 并发 TCCS 的危险因素。早期识别危险因素并针对性干预可有效降低 TCCS 的并发率。Zero-P 和 CSLP 手术固定治疗 TCCS 的疗效较好，两者疗效差异无统计学意义。但 Zero-P 固定术操作时间短，术后恢复快。
