Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
Honghui-hospital, Xi'an Jiaotong University, Xi'an, 710054, China.
BMC Musculoskelet Disord. 2024 Nov 18;25(1):921. doi: 10.1186/s12891-024-08055-z.
The outcomes of surgical and conservative treatment in elderly patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD) were evaluated over medium- and long-term follow-up periods and the case characteristics were analysed.
Data from 39 elderly patients over 65 years of age with CSCIWFD who were admitted to our hospital between January 2010 and June 2022 were retrospectively analysed. Neurological recovery was assessed using the American Spinal Injury Association (ASIA) grading criteria and the Japanese Orthopaedic Association (JOA) score at admission, after surgery, and at the final follow-up. Post-injury imaging data were used to evaluate potential underlying lesions and injury types. In the surgical treatment group, the sagittal and transverse diameters of the cervical spinal canal were measured using magnetic resonance imaging at admission and the final follow-up to effectively assess spinal cord decompression.
At the final follow-up, the JOA score of the 21 patients who underwent surgical treatment was significantly higher than that of the patients who received conservative treatment (P < 0.001). Additionally, the ASIA grading showed a significant improvement compared to the conservative treatment group (P < 0.003). The sagittal and transverse diameters of the cervical canal in the surgical treatment group were significantly larger at the final follow-up than at admission, indicating surgical decompression (P < 0.001).
Elderly men are the most commonly affected group with CSCIWFD, typically presenting with a history of low-energy trauma. For these patients, active surgical management is recommended following the stress period, assuming their physical condition is suitable. Our results suggest that even in patients with prolonged injury, improvement in neurologic and motor function may be superior to conservative treatment after thorough decompression surgery.
评估中老年无骨折脱位型颈脊髓损伤（CSCIWFD）患者手术与保守治疗的中长期疗效，并分析其病例特点。
回顾性分析 2010 年 1 月至 2022 年 6 月我院收治的 39 例年龄超过 65 岁的 CSCIWFD 老年患者资料。采用美国脊髓损伤协会（ASIA）分级标准和日本矫形协会（JOA）评分评估神经功能恢复情况，于入院时、手术后和末次随访时进行评估。受伤后影像学资料用于评估潜在的病变和损伤类型。在手术治疗组中，入院和末次随访时均采用磁共振成像测量颈椎管矢状径和横径，以有效评估脊髓减压情况。
末次随访时，手术治疗组 21 例患者的 JOA 评分明显高于保守治疗组（P<0.001），ASIA 分级也明显优于保守治疗组（P<0.003）。手术治疗组颈椎管矢状径和横径在末次随访时明显大于入院时，表明手术减压有效（P<0.001）。
中老年无骨折脱位型颈脊髓损伤患者以男性多见，多有低能量创伤史。对于这些患者，在身体状况允许的情况下，建议在应激期后积极进行手术治疗。我们的研究结果表明，即使是受伤时间较长的患者，在彻底减压手术后，神经和运动功能的改善也可能优于保守治疗。
