Colterjohn N R, Bednar D A
Department of Surgery, University of Toronto, Ontario, Canada.
Spine (Phila Pa 1976). 1995 Nov 1;20(21):2293-7. doi: 10.1097/00007632-199511000-00006.
This was a retrospective prevalence study.
A review of structural cervical spine injuries (fracture or dislocation) treated at a regional spine injury referral center from 1987 to 1992 was undertaken to identify and analyze patients who had secondary neurologic deterioration after they had arrived and had primary assessment in stable neurologic condition (intact or compromised, but not evolving).
Multiple case reports and cohort studies have suggested possible risk factors for late neurologic deterioration without probabilities analysis.
Information was obtained retrospectively from clinical records and radiographs. Three-hundred-twelve cases were reviewed. Thirty-one were excluded and 281 were analyzed.
An index group of 15 patients (5%) had motor neurologic deterioration after primary assessment at the referral center. Control group "A" was composed of 70 patients (25%) who had a motor neurologic deficit on admission and did not deteriorate. Control group "B" was the balance of 196 patients (70%) with structural cervical injuries, but no neurologic compromise. Factors distinguishing the index group from control subjects included flexural mechanism of injury and chronic multilevel spinal arthritis with ankylosis. All secondary deteriorations occurred with the injury level caudad to the fourth cervical vertebra. Routine three-view cervical radiographs were relatively insensitive in detecting injury in the index group compared with the pooled control subjects. Patients' ability to comply with recommended treatment was not a factor in secondary deteriorations and there generally was no identifiable precipitant event before secondary deterioration.
Cervical traumatized patients with flexural injury or chronic multilevel spinal arthritis with ankylosis are at increased risk of having secondary motor neurologic deterioration.
这是一项回顾性患病率研究。
对1987年至1992年在某地区脊柱损伤转诊中心接受治疗的颈椎结构损伤（骨折或脱位）进行回顾，以识别和分析那些在到达并进行初次评估时神经状况稳定（完整或受损但无进展）后出现继发性神经功能恶化的患者。
多项病例报告和队列研究提出了晚期神经功能恶化的可能危险因素，但未进行概率分析。
通过回顾临床记录和X线片获取信息。共审查了312例病例。排除31例，对281例进行分析。
在转诊中心初次评估后，有15例患者（5%）的运动神经功能出现恶化，构成指数组。对照组“A”由70例入院时存在运动神经功能缺损且未恶化的患者（25%）组成。对照组“B”为其余196例有颈椎结构损伤但无神经功能损害的患者（70%）。区分指数组与对照组的因素包括损伤的屈曲机制和伴有强直的慢性多节段脊柱关节炎。所有继发性恶化均发生在第四颈椎以下的损伤节段。与合并的对照组相比，常规的颈椎三位片在检测指数组损伤方面相对不敏感。患者对推荐治疗的依从能力不是继发性恶化的因素，继发性恶化前通常没有可识别的促发事件。
伴有屈曲损伤或伴有强直的慢性多节段脊柱关节炎的颈椎创伤患者发生继发性运动神经功能恶化的风险增加。
