Adult Spinal Cord Injury without Major Bone Injury: Effects of Surgical Decompression and Predictors of Neurological Outcomes in American Spinal Injury Association Impairment Scale A, B, or C.

Bo-Ram Na,Hyoung-Yeon Seo

doi:10.3390/jcm10051106

Abstract

The cervical spine can be injured even in the absence of radiographic abnormality, and the best surgical treatment for adult spinal cord injury without bone injury is debated. The aim of this study was to retrospectively investigate the effect of surgical decompression for severe adult spinal cord injury without major bone injury and to establish predictors of good neurological outcome. We analyzed 11 patients who underwent surgical decompression in severe adult spinal cord injury without major bone injury patients classified as American Spinal Injury Association Impairment Scale (AIS) grade A, B, or C. Neurological assessments were performed using AIS at preoperative and postoperative 1-year follow-up. Radiological evaluations were performed using cervical magnetic resonance imaging (MRI) at preoperative. Seven cases were classified as AIS grade A; two cases as AIS grade B; and two cases as AIS grade C. Five of 11 (45.5%) patients showed improved neurological grade 1-year postoperatively. Intramedullary lesion length (IMLL) (p = 0.047) and compression rate (p = 0.045) had the most powerful effect on AIS grade conversion. This study shows that the fate of the injured spinal cord is determined at the time of the injury, but adequate decompression may have limited contribution to the recovery of neurological function. Compression rate and IMLL on MRI can be used as a predictor of neurological recovery.

Highlights

Cervical spinal cord injuries represent 20–33% of all spinal cord injuries, and most often, spinal cord injuries occur at the subaxial level [1]
We aimed to investigate the effect of surgical decompression with expansive laminoplasty for severe adult spinal cord injury without major bone injury and to establish predictors of good neurological outcome
Subjects were eligible based on the inclusion criteria: age > 18 years; patients classified as American Spinal Injury Association Impairment Scale (AIS) grade A, B, or C; without bone injury on plain radiography and computed tomography (CT) of the cervical spine; and spinal cord edema or hemorrhage seen on cervical magnetic resonance imaging (MRI)

Summary

Introduction

Cervical spinal cord injuries represent 20–33% of all spinal cord injuries, and most often, spinal cord injuries occur at the subaxial level [1]. Cervical spinal cord injury has been increasing in the elderly population with degenerative changes, even without bony injury such as spinal fracture or dislocation. The terminology regarding this type of injury remains controversial, but we adopted the term spinal cord injury without major bone injury [2,3]. Controversy exists with regard to the choice of surgery or conservative treatment for adult spinal cord injury without major bone injury, because it usually does not require spinal column reconstruction surgery. The efficacy of surgical decompression to reduce secondary cord injury is controversial [5], but adequate decompression may have neurological recovery potential

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