Advantage of ABCD classification in guiding diagnosis and treatment of cervical spinal cord injury without fracture or dislocation

Abstract

Objective To explore whether the ABCD classification has any advantage over the subaxial cervical spine injury classification (SLIC) in the treatment of cervical spinal cord injury without fracture or dislocation. Methods Included in this study were 118 patients who had been treated for cervical spinal cord injury without fracture or dislocation from January 2012 to December 2016.They were 98 men and 20 women, aged from 18 to 78 years (average, 50.1 years).Of them, those admitted from January 2012 to June 2014 were diagnosed and treated according to the SLIC while those admitted from July 2014 to December 2016 were diagnosed and treated by the ABCD classification.After a retrospective re-evaluation of the 118 cases was conducted using the classification other than their original one, 30 cases were identified who showed discrepancy in the guidance indicated by the classification.Conservative treatment had been suggested for them by the SLIC but surgical treatment was suggested by the ABCD classification.Actually, 16 of them had been treated conservatively and 14 surgically.The 2 groups of the 30 cases were compared in terms of pre- and post-operative American Spinal Injury Association (ASIA) and Japanese Orthopedic Association (JOA) scores. Results The 30 patients were followed up for 12 to 48 months (average, 20 months). Ten of them obtained one grade ASIA improvement (4 in the conservative group and 6 in the surgical group) one year after operation. The JOA improvement rate for the conservative group (40.58%±23.02%) was significantly lower than that for the surgical group (61.44%±27.06%) (Z=-2.085, P=0.037). Their gender, age, or operative procedure was not significantly correlated with their treatment results (P>0.05), but their conservative or surgical treatment was significantly correlated with their treatment results (χ2=5.000, P=0.025). Conclusion The ABCD classification may have an advantage over the SLIC in the treatment of cervical spinal cord injury without fracture or dislocation, because it may lead to better neural functional recovery due to the more appropriate treatment protocol it may provide than the SLIC. Key words: Spinal cord injury; Therapy; Surgical procedures, operative; Injury classification