Clinical characteristics of acute central cervical spinal cord injury with only upper extremity involvement and with both upper and lower extremity involvement

Abstract

Objective To compare and analyze the clinical characteristics of acute central cervical spinal cord injury with only upper extremity involvement and with both upper and lower extremity involvement. Methods A retrospective case control study was made on clinical data of 76 patients with acute central cervical spinal cord injury hospitalized from January 2010 to December 2013. Nerve injury involved was only upper extremity in 39 patients (upper extremity group), but both upper and lower extremities in 37 patients (upper-and lower-extremity group). In upper extremity group, there were 35 males and four females, age was 21-80 years [(52.5±13.4)years], injury resulted from traffic accidents in 24 patients, ground-level falls in eight, high-level falls in six and heavy-object hit in one, and level of injury was C3/4in 16 patients, C4/5in 14 and C5/6in nine. In upper- and lower-extremity group, there were 30 males and seven females, age was 36-78 years [(59.6±9.7)years], injury resulted from traffic accidents in 16 patients, ground-level falls in 11, high-level falls in seven and heavy-object hit in three, and level of injury was C3/4in nine patients, C4/5in 18 and C5/6in 10. Sagittal diameter of the cervical spinal canal, maximal canal compromise, maximal spinal cord compression, degenerating factors of the cervical spine and treatment protocols were determined. Upper extremity function was assessed with the American spinal injury association (ASIA) score. Results There were significant differences between upper extremity group and upper- and lower-extremity group in sagittal diameter of the cervical spinal canal [(7.5±1.5)mm ∶(6.8±1.2)mm], maximal canal compromise [(28.9±9.6)% ∶(34.9±10.6)%], ASIA score at admission[(31.6±11.8)points ∶(22.7±11.3)points)] and ASIA score at last follow-up [(46.2±4.2)points ∶(40.2±4.0)points](P 0.05). Lower prevalence of posterior osteophyte of the vertebral body was noted in upper extremity group than upper- and lower-extremity group (15% ∶51%) (P<0.01). Twenty patients (49%) in upper extremity group were surgically treated, while 31 patients (84%) in upper-and lower-extremity group (P<0.05). Conclusions Compared to acute central cervical spinal cord injury with both upper and lower extremity involvement, the injury with only upper extremity involvement is much common in younger patients and is characterized by lowered frequency of osteophyte, large buffer space, mild nerve damage, preferred non-operation treatment and good prognosis. Key words: Spinal cord injuries; Magnetic resonance imaging; Neurological status