Abstract
ObjectiveThe purpose of this study was to investigate the effects of the number of fused segments, the timing of surgery and their interaction on the prognosis of patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD), and to determine the appropriate time restrictions for early surgery in CSCIWFD patients based on the current diagnosis and treatment system in southern China.MethodsCSCIWFD patients who underwent anterior cervical decompression and internal fusion (ACDF) from January 2012 to June 2017 were selected. The patients were grouped according to the timing of surgery and the number of fused segments and evaluated based on their American Spinal Injury Association (ASIA) score, ASIA impairment scale, and Japanese Orthopaedic Association (JOA) score before and after surgery. SPSS22.0 software was used for the statistical analysis.ResultsThe ASIA score, JOA score, and ASIA impairment scale in all follow-ups were significantly higher than before surgery (p < 0.05). The ASIA and JOA scores at 6, 12, and 24 months after surgery of the patients who underwent ACDF within 72 h were significantly better than those of the patients who underwent ACDF after 72 h (p < 0.05). There were significant differences in postoperative ASIA and JOA scores at 12 and 24 months between the short-segment and three-segment fusion groups (p < 0.05). The results of the interaction between the surgical timing and the number of the fused segments showed that the postoperative ASIA and JOA scores at 6, 12, and 24 months were significantly higher in the patients who underwent early short-segment fusion than in those who underwent delayed short-segment fusion (p < 0.05). However, no statistically significant difference was found between early and delayed surgery in the patients who underwent three-segment fusion (p > 0.05).ConclusionACDF is safe and effective for the treatment of CSCIWFD. For patients with single- or double-segment injury, early (within 72 h) ACDF is associated with a more satisfactory prognosis. Due to the limitation of the small sample size, we cautiously recommend that 72 h can be used as a time limit for early surgery for CSCIWFD patients in regions where earlier surgery cannot be provided by the current diagnosis and treatment system.
Highlights
In recent years, with the development of transportation and aerial work, increasing numbers of patients have suffered from traumatic cervical spinal cord injury (SCI)
Main findings To the best of our knowledge, this is the first clinical study to investigate the effect of the interaction between surgical timing and the number of fused segments on the prognosis of patients with CSCIWFD who underwent Anterior cervical decompression and fusion (ACDF)
This study showed that ACDF with different numbers of fused segments performed at different times can lead to varying degrees of functional improvement in CSCIWFD patients, and early ACDF is associated with a better prognosis compared with delayed ACDF
Summary
With the development of transportation and aerial work, increasing numbers of patients have suffered from traumatic cervical spinal cord injury (SCI). Due to a lack of significant positive findings on radiography and other imaging examinations, CSCIWFD is misdiagnosed as post-traumatic spinal shock or concussion; the best time for treatment may be missed [3]. For these patients, conservative treatment is the main option, but problems such as a long treatment cycle, a high complication rate, high mortality, and long-term functional decline are common [4, 5]. For patients with anterior spinal cord compression limited within 3 segments, the anterior approach is preferred [7]
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