Clinical outcomes of cervical spinal cord injuries without radiographic evidence of trauma

Abstract

We investigated 33 cervical spinal cord injury patients (25 males and eight females) without bony injury. Patients whose neurologic recovery had reached a plateau and who had evidence on imaging of persistent spinal cord compression were considered candidates for surgical decompression. When imaging did not show spinal cord compression or patients were maintaining a good neurologic recovery from the early days after injury, we pursued conservative treatment. Age at injury varied from 20 to 76 years (mean, 55.6). Average followup was 31 months. Twelve patients were treated conservatively (Group 1). Groups 2 and 3 had surgery. Group 2 (14 cases) had multi-level compression of spinal cord due to pre-existing cervical spine conditions such as ossi®cation of posterior longitudinal ligament, cervical canal stenosis, and cervical spondylosis. Group 3 (7 cases) patients existed single-level compression of spinal cord by cervical disc herniations or spondylosis. We evaluated clinical results according to the Frankel classi®cation, the American Spinal Injury Association (ASIA) scales and Japanese Orthopaedic Association (JOA) scores. Overall improvement of JOA and ASIA scores after treatment was 56.3+35.5% and 67.1+38.0%, respectively. Patients in Group 1 showed very good recovery after conservative treatment, with improvement of JOA and ASIA scores being 70.4+40.2% and 77.4+34.2%, respectively. The average interval between injury and operation was 4.3+4.4 months. The improvement of the surgically treated patients (Groups 2 and 3) in JOA and ASIA score was 48.2+30.7% and 61.2+39.6% respectively. We obtained good neurological recovery after operation, with signi®cantly more improvement in Group 3 than in Group 2. No signi®cant neurologic recovery had occurred preoperatively in these groups. In such patients operative intervention is essential for neurologic recovery.

Traumatic cervical instability associated with cord oedema and temporary quadriparesis

“…SCI-WORA is most likely to occur in blunt cervical trauma of children beyond the age of 8 years because of the high elasticity of the paediatric spine, resulting from unique anatomic and biomechanical properties. 6,12,13,18,19 In adults, cervical spinal cord injury usually is associated with bony malalignment, locking of facets, disruption of the vertebral body or fracture of elements of the neural arch. Since the introduction of MRI, a post-traumatic abnormality can frequently be depicted in the spine of SCIWORA patients.…”

“…13 Spinal cord injury without radiographic evidence of trauma, the so-called SCIWORET syndrome, 20 is associated with the radiological delineation of spondylotic changes such as bony spurs, cervical canal stenosis, protruded discs and ossification of posterior longitudinal ligament (OPLL). 6,19 These degenerative changes could allow for damage to the neural structures by excessive traction or pinching during the accident. 6,13,19,21,22 SCIWORET patients frequently present with central cord syndrome.…”

“…6,19 These degenerative changes could allow for damage to the neural structures by excessive traction or pinching during the accident. 6,13,19,21,22 SCIWORET patients frequently present with central cord syndrome. 13,19,23 Therefore, an eventual neurological dysfunction is most likely to affect the upper extremities and especially the hands.…”

“…6,13,19,21,22 SCIWORET patients frequently present with central cord syndrome. 13,19,23 Therefore, an eventual neurological dysfunction is most likely to affect the upper extremities and especially the hands. 19 In the adult, SCIWORET is encountered more frequently than SCIWORA syndrome, even though both conditions are rare.…”

“…13,19,23 Therefore, an eventual neurological dysfunction is most likely to affect the upper extremities and especially the hands. 19 In the adult, SCIWORET is encountered more frequently than SCIWORA syndrome, even though both conditions are rare. 9,10,12,19 In recent years, the radiological assessment protocol for acute cervical spine trauma was challenged: increasingly the three standard radiological views are combined with MRI or helical CT of the complete cervical spine instead of conventional CT. [5][6][7] Especially in patients with neurological dysfunction, MRI probably is the first radiological modality to be applied.…”