Early and short-segment anterior spinal fusion for cervical spinal cord injury without fracture and dislocation can achieve more significant neurological recovery: a retrospective study based on the current medical system in southern China

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.

Establishment and assessment of a nomogram for predicting blood transfusion risk in posterior lumbar spinal fusion

“…Posterior spinal fusion is the procedure of choice for patients with trauma, spinal infection, spinal deformities, and degenerative spinal diseases [ 16 ]. The total number of operations in PSL has been rising annually, especially in China [ 17 , 18 ]. Significant blood loss is the most frequent surgical complication and receiving a great deal of attention in the spinal surgeon, as well as anesthesiologist [ 19 ].…”

Efficacy of surgical treatment and conservative treatment for cervical spinal cord injury without fracture and dislocation in adults: A meta-analysis

“…Finally, 12 studies were included. [9][10][11][12][13][14][15][16][17][18][19][20] The literature screening process is shown in Figure 1.…”

“…The risk of bias in blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), selective reporting (reporting bias), and other sources of bias was low for all studies. Nine studies [9,10,12,14,[16][17][18][19][20] showed a high risk of bias for random sequence generation and allocation concealment (selection bias).…”

Establishment and Assessment of a Nomogram for Predicting Blood Transfusion Risk in Posterior Lumbar Spinal Fusion

“…Posterior spinal fusion is the procedure of choice for patients with trauma, spinal infection, spinal deformities and degenerative spinal diseases (16). The total number of operations in PSL has been rising annually, especially in China (17,18). Signi cant blood loss is the most frequent surgical complication and receiving a great deal of attention in the spinal surgeon, as well as anesthesiologist (19).…”