Risk Factors for Poor Prognosis of Spinal Cord Injury without Radiographic Abnormality Associated with Cervical Ossification of the Posterior Longitudinal Ligament

Abstract

Purpose. To investigate the factors associated with the prognosis of spinal cord injury without radiographic abnormality (SCIWORA) accompanied by cervical ossification of the posterior longitudinal ligament (C-OPLL). Methods. We retrospectively investigated 287 patients with SCIWORA associated with C-OPLL, who were admitted within 30 days after trauma to our facility between August 2014 and August 2018. All patients were divided into the good or poor prognosis group. Patient demographics were analyzed. Besides, occupying ratio on CT and spinal cord high signal changes in MRI T2WI were measured and recorded. Multivariate linear regression was applied to analyze the correlation of prognosis with spinal cord high signal changes in MRI T2WI, cause of injury, and occupying ratio. Results. Occupying ratio of ossification mass was 43.5 ± 10.7 % in the poor prognosis group and 27.3 ± 7.7 % in the good prognosis group. The occurrence rate of high signal changes in MRI T2WI was 84.2% in the poor prognosis group and 41.3% in the good prognosis group. Poor prognosis was correlated with high occupying ratio and spinal cord high signal changes in MRI T2WI. In the patient with SCIWORA associated with C-OPLL, ROC curve of occupying ratio showed 30% as a predictor for the poor prognosis. Among the 92 patients with occupying ratio ≤ 30 %, poor prognosis was observed in 5 cases (5.4%), whereas in the 72 cases with occupying ratio > 30 %, poor prognosis was seen in 33 cases (45.8%). Postoperative AIS grade at final follow-up in occupying ratio > 30 % group was significantly worse. Conclusions. Patients suffering from SCIWORA with C-OPLL have poor prognosis when they have higher occupying ratio of ossification mass and spinal cord high signal changes in MRI T2WI. The cut-off value of occupying ratio for predicting the poor prognosis was 30% in patients with SCIWORA associated with C-OPLL.

Analysis of the Curative Effect and Prognostic Factors of Anterior Cervical Surgery for Spinal Cord Injury without Radiographic Abnormalities

“…For adult patients, most surgeons advocate surgical treatment in clinic at present [ 7 , 8 ]. Anterior cervical decompression and bone grafting and internal fixation are the main surgical method for clinical treatment of adult SCIWORA, which can relieve the symptoms of cervical spinal cord compression and repair and reconstruct the cervical spine structure [ 9 , 10 ]. The purpose of this study was to investigate the efficacy of anterior cervical surgery for SCIWORA and to analyze the related factors affecting the prognosis of patients.…”

“…For adult patients, most surgeons advocate surgical treatment in clinic at present [7,8]. Anterior cervical decompression and bone grafting and internal fixation are the main surgical method for clinical treatment of adult SCIWORA, which can relieve the symptoms of cervical spinal cord compression and repair and reconstruct the cervical spine structure [9,10].…”

Surgical tactics and prognostic factors in spinal cord injuries without radiological signs

“…Однако наблюдаемое в последние годы быстрое развитие медицинских технологий и значительный прогресс в области визуальной диагностики, особенно МРТ, позволило более глубоко изучить механизмы травмы, их клинические характеристики, прогноз лечения и другие аспекты травмы. В настоящее время большинство хирургов предпочитают использовать хирургические методы лечения у взрослых пациентов [4,5]. Передняя шейная декомпрессия, костная пластика и внутренняя фиксация являются основными хирургическими методами клинического лечения SCIWORA у взрослых, которые позволяют устранить явления компрессии шейного отдела спинного мозга, восстановить и реконструировать структуру шейного отдела позвоночника [6].…”