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Comparison of Early Surgical Treatment With Conservative Treatment of Incomplete Cervical Spinal Cord Injury Without Major Fracture or Dislocation in Patients With Pre-existing Cervical Spinal Stenosis

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Abstract
Study Design:

This was a retrospective comparative study.

Objective:

The objective of this study was to evaluate the clinical outcomes of early surgical treatment (<24 h) and conservative treatment of incomplete cervical spinal cord injury (CSCI) without major fracture or dislocation in patients with pre-existing cervical spinal canal stenosis (CSCS).

Summary of Background Data:

The relative benefits of surgery, especially early surgical treatment, and conservative treatment for CSCI without major fracture or dislocation in patients with pre-existing CSCS remain unclear. Animal models of CSCI have demonstrated that early surgical decompression immediately after the initial insult may prevent or reverse secondary injury. However, the clinical outcomes of early surgery for incomplete CSCI in patients with pre-existing CSCS are still unclear.

Materials and Methods:

The medical records and radiographic data of 54 patients admitted to our facility between 2005 and 2015 with American Spinal Injury Association (ASIA) impairment scale grade B or C and pre-existing CSCS without major fracture or dislocation were retrospectively reviewed. Thirty-three patients (mean age, 57.4 +/- 14.0 y) underwent early surgical treatment within 24 hours after initial trauma (S group), and 21 patients (mean age, 56.9 +/- 13.6 y) underwent conservative treatment (C group) performed by 2 spinal surgeons in accordance with their policies. The primary outcome was the degree of improvement in ASIA grade after 2 years.

Results:

During the 2-year follow-up period, higher percentages of patients in the S group than in the C group showed >= 1 grade (90.9% vs. 57.1%, P=0.0051) and 2 grade (30.3% vs. 9.5%) improvements in ASIA grade. Multivariate analysis showed that treatment type, specifically early surgical treatment, was the only factor significantly associated with ASIA grade improvement after 2 years (P=0.0044).

Conclusions:

Early surgery yielded better neurological outcomes than conservative treatment in patients with incomplete CSCI without major fracture or dislocation and pre-existing CSCS.
Author(s)
이수범김정환하정기정상구박진훈
Issued Date
2021
Type
Article
Keyword
AnalysisCare and treatmentEmergency medicineFracturesMedical collegesMedical recordsNervous systemPreventionSpinal canalSpinal cord injuriesStenosisSurgery
DOI
10.1097/BSD.0000000000001065
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7846
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2442841122&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Comparison%20of%20Early%20Surgical%20Treatment%20With%20Conservative%20Treatment%20of%20Incomplete%20Cervical%20Spinal%20Cord%20Injury%20Without%20Major%20Fracture%20or%20Dislocation%20in%20Patients%20With%20Pre-existing%20Cervical%20Spinal%20Stenosis&amp;offset=0&amp;pcAvailability=true
Publisher
CLINICAL SPINE SURGERY
Location
미국
Language
영어
ISSN
2380-0186
Citation Volume
34
Citation Number
3
Citation Start Page
141
Citation End Page
146
Appears in Collections:
Medicine > Medicine
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