Surgical treatment of spinal cord injury with inferior cervical fracture-dislocation：prognosis and its affecting factors

English Keywords:Spinal cord injury  Cervical spine  Fractures and dislocations  Prognosis  Factors

English Abstract:

  【Abstract】 Objective：To find out the factors that affect the prognosis of inferior cervical spinal injury with cervical spinal fractures or dislocations in order to guide clinical treatment of this kind of injury.Method：115 acute cervical spinal injury patients with cervical fractures or dislocations were followed up continuously between April 2005 and February 2010.The data were analyzed retrospectively which included age，sex，mode of injury，time to hospital，time to operation，injury level，classification of fractures or dislocations，canal clearance，steroids treatment，use of neck brace，traction and surgery approaches with logistic regression in order to find out the main factors that affect the prognosis.Result：115 cases were included，with 98 male cases（85.2%） and 17 female cases（14.8%）；ages ranged from 16 to 80 years，averaging 40.1 years.According to ASIA classification，there were 54 complete injury（ASIA A） cases（47.0%） and 61 incomplete injury（ASIA B，C，D） cases（53.0%），grade B for 17 cases（14.8%），grade C for 27 cases（23.5%），and grade D for 17 cases（14.8%）.Injury modes included traffic injury for 65 cases（56.5%），high fall for 25 cases（21.7%），fall damage for 17 cases（14.8%） and heavy pound injury for 8 cases（7.0%）.Multiple injuries were in 28 cases（24.3%）.Following up 12 to 69 months（average，25.3 months），28 cases were lost of follow-up，and the rate of follow-up was 75.7%.Factors including time to hospital，time to operation，canal clearance，use of steroids within 8 hours，use of neck brace and traction were screened out by univariate analysis（P＜0.1）.After logistic regression analysis in Back-forward Wald method，factors including time to hospital，time to operation，canal clearance and the use of steroids within 8 hours were left in the regression equation（P＜0.05），which were the four main factors that affected the prognosis of spinal cord injury（SCI）.Conclusion：Time to hospital，time to operation，canal clearance and use of steroids within 8 hours are factors that affect the prognosis of spinal cord injury.Safe，rapid and effective pre-hospital care，appropriate surgical intervention，adequate decompression and steroids applying within 8 hours after injury may effectively improve the prognosis of spinal cord injury with cervical spinal fractures or dislocations（SCI）.