Therapeutic experience and predictor of neurological recovery of traumatic cervical spinal cord injury with hematoma and edema

English Keywords:Cervical spinal cord injury  Clinical efficacy  Hematoma  Edema

English Abstract:

  【Abstract】 Objectives: To investigate the surgical effects of traumatic cervical spinal cord injury(CSCI) with intramedullary hemorrhage and edema and analyze the predictor of neurological recovery. Methods: Retrospective analysis was performed on 83 cases of traumatic CSCI patients with intramedullary hemorrhage and edema who received surgical treatment in our hospital from January 2014 to December 2019. Neurological function was assessed through American Spinal Association(ASIA) impairment scale(AIS), and the patients enrolled had grade A-C of AIS with a follow-up time of more than 6 months. The AIS improvement of at least 1 level at 6 months after surgery was regarded as neurological function recovery. The patients were divided into recovery group and non-recovery group. General information was collected, such as age, gender, and observation indicators including preoperative AIS grade, preoperative ASIA motor score(AMS), preoperative intramedullary edema length(IEL), preoperative intramedullary hematoma length(IHL), preoperative maximum spinal cord compression(MSCC), injury mechanism, time from injury to hospital, time from injury to decompression, soft tissue injury, injured segments, surgical approach, AMS 3 days after decompression, AMS improvement rate 3 days after decompression, postoperative rehabilitation, and AIS grade 6 months after decompression. The number of patients with improved AIS score 6 months after surgery was counted, and the variables were analyzed by single factor analysis between groups. Variables with P<0.05 were included in binary logistic regression. Results: AIS improved in 60 patients within 6 months after the operation, with an improvement rate of 72.3%. There was no statistically significant difference in the age, gender and preoperative AIS grade between the two groups(P>0.05). In univariate analysis, there were statistically significant differences in AMS 3 days after surgery, AMS recovery rate, preoperative IEL, preoperative IHL, preoperative MSCC(P<0.05), and injured segments, while there was no statistically significant difference in preoperative AMS, injury mechanism, time from injury to hospital, soft tissue injury, time from injury to decompression, surgical approach, and postoperative rehabilitation(P>0.05). Variables with P<0.05 were included in logistic regression analysis, and the results showed that AMS recovery rate(odds ratio 1.331, 95%CI 1.063-1.665) and preoperative IHL(odds ratio 0.773, 95%CI 0.653-0.915) were the predictors of neurological function recovery 6 months after surgery. Conclusions: Surgical treatment is helpful to improve the neurological function of patients with haemorrhagic edematous CSCI, and the AMS improvement rate and preoperative IHL are the predictors for the neurological function recovery of patients 6 months after surgery.