The impact of spine stability on cervical spinal cord injury with respect to demographics, management and outcome: a prospective cohort from a national SCI registry

Publication date: Available online 1 July 2017
Source:The Spine Journal
Author(s): Jérôme Paquet, Carly S. Rivers, Dilinuer Kuerban, Joel Finkelstein, Jin W. Tee, Vanessa K. Noonan, Brian K. Kwon, R. John Hurlbert, Sean Christie, Eve C. Tsai, Henry Ahn, Brian Drew, Christopher S. Bailey, Daryl R. Fourney, Najmedden Attabib, Michael G. Johnson, Michael G. Fehlings, Stefan Parent, Marcel F. Dvorak
Background contextEmergent surgery for patients with a traumatic spinal cord injury (SCI) is seen as the gold standard in acute management. However, optimal treatment for those with the clinical diagnosis of central cord syndrome (CCS) is less clear and classic definitions of CCS do not identify a unique population of patients.PurposeTo test the authors' hypothesis that spine stability can identify a unique group of patients with regards to demographics, management, and outcomes, which classic CCS definitions do not.Study design/settingProspective observational study.Patient sampleParticipants with cervical SCI included in a prospective Canadian registry.Outcome measuresInitial hospitalization length of stay, change in total motor score from admission to discharge, and in-hospital mortality.MethodsPatients with cervical SCI from a prospective Canadian SCI registry were grouped into stable and unstable spine cohorts. Bivariate analyses were used to identify differences in demographic, injury, management, and outcomes. Multivariate analysis was used to better understand the impact of spine stability on motor score improvement. No conflicts of interest were identified.ResultsCompared to those with an unstable spine, patients with cervical SCI and a stable spine were older (58.8 vs 44.1 years, p<0.0001), more likely male (86.4% vs. 76.1%, p=0.0059), and have more medical comorbidities. Patients with stable spine cervical SCI were more likely to have sustained their injury by a fall (67.4% vs. 34.9%, p<0.0001), have high cervical (C1-C4; 58.5% vs. 43.3%, p=0.0009) and less severe neurological injuries (AIS C or D; 81.3% vs. 47.5%, p<0.0001). Those with stable spine injuries were less likely to have surgery (67.6% vs. 92.6%, p<0.0001), had shorter in-hospital lengths of stay (median 84.0 vs. 100.5 days, p=0.0062), and higher total motor score change (20.7 vs. 19.4 points, p=0.0014). Multivariate modelling revealed that neurological severity of injury and spine stability were significantly related to motor score improvement; patients with stable spine injuries had more motor score improvement.ConclusionsWe propose that classification of stable cervical SCI is more clinically relevant than classic CCS classification as this group was found to be unique with regards to demographics, neurological injury, management, and outcome whereas classic CCS classifications do not . This classification can be used to assess optimal management in patients where it is less clear if and when surgery should be performed.



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