Does surgery improve neurological outcomes in older individuals with cervical spinal cord injury without bone injury? A multicenter study

Satoshi Nori, Kota Watanabe, Kazuki Takeda, Junichi Yamane, Hitoshi Kono, Noriaki Yokogawa, Takeshi Sasagawa, Kei Ando, Hiroaki Nakashima, Naoki Segi, Toru Funayama, Fumihiko Eto, Akihiro Yamaji, Takeo Furuya, Atsushi Yunde, Hideaki Nakajima, Tomohiro Yamada, Tomohiko Hasegawa, Yoshinori Terashima, Ryosuke HirotaHidenori Suzuki, Yasuaki Imajo, Shota Ikegami, Masashi Uehara, Hitoshi Tonomura, Munehiro Sakata, Ko Hashimoto, Yoshito Onoda, Kenichi Kawaguchi, Yohei Haruta, Nobuyuki Suzuki, Kenji Kato, Hiroshi Uei, Hirokatsu Sawada, Kazuo Nakanishi, Kosuke Misaki, Hidetomi Terai, Koji Tamai, Eiki Shirasawa, Gen Inoue, Katsuhito Kiyasu, Yoichi Iizuka, Eiji Takasawa, Haruki Funao, Takashi Kaito, Toshitaka Yoshii, Masayuki Ishihara, Seiji Okada, Shiro Imagama, Satoshi Kato

Research output: Contribution to journalArticlepeer-review

Abstract

Study design: Retrospective multicenter study. Objectives: To investigate the neurological outcomes of older individuals treated with surgery versus conservative treatment for cervical spinal cord injury (CSCI) without bone injury. Setting: Thirty-three medical institutions in Japan. Methods: This study included 317 consecutive persons aged ≥65 years with CSCI without bone injury in participating institutes between 2010 and 2020. The participants were followed up for at least 6 months after the injury. Individuals were divided into surgery (n = 114) and conservative treatment (n = 203) groups. To compare neurological outcomes and complications between the groups, propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed. Results: After propensity score matching, the surgery and conservative treatment groups comprised 89 individuals each. Surgery was performed at a median of 9.0 (3–17) days after CSCI. Baseline factors were comparable between groups, and the standardized difference in the covariates in the matched cohort was <10%. The American Spinal Injury Association (ASIA) impairment scale grade and ASIA motor score (AMS) 6 months after injury and changes in the AMS from baseline to 6 months after injury were not significantly different between groups (P = 0.63, P = 0.24, and P = 0.75, respectively). Few participants who underwent surgery demonstrated perioperative complications such as dural tear (1.1%), surgical site infection (2.2%), and C5 palsy (5.6%). Conclusion: Conservative treatment is suggested to be a more favorable option for older individuals with CSCI without bone injuries, but this finding requires further validation.

Original languageEnglish
JournalSpinal Cord
DOIs
Publication statusAccepted/In press - 2022

All Science Journal Classification (ASJC) codes

  • Rehabilitation
  • Neurology
  • Clinical Neurology

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