Influence of the timing of surgery forcervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study

被引：7

作者：

Nori, Satoshi ^{[1
]}

Watanabe, Kota ^{[1
]}

Takeda, Kazuki ^{[1
,2
]}

Yamane, Junichi ^{[1
,3
]}

Kono, Hitoshi ^{[1
,4
]}

Yokogawa, Noriaki ^{[5
]}

Sasagawa, Takeshi ^{[5
,6
]}

Ando, Kei ^{[7
]}

Nakashima, Hiroaki ^{[7
]}

Segi, Naoki ^{[7
]}

Funayama, Toru ^{[8
]}

Eto, Fumihiko ^{[9
]}

Yamaji, Akihiro ^{[10
]}

Furuya, Takeo ^{[11
]}

Yunde, Atsushi ^{[11
]}

Nakajima, Hideaki ^{[12
]}

Yamada, Tomohiro ^{[13
,14
]}

Hasegawa, Tomohiko ^{[13
]}

Terashima, Yoshinori ^{[15
,16
]}

Hirota, Ryosuke ^{[15
]}

Suzuki, Hidenori ^{[17
]}

Imajo, Yasuaki ^{[17
]}

Ikegami, Shota ^{[18
]}

Uehara, Masashi ^{[18
]}

Tonomura, Hitoshi ^{[19
]}

Sakata, Munehiro ^{[19
,20
]}

Hashimoto, Ko ^{[21
]}

Onoda, Yoshito ^{[21
]}

Kawaguchi, Kenichi ^{[22
]}

Haruta, Yohei ^{[22
]}

Uei, Hiroshi ^{[23
,24
]}

Sawada, Hirokatsu ^{[24
]}

Nakanishi, Kazuo ^{[25
]}

Misaki, Kosuke ^{[25
]}

Terai, Hidetomi ^{[26
]}

Tamai, Koji ^{[26
]}

Shirasawa, Eiki ^{[27
]}

Inoue, Gen ^{[27
]}

Kiyasu, Katsuhito ^{[28
]}

Iizuka, Yoichi ^{[29
]}

Takasawa, Eiji ^{[29
]}

Funao, Haruki ^{[30
,31
,32
,33
]}

Kaito, Takashi ^{[34
]}

Yoshii, Toshitaka ^{[35
]}

Ishihara, Masayuki ^{[36
]}

Okada, Seiji ^{[34
]}

Imagama, Shiro ^{[7
]}

Kato, Satoshi ^{[5
]}

机构：

[1] Keio Univ, Dept Orthopaed Surg, Sch Med, 35 Shinanomachi,Shinju ku, Tokyo 1608582, Japan

[2] Japanese Red Cross Shizuoka Hosp, Dept Orthopaed Surg, 8-2 Otemachi,Aoi ku, Shizuoka 4200853, Japan

[3] Natl Hosp Org Murayama Med Ctr, Dept Orthopaed Surg, 2-37-1 Gakuen, Musashimurayama, Tokyo 2080011, Japan

[4] Keiyu Orthoped Hosp, 2267 Akodacho, Tatebayashi, Gunma 3740013, Japan

[5] Kanazawa Univ, Grad Sch Med Sci, Dept Orthopaed Surg, 13-1 Takara machi, Kanazawa, Ishikawa 9208641, Japan

[6] Toyama Prefectural Cent Hosp, Dept Orthopaed Surg, 2-2-78 Nishinagae, Toyama, Toyama 9308550, Japan

[7] Nagoya Univ, Dept Orthoped Surg, Grad Sch Med, 65 Tsurumai cho,Showa ku, Nagoya 4668550, Japan

[8] Univ Tsukuba, Fac Med, Dept Orthopaed Surg, 1-1-1 Tennodai, Tsukuba, Ibaraki 3058575, Japan

[9] Univ Tsukuba, Grad Sch Comprehens Human Sci, Dept Orthopaed Surg, 1-1-1 Tennodai, Tsukuba, Ibaraki 3058575, Japan

[10] Ibaraki Seinan Med Ctr Hosp, Dept Orthopaed Surg, 2190 Sakaimachi, Sashima, Ibaraki 3060433, Japan

[11] Chiba Univ, Grad Sch Med, Dept Orthopaed Surg, 1-8-1 Inohana,Chuo-ku, Chiba, Chiba 2608670, Japan

[12] Univ Fukui, Dept Orthopaed & Rehabil Med, Fac Med Sci, 23-3 Matsuoka Shimoaizuki, Eiheiji, Fukui 9101193, Japan

[13] Hamamatsu Univ Sch Med, Dept Orthopaed Surg, 1-20-1 Handayama,Higashi ku, Hamamatsu, Shizuoka 4313192, Japan

[14] Nagoya Kyoritsu Hosp, Dept Orthopaed Surg, 1-172 Hokke,Nakagawa ku, Nagoya, Aichi 4540933, Japan

[15] Sapporo Med Univ, Dept Orthopaed Surg, South 1 West 16-291,Chuo ku, Sapporo 0608543, Japan

[16] Matsuda Orthoped Mem Hosp, Dept Orthopaed Surg, North 18 East 4-1 Kita ku, Sapporo 0010018, Japan

[17] Yamaguchi Univ, Dept Orthopaed Surg, Grad Sch Med, 1-1-1 Minami kogushi, Ube, Yamaguchi 7558505, Japan

[18] Shinshu Univ, Dept Orthopaed Surg, Sch Med, 3-1-1 Asahi, Matsumoto, Nagano 3908621, Japan

[19] Kyoto Prefectural Univ Med, Grad Sch Med Sci, Dept Orthopaed, Kamigyo ku, Kyoto 6028566, Japan

[20] Saiseikai Shiga Hosp, Dept Orthopaed, 2-4-1 Ohashi, Ritto, Shiga 5203046, Japan

[21] Tohoku Univ, Dept Orthopaed Surg, Grad Sch Med, 1-1 Seiryo machi,Aoba ku, Sendai, Miyagi 9808574, Japan

[22] Kyushu Univ, Grad Sch Med Sci, Dept Orthopaed Surg, 3-1-1 Maidashi Higashi ku, Fukuoka 8128582, Japan

[23] Nihon Univ Hosp, Dept Orthopaed Surg, 1-6 Kanda Surugadai,Chiyoda ku, Tokyo 1018393, Japan

[24] Nihon Univ, Dept Orthopaed Surg, Sch Med, 30-1 Oyaguchi Kami cho,Itabashi ku, Tokyo 1738610, Japan

[25] Kawasaki Med Sch, Dept Orthoped Traumatol & Spine Surg, 577 Matsushima, Kurashiki, Okayama 7010192, Japan

[26] Osaka Metropolitan Univ, Dept Orthopaed Surg, Grad Sch Med, 1-4-3 Asahimachi,Abeno ku, Osaka, Osaka 5458585, Japan

[27] Kitasato Univ, Dept Orthopaed Surg, Sch Med, 1-15-1 Kitazato,Minami ku, Sagamihara, Kanagawa 2520374, Japan

[28] Kochi Univ, Kochi Med Sch, Dept Orthopaed Surg, Nankoku 7838505, Japan

[29] Gunma Univ, Grad Sch Med, Dept Orthopaed Surg, 3-39-22 Showa, Maebashi, Gunma 3718511, Japan

[30] Int Univ Hlth & Welf, Sch Med, Dept Orthopaed Surg, 852 Hatakeda, Narita, Chiba 2860124, Japan

[31] Int Univ Hlth & Welf, Narita Hosp, Dept Orthopaed Surg, 852 Hatakeda, Narita, Chiba 2860124, Japan

[32] Int Univ Hlth & Welf, Mita Hosp, Dept Orthopaed Surg, 1-4-3 Mita,Minato ku, Tokyo 1088329, Japan

[33] Int Univ Hlth & Welf, Mita Hosp, Spine & Spinal Cord Ctr, 1-4-3 Mita,Minato ku, Tokyo 1088329, Japan

[34] Osaka Univ, Dept Orthopaed Surg, Grad Sch Med, 2-2 Yamadaoka, Suita, Osaka 5650871, Japan

[35] Tokyo Med & Dent Univ, Dept Orthopaed Surg, Yushima 1-5-45,Bunkyo Ku, Tokyo 1138519, Japan

[36] Kansai Med Univ Hosp, Dept Orthopaed Surg, 2-3-1 Shinmachi, Hirakata, Osaka 5731191, Japan

来源：

JOURNAL OF ORTHOPAEDIC SCIENCE | 2024年 / 29卷 / 02期

关键词：

Cervical spinal cord injury; No bone injury; Elderly patients; Surgical timing; Relatively early surgery; Neurological outcomes; DECOMPRESSION; OUTCOMES; TRAUMA;

D O I：

10.1016/j.jos.2023.01.004

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

Background: Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. Methods: In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged >= 65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early ( < 48 h after CSCI, n = 24) and late surgery ( > 48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. Results: The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group ( P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury ( P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed ( P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement ( P < 0.001). Delirium ( P = 0.006), pneumonia ( P = 0.030), and diabetes mellitus ( P = 0.039) negatively influenced postoperative improvement. Conclusions: Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly. (c) 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

引用

页码：480 / 485

页数：6

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