Case characteristics and surgical efficacy in elderly patients over 65 years of age with cervical spinal cord injury without fracture and dislocation: a retrospective study

Objective The outcomes of surgical and conservative treatment in elderly patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD) were evaluated over medium- and long-term follow-up periods and the case characteristics were analysed. Methods Data from 39 elderly patients over 65 years of age with CSCIWFD who were admitted to our hospital between January 2010 and June 2022 were retrospectively analysed. Neurological recovery was assessed using the American Spinal Injury Association (ASIA) grading criteria and the Japanese Orthopaedic Association (JOA) score at admission, after surgery, and at the final follow-up. Post-injury imaging data were used to evaluate potential underlying lesions and injury types. In the surgical treatment group, the sagittal and transverse diameters of the cervical spinal canal were measured using magnetic resonance imaging at admission and the final follow-up to effectively assess spinal cord decompression. Results At the final follow-up, the JOA score of the 21 patients who underwent surgical treatment was significantly higher than that of the patients who received conservative treatment (P < 0.001). Additionally, the ASIA grading showed a significant improvement compared to the conservative treatment group (P < 0.003). The sagittal and transverse diameters of the cervical canal in the surgical treatment group were significantly larger at the final follow-up than at admission, indicating surgical decompression (P < 0.001). Conclusion Elderly men are the most commonly affected group with CSCIWFD, typically presenting with a history of low-energy trauma. For these patients, active surgical management is recommended following the stress period, assuming their physical condition is suitable. Our results suggest that even in patients with prolonged injury, improvement in neurologic and motor function may be superior to conservative treatment after thorough decompression surgery.