The Risk of Acute Spinal Cord Injury After Minor Trauma in Patients With Preexisting Cervical Stenosis

BACKGROUND:Cervical stenosis patients are commonly advised to undergo surgery due to the risk of spinal cord injury (SCI) after a traumatic event. However, the actual risk of SCI in this scenario is unknown.OBJECTIVE:To evaluate the risk of SCI after minor trauma in a cohort of prospectively followed cervical stenosis patients.METHODS:Clinical and radiographical analysis was performed in 55 nonoperatively treated patients evaluated between 2009 and 2014. Each patient was asked standardized questions including: 1) whether a previous physician recommended neck surgery, 2) whether a physician indicated that they would become paralyzed after a traumatic event, and 3) whether they experienced a traumatic event during the follow-up period.RESULTS:The mean age was 65, with a mean modified Japanese Orthopedic Association score of 16.6. The mean canal diameter was 6.1 mm. Nineteen patients (35%) had evidence of intramedullary T2 signal abnormality. Thirty-one patients (56%) were previously recommended for surgery. Twenty-six patients (47%) were told that they would be paralyzed after a motor vehicle accident or fall unless surgery was performed. Ten patients (18%) experienced a traumatic event during the follow-up, with none sustaining an SCI.CONCLUSION:Asymptomatic and mildly symptomatic cervical stenosis patients are commonly recommended to undergo surgery due to risk of paralysis after a traumatic event. SCI was not observed after minor trauma in our cohort of prospectively followed patients. It seems that occurrence of SCI in this patient population after minor trauma is likely smaller than many physicians surmise, yet will require future prospective study in a large cohort of patients.ABBREVIATIONS:CSM, cervical spondylotic myelopathymJOA, modified Japanese Orthopedic AssociationMVA, motor vehicle accidentSCI, spinal cord injury