Outcome Analysis of Upper versus Lower Cervical Spine Injuries

Abstract

Back Ground/Objective Cervical spine injuries are considered to be a major trauma and classified in various types. They are associated with various neurologic deficits and mortality rates. They account for 50 to 75% of all spine injuries. Various studies are associated with outcome of spinal cord injuries. Our aim was to analyze outcome of upper and lower cervical spine injuries.

Study Design It was a retrospective study in all traumatic cervical spine injuries in all age groups at our center during the past 3 years.

Method All cases operated in the past 3 years at our center were taken up for study. Initial hospital records were reviewed. Patients will be divided into two groups on the basis of anatomic level upper (C1 and C2) and lower (C3 or below) cervical spine. Outcomes were analyzed on criteria of demography, mechanism of injury, preoperative neurologic status, involvement of respiratory system, and time of surgery following injury.

Result tatically significant test was applied for analysis of outcome of cervical spine injury based on aforementioned criteria.

Conclusion In this study, survival rates of patients with upper and lower cervical spine injuries were calculated on the basis of mechanism of injury, preoperative neurologic status, respiratory involvement, and time of surgery following injury. Operative treatment of lower cervical injury was better associated with an improved outcome than upper cervical spine injuries. Further prospective study is required for better assessment.

Keywords

cervical spinal cord - injury - outcome analysis

• References

• 1 Clark CR, Benzel EC, Currier BL. et al eds. Cervical Spine. 4th ed.. Philadelphia, PA: Lippincott, Williams & Wilkins; 2005: 222
• 2 Vaccaro AR, Regan JJ, Crawford AH, Benzel EC, Anderson DG. eds. Cervical Spine. 5th ed.. Lippincott, Williams & Wilkins; 2012: 1594
• 3 Patel VV, Burger E, Brown CW. eds. Spine Trauma, Surgical Techniques. 1st ed.. Berlin-Heidelberg, Germany: Springer; 2010: 413
• 4 Suchomel P, Choutka O. Reconstruction of Upper Cervical Spine and Craniovertebral Junction. Springer; 2011: 322
• 5 Shao J, Zhu W, Chen X. et al. Factors associated with early mortality after cervical spinal cord injury. J Spinal Cord Med 2011; 34 (06) 555-562
• 6 Frymoyer JW, Wiesel SW, Boden SD. et al. eds. Adult and Pediatric Spine. 3rd ed.. Philadelphia, PA: Lippincott, Williams & Wilkins; 2004: 1236
• 7 Herkowitz HN. The Spine. 6th ed.. Philadelphia, PA: Elsevier Saunders; 2011: 2020
• 8 Bötel U, Gläser E, Niedeggen A. The surgical treatment of acute spinal paralysed patients. Spinal Cord 1997; 35 (07) 420-428
• 9 Campagnolo DI, Esquieres RE, Kopacz KJ. Effect of timing of stabilization on length of stay and medical complications following spinal cord injury. J Spinal Cord Med 1997; 20 (03) 331-334
• 10 Duh MS, Shepard MJ, Wilberger JE, Bracken MB. The effectiveness of surgery on the treatment of acute spinal cord injury and its relation to pharmacological treatment. Neurosurgery 1994; 35 (02) 240-248 discussion 248–249
• 11 Guest J, Eleraky MA, Apostolides PJ, Dickman CA, Sonntag VK. Traumatic central cord syndrome: results of surgical management. J Neurosurg 2002; 97 (01) Suppl 25-32
• 12 Krengel III WF, Anderson PA, Henley MB. Early stabilization and decompression for incomplete paraplegia due to a thoracic-level spinal cord injury. Spine 1993; 18 (14) 2080-2087
• 13 Levi L, Wolf A, Rigamonti D, Ragheb J, Mirvis S, Robinson WL. Anterior decompression in cervical spine trauma: does the timing of surgery affect the outcome?. Neurosurgery 1991; 29 (02) 216-222
• 14 McLain RF, Benson DR. Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine 1999; 24 (16) 1646-1654
• 15 Pollard ME, Apple DF. Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia. Spine 2003; 28 (01) 33-39
• 16 Tator CH, Fehlings MG, Thorpe K, Taylor W. Current use and timing of spinal surgery for management of acute spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study. J Neurosurg 1999; 91 (01) Suppl 12-18
• 17 Vaccaro AR, Daugherty RJ, Sheehan TP. et al. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine 1997; 22 (22) 2609-2613
• 18 McKinley W, Meade MA, Kirshblum S, Barnard B. Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch Phys Med Rehabil 2004; 85 (11) 1818-1825
• 19 Chipman JG, Deuser WE, Beilman GJ. Early surgery for thoracolumbar spine injuries decreases complications. J Trauma 2004; 56 (01) 52-57
• 20 Croce MA, Bee TK, Pritchard E, Miller PR, Fabian TC. Does optimal timing for spine fracture fixation exist?. Ann Surg 2001; 233 (06) 851-858
• 21 Kerwin AJ, Frykberg ER, Schinco MA, Griffen MM, Murphy T, Tepas JJ. The effect of early spine fixation on non-neurologic outcome. J Trauma 2005; 58 (01) 15-21
• 22 Mirza SK, Krengel III WF, Chapman JR. et al. Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res 1999; (359) 104-114
• 23 Sapkas GS, Papadakis SA. Neurological outcome following early versus delayed lower cervical spine surgery. J Orthop Surg (Hong Kong) 2007; 15 (02) 183-186
• 24 Schinkel C, Frangen TM, Kmetic A, Andress HJ, Muhr G. German Trauma Registry. Timing of thoracic spine stabilization in trauma patients: impact on clinical course and outcome. J Trauma 2006; 61 (01) 156-160 discussion 160
• 25 Cengiz SL, Kalkan E, Bayir A, Ilik K, Basefer A. Timing of thoracolumbar spine stabilization in trauma patients; impact on neurological outcome and clinical course. A real prospective (RCT) randomized controlled study. Arch Orthop Trauma Surg 2008; 128 (09) 959-966
• 26 Ng WP, Fehlings MG, Cuddy B. et al. Surgical treatment for acute spinal cord injury study pilot study #2: evaluation of protocol for decompressive surgery within 8 hours of injury. Neurosurg Focus 1999; 6 (01) e3
• 27 Clohisy JC, Akbarnia BA, Bucholz RD, Burkus JK, Backer RJ. Neurologic recovery associated with anterior decompression of spine fractures at the thoracolumbar junction (T12-L1). Spine 1992; 17 (08) Suppl S325-S330
• 28 Chen L, Yang H, Yang T, Xu Y, Bao Z, Tang T. Effectiveness of surgical treatment for traumatic central cord syndrome. J Neurosurg Spine 2009; 10 (01) 3-8
• 29 Fehlings MG, Vaccaro A, Wilson JR. et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One 2012; 7 (02) e32037