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Lv et al. | Journal of Clinical and Translational Research 2024; 10(1): 1-8 5
Table 3. Comparison of pre-operative and final follow-up ASIA grades PHT was as effective as ADF in the treatment of cervical SCI,
between the two groups based on the fact that PHT was superior to ADF in improving the
ASIA PSF group ASF group Total P‑value patient’s health-related quality of life and preserving cervical spine
grades (n=116) (%) (n=142) (%) (n=258) mobility in the long-term follow-up period.
Pre-operative ASIA grades Early decompression surgery for extensional cervical spinal
A 7 (6.0) 11 (7.7) 18 (7.0) 0.690 injury had a beneficial outcome [10]. The optimal timing for
B 39 (33.6) 42 (29.6) 81 (31.4) surgical intervention remains unclear. La Rosa et al. [11] reported
C 59 (50.9) 70 (49.3) 129 (50.0) that early decompression surgery within 24 h of trauma exerted a
D 11 (9.5) 19 (13.4) 30 (11.6) significantly better effect [12,13] than late surgical management.
Final follow-up ASIA grades Guest et al. also reported that early surgery (within 24 h of injury)
A 4 (3.4) 6 (4.2) 10 (3.9) 0.926 improves overall motor recovery in patients whose traumatic central
B 15 (12.9) 18 (12.7) 33 (12.8) cord syndrome was related to acute disc herniation or fracture [14].
C 29 (25.0) 38 (26.8) 67 (26.0) The patients in this cohort received early decompression, and
D 54 (46.6) 59 (41.5) 113 (43.8) an obvious improvement in post-surgical neurological scores
E 14 (12.1) 21 (14.8) 35 (13.5) was observed. In contrast, other studies reported that surgical
Abbreviations: PSF: Posterior short-segment fusion, ASF: Anterior short-segment fusion treatment was not superior to conservative treatment for traumatic
CSCI without major fracture or dislocation with spinal cord
compression in the acute phase [15-17]. No relationships between
Table 4. Comparison of pre-operative and final follow-up JOA scores
between the two groups pre-existing CSCS and neurological outcomes were evident after
JOA PSF group (n=116) ASF group (n=142) P‑value traumatic CSCI. These results suggest that decompression surgery
might not be recommended for traumatic CSCI without major
Pre-operative JOA 6.21±1.85 6.45±2.17 0.345 fracture or dislocation despite pre-existing CSCS. Some results
Final follow-up JOA 10.90±3.56 11.48±3.62 0.134 suggest that prophylactic surgical treatment for CSCS may not
Abbreviations: PSF: Posterior short-segment fusion, ASF: Anterior short-segment fusion have a significant impact on the incidence of traumatic CSCI.
However, patients with pre-existing CSCS do have an increased
4. Discussion incidence of CSCI, which is noteworthy [18]. We considered that
Owing to the risk for paralysis, sensory impairment, bowel, the injured cord would be more severely squeezed in patients with
bladder, and sexual dysfunction, acute cervical SCI is a potentially a pre-conditioned stenotic canal under the rapid development
devastating condition. Individuals with cervical canal stenosis are of edema in the early stage after spinal cord trauma. Therefore,
in this scenario, laminoplasty provides a feasible approach
known to be at high risk for developing cervical SCI when injured. for the complete decompression of cervical spinal cord, with
Among cervical SCI patients with cervical stenosis, an extensional multisegmental decompression in particular delivering more
injury is the most common injury mechanism and occurs in effective outcomes. A study has shown that patients with minimal
many patients without any radiological evidence of fracture cord changes on MRI have the best outcome, followed by those
or dislocation. This injury should be classified as a distractive with cord edema, and patients with parenchymatous hemorrhage
extension type according to Allen’s report or as a B3 type injury and contusion on MRI fare poorly [19]. MRI of the latter cases
according to the AO classification [8], which requires surgical frequently reveals hematomas and intramedullary edema [20].
intervention. Extensional injuries are characterized by progressive According to relevant studies, dynamic changes in the cervical
failure of the motion segment in an anterior-to-posterior direction, spine and spinal cord in cervical spinal cord injury patients
which consists of failure of the anterior longitudinal ligament and without fractures or dislocations were assessed by kinematic
annulus fibrosus. Widening of the disc space could be seen on the MRI. Kinematic MRI showed dynamic patho-anatomical changes
X-ray under extension. There may be a small avulsion fracture at in patients with a cervical SCI, such as spinal stenosis in different
the anterior margin of the disc space in some cases. If extensional locations without fractures or dislocations. The injured segments
force continued, posterior subluxation could occur. It is also had small spinal canal diameters, high Muhle grades, little space
common that the magnitude of posterior displacement could often available for the spinal cord, and a high spinal cord diameter to
vanish following flexion of the head. Extensional injuries were vertebral canal diameter ratio. MRI techniques can be utilized to
often the result of a fall on the face. Therefore, for patients with a examine SCI in patients [21].
facial injury who are diagnosed with an SCI even without fracture Moreover, posterior laminoplasty is a relatively simple procedure
or dislocation, attention should be given to an extensive cervical that can preserve cervical mobility without engendering substantial
spinal injury. In this study, we advocated that cervical laminoplasty post-operative complications. Laminoplasty achieves a decompressive
combined with transpedicular screw fixation is a preferred approach effect for patients with SCI, and the combined anterior spinal fusion
to treating an extensional cervical spinal injury in patients with in the ASF group as well as the posterior decompression fusion in the
stenosis. This study retrospectively analyzed the clinical outcomes PFS group enabled long-term post-operative stabilization, increasing
of patients who underwent anterior decompression and fusion the patient’s range of motion and their ability to perform daily activities
surgery and those who underwent posterior hybrid surgery [9]. and ultimately enhancing their post-operative quality of life, which is
DOI: https://doi.org/10.36922/jctr.00037