Imaging And Clinical Study Of Traumatic Cervical Spinal Cord Injury Without Fracture Or Dislocation

Cervical spinal cord injury often causes serious damage to patients.Severe spinal cord injury with total paralysis or paraplegia is difficult to care,has many complications,poor patient expectations,and huge medical costs,which is a huge loss to patients,medical institutions and society.Traumatic spinal cord injury accounts for the largest proportion of clinical spinal cord injury,especially cervical spinal cord injury.As an important index to evaluate the cervical sagittal balance,cervical curvature is of great significance in predicting the prognosis of cervical spine surgery and cervical degenerative diseases.In recent years,there have been many studies on cervical curvature and cervical sagittal balance.The combination of cervical curvature and cervical spinal cord injury is also a hot topic in trauma orthopedics and spinal surgery.In view of the above research hotspots,this thesis mainly carried out three parts: the first part was to analyze the difference and correlation of cervical curvature measurement between X-ray and MRI in traumatic cervical spinal cord injury without fracture or dislocation;The second part was whether cervical curvature affected the neurological outcome of traumatic cervical spinal cord injury without fracture or dislocation: 1-year follow-up;The third part is the analysis of cervical curvature loss and C5 nerve root palsy after posterior surgery for traumatic cervical spinal cord injury without fracture or dislocation.To provide reference for the treatment of traumatic cervical spinal cord injury without fracture or dislocation through the imaging and clinical research on cervical spinal cord injury.Part Ⅰ.Comparison and correlation analysis of cervical curvature measured by X-ray and MRI in traumatic cervical spinal cord injury without fracture or dislocationObjective: To measure cervical curvature in patients with traumatic cervical spinal cord injury without fracture or dislocation on X-ray and MRI,and to analyze the difference and correlation of the data,so as to provide a basis for measuring cervical curvature by MRI in clinical practice.Methods: The image data of 159 patients with traumatic cervical spinal cord injury patients without fracture and dislocation who underwent X-ray and MRI examination in the Third Hospital of Hebei Medical University from January 2019 to June 2022 were collected,and the C2-7 Cobb angle,CCI,CSA,arc-chord distance and other data were measured.The correlation between the four groups of data and the difference of MRI and X-ray measurement values were statistically analyzed.Results: All the measured data were verified to be true and reliable by consistency test.Spearman correlation analysis showed that C2-7 Cobb angle,CCI,CSA,and arc-chord distance were correlated,and the MRI measurement data showed a stronger overall correlation.Wilcoxon signed rank test showed that there was no significant difference in C2-7 Cobb angle,CCI,CSA,and arc-chord distance between X-ray and MRI measurementsPart Ⅱ.Does cervical curvature affect neurological outcome after incomplete spinal cord injury without radiographic abnormality(SCIWORA):1-year follow-upObjective: To explore the correlation between cervical curvature and the prognosis of spinal cord injury by measuring cervical curvature in patients with traumatic cervical spinal cord injury without fracture or dislocation,and to analyze the correlation between cervical curvature and the prognosis of spinal cord injury,to analyze the factors affecting the prognosis of spinal cord injury in clinical practice,and to provide help for the treatment of such injuries.Methods: A retrospective study was conducted on all patients with spinal cord injury admitted to the Third Affiliated Hospital of Hebei Medical University from January 2017 to June 2020.After screening,data were recorded from 106 patients who met the study requirements,including: gender,age,injury factors,Cobb angle,CCI,CSA,and ASIA motor and sensory scores.Wilcoxon signed-rank test was used to compare and analyze the data after injury and 1-year follow-up.Pearson correlation analysis was performed on Cobb angle,CCI and CSA.The variables of each group were analyzed by simple linear regression analysis and multiple linear regression analysis.Results: The results of Wilcoxon signed rank test showed that there was no significant difference in Cobb angle,CCI and CSA at 1 year follow-up compared with those after injury,but the ASIA motor and sensory scores were significantly improved.Pearson correlation analysis showed that there were correlations among Cobb angle,CCI and CSA.Simple linear regression analysis and multiple linear regression analysis showed that the neurological improvement rate was negatively correlated with age,and positively correlated with Cobb angle.Part Ⅲ.Analysis of cervical curvature loss and C5 nerve root palsy after posterior surgery for traumatic cervical spinal cord injury without fracture or dislocationObjective: To analyze the C5 nerve root palsy and cervical curvature changes after posterior surgery for traumatic cervical spinal cord injury without fracture or dislocation,to provide help for the prevention of C5 nerve root palsy in clinical practice,to explore the influencing factors of postoperative cervical curvature loss,and to provide reference for the selection of posterior surgery.Methods: A total of 131 patients with traumatic cervical spinal cord injury without fracture or dislocation who underwent posterior cervical open-door laminoplasty or posterior cervical laminectomy decompression and lateral mass screw internal fixation in the Third Hospital of Hebei Medical University from January 2012 to January 2022 were selected.Group A included 73 patients who underwent cervical single open-door laminoplasty.Group B included 58 patients who underwent posterior cervical laminectomy decompression and lateral mass screw fixation.The preoperative Cobb angle,postoperative Cobb angle,Cobb angle at the last follow-up,JOA score and C5 nerve root palsy were measured and recorded.Results: There was no significant difference in gender,age and JOA score between group A and group B by Mann-Whitney test.The JOA score of the two groups improved after operation and was statistically significant compared with that before operation.The change of cervical curvature in group A after operation was statistically significant compared with that in group B.The Cobb angle of group B after operation was higher than that before operation.Long-term follow-up showed that there were different degrees of loss of cervical curvature,but the loss of cervical spine in group B was less than that in group A.A total of 131 cases were included in this study,including 11 cases of C5 nerve root palsy,accounting for 8.4%,including 3cases in group A,accounting for 4.11%,and 8 cases in group B,accounting for 13.79%.C5 nerve root palsy was more likely to occur in the group of posterior cervical laminectomy decompression and lateral mass screw internal fixation.Spearman correlation analysis and multiple linear regression analysis showed that Cobb angle loss was positively correlated with postoperative Cobb angle improvement(correlation coefficient =0.82,β=0.92).Preoperative Cobb angle,postoperative Cobb angle improvement,postoperative Cobb angle and C5 nerve root palsy analysis showed that the improvement of postoperative Cobb angle had the greatest impact on C5 nerve root palsy.Conclusions:1.The evaluation of cervical curvature requires the synthesis of multiple data.There is a significant correlation between each cervical curvature parameter on either X-ray or MRI images,and the correlation value measured by MRI is better than that measured by X-ray,which is more reliable for cervical curvature evaluation.MRI examination position is closer to the clinical treatment process,and has more reference value for surgery or rehabilitation to correct cervical curvature.2.For some patients with spinal cord injury without fracture or dislocation,conservative treatment can also achieve good therapeutic effect.The prognosis of spinal cord injury becomes worse with age.Cobb angle as an important risk factor should be paid attention to,and it has a positive impact on the prognosis of spinal cord injury within a certain range.For patients with traumatic cervical spinal cord injury without fracture or dislocation,the improvement of cervical curvature is beneficial to the neurological prognosis of patients.3.Posterior cervical spine surgery can improve the neurological function of patients.Cervical curvature is closely related to the occurrence of C5 nerve root palsy.Comprehensive evaluation of cervical curvature before and after surgery is helpful to reduce the occurrence of C5 nerve root palsy.Although the incidence of C5 nerve root palsy after posterior cervical laminectomy decompression and lateral mass screw fixation is relatively high,the long-term recovery effect is good.The long-term effect of intraoperative correction of cervical curvature is not ideal,and there is a loss of cervical curvature.Although posterior cervical laminectomy decompression and lateral mass screw internal fixation can better correct the loss of cervical curvature and maintain the balance of the cervical spine,it may cause aggravation of upper cervical spine degeneration and local pseudarthrosis formation.Therefore,the choice of posterior cervical spine surgery should be comprehensively considered from many aspects such as cervical curvature,postoperative complications,cervical spine degeneration,and spinal balance.