Analysis Of The Prognosis Of The Surgical Treatment Of The Acute Traumatic Central Cord Syndrome Without Fracture And Dislocation

Objective: Central canal syndrome(CCS)is a common incomplete spinal cord injury and operative decompression is an effective method.However,there are still many controversies on the timing of surgical treatment and the factors affecting the prognosis of patients with acute traumatic central canal syndrome without fracture and dislocation.This study retrospectively analyzed the imaging and clinical data of 76 cases with acute traumatic central canal syndrome without fracture and dislocation treated in our hospital to evaluate the effect of operation and to explore the related factors of prognosis.Method: The imaging and clinical data of 76 patients with acute traumatic central canal syndrome without fracture and dislocation were reviewed retrospectively from January 2014 to June 2018.ASIA motor scores(AMS)and Japanese Orthopaedic Association Score(JOA)were used to evaluate the neurological function of patients at preoperative and the last follow-up and assess the therapeutic effect.they were divided into early operation group(less than 96 hours)and late operation group(> 96 hours)according to preoperative time,and the recovery of spinal cord function was compared.The correlation between the factors and AMS and JOA scores was analyzed by bivariate analysis.According to the improvement rate of JOA,the patients were divided into two groups with good prognosis(> 50%)and poor prognosis(≤50%).Independent sample t test and chi square test were used to analyze the factors affecting the recovery of spinal cord function after operation.Bilateral pvalue < 0.05 was considered statistically significant.Results: The mean age of 76 patients were 62.50±12.85 years old,58(76.30%)were male and 18(23.70%)were female.The average postoperative time was(5.20 ± 3.72)days.49(64.5%)patients underwent anterior operation and 27(35.5%)patients underwent posterior operation.The JOA score and AMS score of 76 patients at the last follow-up were significantly higher than those before operation(P < 0.05).The time before operation had no effect on the recovery of spinal cord function(P > 0.05).The results of bivariate analysis showed that spinal cord area/spinal canal area,length of high signal in spinal cord were negatively correlated with AMS score and JOA score at admission,while intrinsic muscle strength of hand was positively correlated with AMS score and JOA score at admission.The results of subgroup analysis of two groups showed that intrinsic muscle strength of hand(P=0.003),maximum spinal cord compression(P= 0.013)and maximum canal compromise(P=0.011)were significant effect on the recovery of spinal cord function.Conclusion: Surgical treatment of acute traumatic cervical spinal cord syndrome without fracture and dislocation is safe and effective.Low spinal cord area/spinal canal area and intrinsic muscle strength of hand at admission,long high intensity signal in spinal cord indicate that the spinal cord function after injury was severe,while the higher AMS and JOA scores were at admission,the smaller maximum spinal cord compression and maximum canal compromise the maximum compression,and the higher intrinsic muscle strength of hand suggest a better prognosis after operation.