| Objective(s):SCIWORA(spinal cord injury without radiographic abnormality),also known as spinal cord injury without radiographic fracture and dislocation,is an injury to the spinal cord caused by external forces,but without skeletal abnormalities of fracture and dislocation on X-ray and CT imaging.SCIWORA occurs mainly in children,but it is not uncommon in adult patients as well.Several studies have shown that surgical treatment can lead to better neurological recovery,but the timing of surgery is still controversial.In this study,we retrospectively analyzed the efficacy and prognosis of cervical spinal cord injury without radiographic abnormality(CSCIWORA)in adults,and investigated the effect of different surgical timing on postoperative neurological recovery after CSCIWORA.To investigate the effect of different surgical timing on the recovery of neurological function after CSCIWORA in adults.Methods: This study retrospectively analyzed the data of 56 adult CSCIWORA patients with complete clinical information admitted to the Department of Neurosurgery of the Ninth 20 Hospital of the People’s Liberation Army Joint Security Force from January 2017 to December 2021.All patients were divided into three groups according to the time of obtaining surgery after injury;those who obtained surgical treatment within 3 days after injury were group A,those who obtained surgical treatment within 3-7 days after injury were group B,and those who obtained surgical treatment after 7 days after injury were group C.All three groups of patients were treated preoperatively using the Japanese Orthopaedic Association(JOA)cervical spine score,the American The patients in all three groups were evaluated preoperatively using the Japanese Orthopaedic Association(JOA)cervical spine score,the American Spinal Cord Injury Association(ASIA)spinal cord impairment scale(AIS),and the ASIA motor function score;the patients were followed up at 1 week,6months,and 12 months after surgery,and the cervical spine score,ASIA motor function score,and AIS were assessed.The patients were followed up at 1 week,6months and 12 months postoperatively to evaluate the JOA score,ASIA motor function score,AIS classification and postoperative complications.Results: 1.At 1 week,6 months,and 12 months after surgery,there were statistically significant differences in cervical JOA scores between groups A and B,and between groups A and C patients(P < 0.05),and the cervical JOA scores in group A improved significantly compared with those in groups B and C.At 1 week postoperatively,there was no statistically significant difference in cervical JOA scores between patients in groups B and C(P>0.05).At 6 and 12 months postoperatively,the differences in cervical JOA scores between patients in groups B and C were statistically significant(P < 0.05),and the cervical JOA scores in group B improved significantly compared with those in group C.In the follow-up of patients in each group at 1 week,6 months,and 12 months after surgery,there was a statistically significant difference in cervical JOA scores when comparing within groups(P <0.05),and a two-by-two comparison of cervical JOA scores at four time points yielded that groups A,B,and C were: 12 months postoperative > 6 months postoperative > 1 week postoperative > preoperative,and the follow-up results revealed that spinal cord function in group A recovered quickly in the early stage and slowly in the late stage The recovery of JOA score was faster in 1 week postoperatively and slowed down significantly after 6 months.2.The overall difference in ASIA motor scores between the three groups before surgery was not statistically significant(P > 0.05);at 1 week,6 months and 12 months after surgery,the differences in cervical JOA scores between groups A and B,and between groups A and C were statistically significant(P < 0.05),and the ASIA motor scores in group A improved significantly compared with those in groups B and C.At 1week postoperatively,there was no statistically significant difference in ASIA motion scores between patients in groups B and C(P>0.05).At 6 and 12 months postoperatively,the differences in ASIA motor scores between patients in groups B and C were statistically significant(P<0.05),and the ASIA motor scores in group B improved significantly compared with group C.In the follow-up of patients in each group at 1 week,6 months,and 12 months after surgery,there was a statistically significant difference in ASIA motor scores when comparing within groups(P < 0.05),and a two-by-two comparison of ASIA motor scores at four time points yielded that groups A,B,and C were: 12 months postoperative > 6 months postoperative > 1 week postoperative > preoperative.The follow-up results revealed that the recovery of motor function in group A was fast in the early stage and slow in the later stage,and the recovery of ASIA motor score was faster within 1 week after surgery and slowed down significantly after 6 months.3.The overall difference in urinary tract infection among the three groups was statistically significant(P < 0.05),with the incidence of urinary tract infection in group C being higher than that in groups A and B,and the incidence of urinary tract infection in group B being higher than that in group A.In contrast,the differences in the incidence of respiratory system infection,intraoperative port infection,lower limb deep vein thrombosis,and transient respiratory failure were not statistically significant(P > 0.05).Conclusion(s): 1.Early surgical decompression(i.e.,within 3 days after spinal cord injury)can result in better neurological recovery in adult CSCIWORA patients compared with later decompression times,which has an important role in the improvement of clinical symptoms and recovery of sensory and motor functions after spinal cord injury in patients.2.Surgical decompression within 3 to 7 days after spinal cord injury,again,can achieve better neurological recovery than later decompression time,but the ability to improve neurological function is weaker than early surgical decompression.3.Early surgical decompression is better for early functional recovery than later decompression in adult CSCIWORA patients and is effective in reducing the incidence of postoperative urinary tract infections.The incidence of postoperative urinary tract infections increases as the time to obtain surgery progresses. |
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