A Study On The Influencing Factors Of Mid-Long-Term Efficacy And Prognosis Of Surgical Intervention In Central Cord Syndrome

Objective: To evaluate the mid-long-term efficacy and prognosis of surgical intervention for central cord syndrome(CCS),compare the efficacy and prognosis between the early operation group(≤7d)and the late operation group(> 7d),and analyze the influencing factors of efficacy and prognosis.Methods: Data of 96 patients with CCS who underwent surgical treatment in the spinal surgery department of our hospital on December 31,2013 were collected and analyzed retrospectively.The neurologic function of the patients at admission,7 days after surgery and at the last follow-up was evaluated by JOA score and ASIA injury grade.Compared the efficacy and prognosis between the early operation group(≤7d)and the late operation group(> 7d).Possible influencing factors were extracted by literature search and analysis of the original data.Single linear factors and multiple linear regression analysis were performed to analyze the related factors that might affect the efficacy and prognosis.Results: A total of 96 eligible patients were included in this study,and the postoperative follow-up time was 74.23±10.54)months(62~115 months).All patients who were followed up at the last follow-up achieved varying degrees of neurological recovery.At the last follow-up,75patients(about 78.1%)had the ASIA injury grade upgraded by at least one level.At the last follow-up,the mean JOA score increased from(9.03±3.32)before treatment to(13.95±2.53),and the JOA improvement rate was(64.86±23.11)%.JOA scores at 7 days after surgery and at the last follow-up were significantly higher than those at admission(P< 0.05),and the improvement rate of JOA in the early surgery group was significantly higher than that in the late surgery group at the last follow-up,with statistically significant differences(P< 0.05).Single factors linear regression analysis showed that age,JOA score on admission,abnormal spinal cord signals,timing of surgery,number of surgical segments,and with diabetes were the influencing factors for the efficacy and prognosis,and hypertension was only the influencing factor for the efficacy.Multi-factor linear regression analysis was carried out for each single factor mentioned above showed that JOA score on admission,age,with diabetes,with hypertension and timing of surgery were independent influencing factors for the efficacy.JOA score,age,and concomitant diabetes were independent prognostic factors.Conclusion:Surgical treatment of CCS patients can achieve good recovery of neurologic function,no late neurological damage,safe and effective,early surgery(≤7d)have better neurologic function recovery than late surgery(> 7d).The less the neurological impairment,the better the postoperative efficacy and the stronger the potential neurological function recovery ability.The older the patient,the worse the postoperative efficacy and the worse the recovery ability of nerve function.The efficacy of patients with hypertension and diabetes is poor.The timing of surgery is negatively correlated with the efficacy,so we believe that the efficacy of early surgery(≤7d)is better than that of late surgery(> 7d).The lower the neurological impairment,the better the prognosis,and the better the mid-long-term recovery of neurological function(≥5years).The older the patient,the worse the prognosis.In patients with diabetes,the prognosis is poor.