Orthopaedic Surgery (Dec 2023)

Benefits of Early Surgical Treatment for Patients with Multilevel Cervical Canal Stenosis of Acute Traumatic Central Cord Syndrome

  • Quan Zhou,
  • Wei He,
  • Jiaheng Lv,
  • Hao Liu,
  • Huilin Yang,
  • Junxin Zhang,
  • Tao Liu

DOI
https://doi.org/10.1111/os.13904
Journal volume & issue
Vol. 15, no. 12
pp. 3092 – 3100

Abstract

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Introduction Currently, there exists considerable debate surrounding the optimal treatment approaches for different subtypes of patients with spinal cord injury (SCI). The purpose of this study was to conduct a comparative analysis of the benefits associated with conservative treatment and treatments with different surgical periods for patients diagnosed with acute traumatic central cord syndrome (ATCCS) and multilevel cervical canal stenosis (CCS). Methods A retrospective cohort study was conducted, and 93 patients who met inclusion and exclusion criteria in our hospital between 2015 and 2020 were followed for a minimum duration of 2 years. Among them, 30 patients (Group A) received conservative treatment, 18 patients (Group B) received early surgery (≤7 days), and 45 patients (Group C) received late surgery (>7 days). The American Spinal Injury Association (ASIA) grade, Japanese Orthopedic Association (JOA) score, and recovery rate (RR) were evaluated. Multivariate linear regression was used to analyze prognostic determinants. Cost‐utility analysis was performed based on the EQ‐5D scale. Results The ASIA grade, JOA score, and RR of all three groups improved compared with the previous evaluation (P 0.05). The EQ‐5D scale in Group B was optimal at the last follow‐up. The incremental cost‐utility ratio (ICUR) of Group A was the lowest, while that of Group B compared to Group A was less than the threshold of patients’ willingness to pay. Age, initial ASIA grade, and treatment types significantly affected the outcomes. Conclusions Both conservative and surgical treatments yield good results. Compared with patients who received conservative treatment and late surgery, patients who received early surgery had better clinical function and living quality. Despite the higher cost, early surgery is cost‐effective when compared to conservative treatment. Younger age, initial better ASIA grade, and earlier surgery were associated with better prognosis.

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