Prognostic factors in distractive extension injuries of the subaxial cervical spine.
BACKGROUND
The subaxial spine has high risk of fatal damage by trauma and thereby requires more accurate and aggressive treatment. For the proper treatment and predicting the prognosis, the evaluation to reveal the risk factors for the prognosis is important. We analyzed the various factors contributing to the prognosis in distractive extension injuries of the subaxial cervical spine.


METHODS
The study included 103 patients who were diagnosed as distractive extension injury of subaxial cervical spine. We evaluate the patient age, sex, cause of injury, initial neurological impairment, number and portion of injured segment, spinal stenosis, extent of soft tissue damage, ossification of the posterior longitudinal ligament, and degenerative spondylosis as a prognostic factor. To analyze the factor related with prognosis, the subjects were divided into group A, in which patients had neurological recovery ≥grade 2 on the ASIA scale or showed normal in final follow-up and group B, in which patients have no neurological recovery.


RESULTS
Prognosis was not associated with age, sex, and cause of injury (P = 0.677, 0.541, and 0.965, respectively). Prognosis was poor in cases with spinal stenosis (P = 0.009), soft tissue damage ≥grade 3 on magnetic resonance imaging (MRI) (P = 0.002), or severe neurological impairment (P ≤ 0.001). Logistic regression analysis also showed that prognosis was poor in cases with spinal stenosis (OR 5.03; 95% CI 1.20-16.93), soft tissue damage ≥grade 3 on MRI (OR 7.63; 95% CI 1.86-31.34), or severe neurological impairment (ASIA C, D, OR 0.59, 95% CI 0.14-2.41; ASIA A, B, OR 18.43, 95% CI 1.64-207.69).


CONCLUSIONS
The prognosis of patients with distractive extension injury of the subaxial cervical spine was poor in cases with spinal stenosis, severe soft tissue damage in MRI findings or severe initial neurological impairment.
Department of Orthopedic Surgery, Chonbuk National University Hospital, Jeonju, Korea.
Kyung-Jin
KJ
Song
Byung-Wan
BW
Choi
Chan-Il
CI
Park
Kwang-Bok
KB
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications*; D011379:Prognosis; D011859:Radiography; D012307:Risk Factors; D017695:Soft Tissue Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D013124:Spinal Injuries / Q000150:complications / Q000601:surgery; D013130:Spinal Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D055815:Young Adult