Risk factors for spinal cord injury progression after anterior fusion for cervical spine trauma: a retrospective case-control study

Single-center, retrospective case-control study.

This study aimed to determine the risk factors for progression of neurological symptoms after anterior fusion for cervical spine trauma with no or incomplete spinal cord injury.

Community-based hospital with an acute care center in Japan.

We retrospectively reviewed 54 consecutive unstable subaxial cervical spine fracture/dislocation cases that had undergone surgical treatment. A total of 20 patients with no or incomplete spinal cord injury who underwent anterior fusion were identified. Injury characteristics, bony spinal canal diameter (SCD) at the injured level on computed tomography (CT), diagnosis delay of more than 24 h, and other surgery-related parameters were documented as potential risk factors.

The study population included 16 male and 4 female patients. The median age was 71.5 (range: 20-88) years. Two cases of SCI progression were identified (AIS E to C5-8 C and AIS D to C5-8 C). Both cases occurred in men who were older than the average age of all the patients. Only delayed diagnosis was significantly associated with the progression of SCI (p = 0.02). SCDs on CT demonstrated a tendency to be smaller than those of cases without progression, but this was not statistically significant (progression: median, 8.1 [7.2-8.9] mm; no progression: median, 10.1 [4.2-12.6] mm; p = 0.21).

Our results suggested that a delay in diagnosis was associated with neurological progression after ACF. Furthermore, imposing ligamentous flavum might become a compression factor if the diagnosis is delayed.