Surgical tactics and prognostic factors in spinal cord injuries without radiological signs

Abstract

Aim. To study the outcomes of surgical interventions using the anterior cervical approach in spinal cord injuries.Material and Methods. This study examined 86 patients with SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) who were hospitalized from June 2018 to March 2021. Based on treatment methods, patients were divided into two groups: a control group (n=38) and a primary group (n=48). In the control group, patients received conservative treatment. In the primary group, patients underwent anterolateral total laminectomy with decompression, internal fixation, and spinal fusion using a bone graft.Results and Discussion. The JOA (Japanese Orthopedic Association) score in the primary group was 14.98±2.75 six months post-operation, compared to 12.16±2.54 in the control group (p<0.05). The improvement coefficient of the JOA index in the postoperative period was higher in the primary group than in the control group (p<0.05). Postoperative health status, physiological function, and role physical condition scores in the primary group were 23.18±1.09, 22.75±1.54, and 22.64±1.46 respectively, significantly higher than in the control group, which scored 20.94±1.65, 20.26±1.78, and 19.56±1.82 respectively (p<0.05).Conclusion. Performing anterolateral total laminectomy with decompression, internal fixation and spinal fusion using a bone graft in patients with SCIWORA contributes to a more effective restoration of the function of the cervical spinal cord and improves the prognosis and quality of life. Independent prognostic factors for patients include: type of cervical spinal cord injury according to the ASIA classification; MRI findings, the extent of cervical spinal cord injury; time from the moment of injury to the start of treatment.