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Does surgery improve neurological outcomes in older individuals with cervical spinal cord injury without bone injury? A multicenter study

Spinal Cord (2022)Cite this article

Subjects

Abstract

Study design

Retrospective multicenter study.

Objectives

To investigate the neurological outcomes of older individuals treated with surgery versus conservative treatment for cervical spinal cord injury (CSCI) without bone injury.

Setting

Thirty-three medical institutions in Japan.

Methods

This study included 317 consecutive persons aged ≥65 years with CSCI without bone injury in participating institutes between 2010 and 2020. The participants were followed up for at least 6 months after the injury. Individuals were divided into surgery (n = 114) and conservative treatment (n = 203) groups. To compare neurological outcomes and complications between the groups, propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed.

Results

After propensity score matching, the surgery and conservative treatment groups comprised 89 individuals each. Surgery was performed at a median of 9.0 (3–17) days after CSCI. Baseline factors were comparable between groups, and the standardized difference in the covariates in the matched cohort was <10%. The American Spinal Injury Association (ASIA) impairment scale grade and ASIA motor score (AMS) 6 months after injury and changes in the AMS from baseline to 6 months after injury were not significantly different between groups (P = 0.63, P = 0.24, and P = 0.75, respectively). Few participants who underwent surgery demonstrated perioperative complications such as dural tear (1.1%), surgical site infection (2.2%), and C5 palsy (5.6%).

Conclusion

Conservative treatment is suggested to be a more favorable option for older individuals with CSCI without bone injuries, but this finding requires further validation.

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Fig. 1: Participant flow chart of this multicenter cohort.

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge the contributions of the members of the 33 participating institutions in the assistance with data collection. The authors thank Naoki Miyazaki, MPH, Kengo Nagahima, PhD, and Noriyuki Ishida, MPH for their help with the statistical analyses in the study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Satoshi Nori, Kota Watanabe, Kazuki Takeda, Junichi Yamane & Hitoshi Kono

  2. Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Otemachi, Aoi-ku, Shizuoka, 420-0853, Japan

    Kazuki Takeda

  3. Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan

    Junichi Yamane

  4. Keiyu Orthopedic Hospital, 2267 Akodacho, Tatebayashi-shi, Gunma, 374-0013, Japan

    Hitoshi Kono

  5. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan

    Noriaki Yokogawa, Takeshi Sasagawa & Satoshi Kato

  6. Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan

    Takeshi Sasagawa

  7. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Kei Ando, Hiroaki Nakashima, Naoki Segi & Shiro Imagama

  8. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Toru Funayama

  9. Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan

    Fumihiko Eto

  10. Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, 2190, Sakaimachi, Sashima, Ibaraki, 306-0433, Japan

    Akihiro Yamaji

  11. Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan

    Takeo Furuya & Atsushi Yunde

  12. Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Hideaki Nakajima

  13. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan

    Tomohiro Yamada & Tomohiko Hasegawa

  14. Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya-shi, Aichi, 454-0933, Japan

    Tomohiro Yamada

  15. Department of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan

    Yoshinori Terashima & Ryosuke Hirota

  16. Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, North 18-East 4-1 Kita-ku, Sapporo, 001-0018, Japan

    Yoshinori Terashima

  17. Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube city, Yamaguchi, 755-8505, Japan

    Hidenori Suzuki & Yasuaki Imajo

  18. Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan

    Shota Ikegami & Masashi Uehara

  19. Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Hitoshi Tonomura & Munehiro Sakata

  20. Department of Orthopaedics, Saiseikai Shiga Hospital, 2-4-1 Ohashi Ritto, Shiga, 520-3046, Japan

    Munehiro Sakata

  21. Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Ko Hashimoto & Yoshito Onoda

  22. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Kenichi Kawaguchi & Yohei Haruta

  23. Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan

    Nobuyuki Suzuki & Kenji Kato

  24. Department of Orthopaedic Surgery, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8393, Japan

    Hiroshi Uei

  25. Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan

    Hiroshi Uei & Hirokatsu Sawada

  26. Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan

    Kazuo Nakanishi & Kosuke Misaki

  27. Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan

    Hidetomi Terai & Koji Tamai

  28. Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan

    Eiki Shirasawa & Gen Inoue

  29. Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505, Japan

    Katsuhito Kiyasu

  30. Department of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan

    Yoichi Iizuka & Eiji Takasawa

  31. Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-0124, Japan

    Haruki Funao

  32. Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan

    Haruki Funao

  33. Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, 1-4-3 Mita, Minato-ku, Tokyo, 108-8329, Japan

    Haruki Funao

  34. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaokal, Suita, Osaka, 565-0871, Japan

    Takashi Kaito & Seiji Okada

  35. Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan

    Toshitaka Yoshii

  36. Department of Orthopaedic Surgery, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan

    Masayuki Ishihara

Authors
  1. Satoshi Nori
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  2. Kota Watanabe
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  3. Kazuki Takeda
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  4. Junichi Yamane
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  5. Hitoshi Kono
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  7. Takeshi Sasagawa
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  8. Kei Ando
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  9. Hiroaki Nakashima
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  10. Naoki Segi
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  19. Yoshinori Terashima
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  20. Ryosuke Hirota
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  48. Seiji Okada
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  49. Shiro Imagama
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  50. Satoshi Kato
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Contributions

SN and KW designed the research. SN analyzed the data. SN and KW wrote the paper. SN, KT, JY, HK, NY, TS, HN, NS, TF, FE, AY, AY, HN, TY, TH, YT, RH, HS, YI, SI, MU, HT, MS, KH, YO, KK, YH, NS, KK, HU, HS, KN, KM, HT, KT, ES, KK, YI, ET, HF, TY and MI performed data collection. KA, GI, TK, SK, TF, KW, SO, and SI supervised the study. All authors reviewed and approved the manuscript.

Corresponding author

Correspondence to Kota Watanabe.

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The authors declare no competing interests.

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This study received ethical approval from the institutional review board of the representative facility (Keio University School of Medicine, No. 20200233). We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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Nori, S., Watanabe, K., Takeda, K. et al. Does surgery improve neurological outcomes in older individuals with cervical spinal cord injury without bone injury? A multicenter study. Spinal Cord (2022). https://doi.org/10.1038/s41393-022-00818-6

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  • DOI: https://doi.org/10.1038/s41393-022-00818-6

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