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


Study design

Retrospective multicenter study.


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


Thirty-three medical institutions in Japan.


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.


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%).


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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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.

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Authors and Affiliations



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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Competing interests

The authors declare no competing interests.

Ethical approval

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).

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