Satoshi Nori1, Kota Watanabe2, Kazuki Takeda1,3, Junichi Yamane1,4, Hitoshi Kono1,5, Noriaki Yokogawa6, Takeshi Sasagawa6,7, Kei Ando8, Hiroaki Nakashima8, Naoki Segi8, Toru Funayama9, Fumihiko Eto10, Akihiro Yamaji11, Takeo Furuya12, Atsushi Yunde12, Hideaki Nakajima13, Tomohiro Yamada14,15, Tomohiko Hasegawa14, Yoshinori Terashima16,17, Ryosuke Hirota16, Hidenori Suzuki18, Yasuaki Imajo18, Shota Ikegami19, Masashi Uehara19, Hitoshi Tonomura20, Munehiro Sakata20,21, Ko Hashimoto22, Yoshito Onoda22, Kenichi Kawaguchi23, Yohei Haruta23, Nobuyuki Suzuki24, Kenji Kato24, Hiroshi Uei25,26, Hirokatsu Sawada26, Kazuo Nakanishi27, Kosuke Misaki27, Hidetomi Terai28, Koji Tamai28, Eiki Shirasawa29, Gen Inoue29, Katsuhito Kiyasu30, Yoichi Iizuka31, Eiji Takasawa31, Haruki Funao32,33,34, Takashi Kaito35, Toshitaka Yoshii36, Masayuki Ishihara37, Seiji Okada35, Shiro Imagama8, Satoshi Kato6. 1. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. 2. Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. kw197251@keio.jp. 3. Department of Orthopaedic Surgery, Japanese Red Cross Shizuoka Hospital, 8-2 Otemachi, Aoi-ku, Shizuoka, 420-0853, Japan. 4. Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, 2-37-1 Gakuen, Musashimurayama-shi, Tokyo, 208-0011, Japan. 5. Keiyu Orthopedic Hospital, 2267 Akodacho, Tatebayashi-shi, Gunma, 374-0013, Japan. 6. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan. 7. Department of Orthopedics Surgery, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan. 8. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. 9. Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. 10. Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. 11. Department of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, 2190, Sakaimachi, Sashima, Ibaraki, 306-0433, Japan. 12. Department of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan. 13. 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. 14. Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan. 15. Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawa-ku, Nagoya-shi, Aichi, 454-0933, Japan. 16. Department of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan. 17. Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, North 18-East 4-1 Kita-ku, Sapporo, 001-0018, Japan. 18. Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube city, Yamaguchi, 755-8505, Japan. 19. Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. 20. Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. 21. Department of Orthopaedics, Saiseikai Shiga Hospital, 2-4-1 Ohashi Ritto, Shiga, 520-3046, Japan. 22. Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan. 23. Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 24. Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan. 25. Department of Orthopaedic Surgery, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8393, Japan. 26. Department of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan. 27. Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan. 28. Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan. 29. Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan. 30. Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505, Japan. 31. Department of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan. 32. Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-0124, Japan. 33. Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, 852 Hatakeda, Narita, Chiba, 286-0124, Japan. 34. 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. 35. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaokal, Suita, Osaka, 565-0871, Japan. 36. Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan. 37. Department of Orthopaedic Surgery, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
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.
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.