Prognosis and conditional nomogram of cervical spine fracture in patients with severe spinal cord injury: a multicenter retrospective study

International Journal of Surgery, 2023 · DOI: http://dx.doi.org/10.1097/JS9.0000000000000365 · Published: March 31, 2023

Spinal Cord Injury Research Methodology & Design Musculoskeletal Medicine

Simple Explanation

This study focuses on patients with cervical spine fractures and severe spinal cord injuries, who often face a high risk of death. The goal was to better understand the factors influencing their survival and to create tools that can help predict survival rates at different times after the injury. The researchers used a method to calculate the immediate risk of death and also looked at conditional survival rates, which show the chances of survival for patients who have already lived for a certain period after their injury. They then developed special charts, called nomograms, to predict survival rates based on how long a patient has already survived. The study found that the risk of death is highest in the first year after the injury, and that surgery, especially early surgery, can help reduce this risk. The survival rates improve the longer a patient survives after the injury. The nomograms created in the study can be used to predict survival rates at different time points and can help doctors and families make informed decisions about treatment.

Study Duration

2012 to 2022

Participants

450 patients with cervical spine fractures and severe SCI

Evidence Level

Retrospective Cohort Study

Key Findings

1
The instantaneous death risk was highest during the first 12 months after injury.
2
Surgical treatment can help decrease the instantaneous death risk quickly, especially in early-term surgery.
3
The 5-year CS increased constantly from 73.3% at baseline to 88.0% after 2 years of survival.

Research Summary

The study aimed to evaluate the instantaneous death risk and conditional survival (CS) of patients with cervical spine fractures and severe SCI, and developed conditional nomograms to predict survival rates. The study found that the instantaneous death risk was highest in the first 12 months, and surgical treatment, especially early-term surgery, could decrease this risk. The 5-year CS increased from 73.3% at baseline to 88.0% after 2 years of survival. Conditional nomograms were constructed and validated, showing good performance in predicting survival probability, which can aid in understanding prognosis and improving shared decision-making.

Practical Implications

Improved Understanding of Death Risk

The results improve the understanding of the instantaneous death risk of patients in different periods following injury, aiding in better patient management.

Accurate Survival Rate Prediction

Conditional nomograms provide accurate predictive tools for the risk of death, helping surgeons and patients understand certain prognoses.

Personalized Medicine

The findings support progress toward personalized medicine by offering tailored prognostic assessments based on individual patient characteristics and survival duration.

Study Limitations

1
Retrospective data introduce inherent bias.
2
Results based on Chinese patients may not apply to other populations.
3
Exclusion of patients who died before admission may overestimate survival rates.

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