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  4. Prognostic Factors for Cervical Spinal Cord Injury without Major Bone Injury in Elderly Patients

Prognostic Factors for Cervical Spinal Cord Injury without Major Bone Injury in Elderly Patients

Journal of Neurotrauma, 2022 · DOI: 10.1089/neu.2021.0351 · Published: May 1, 2022

Spinal Cord InjuryAgingResearch Methodology & Design

Simple Explanation

This study aimed to identify factors that predict how well elderly patients recover from cervical spinal cord injuries (CSCI) without major bone damage. The study looked at patients aged 65 and older who had this type of injury. The research examined things like the patient's age, weight, MRI results, and other health problems to see which ones were linked to better or worse recovery. The goal was to improve treatment and rehabilitation for these patients. The researchers found that factors such as body mass index, MRI findings, the severity of the injury at the start, cognitive issues like dementia, and lung infections after the injury all played a role in how well patients recovered their ability to walk.

Study Duration
2010-2020 (10 years)
Participants
591 patients aged ≥65 years with CSCI without major bone injury
Evidence Level
Not specified

Key Findings

  • 1
    In AIS A–C cases, body mass index (BMI), MRI signal change, AIS grade on admission, dementia/delirium comorbidity, and post-injury pneumonia were identified as independent prognostic factors for walking recovery.
  • 2
    In AIS B and C cases only, the prevalence of ossification of the posterior longitudinal ligament (OPLL) was an independent prognostic factor.
  • 3
    In AIS D cases, age, upper extremity ASIA motor score on admission, and whether or not the patient had surgery were independent prognostic factors for full motor recovery.

Research Summary

This multi-center study aimed to identify predictors of neurological improvement in elderly patients with CSCI without major bone injury. In AIS A–C cases, body mass index (OR: 1.112), magnetic resonance imaging signal change (OR: 0.240), AIS on admission (OR: 3.497), comorbidity of dementia/delirium (OR: 0.365), and post-injury pneumonia (OR: 0.194) were identified as independent prognostic factors for walking recovery. In AIS D cases, age (OR: 0.937), upper extremity ASIA motor score on admission (OR: 1.230 [per 5 scores]), and operation (OR: 0.519) were independent prognostic factors for full motor recovery.

Practical Implications

Rehabilitation Strategies

Promoting rehabilitation measures to reduce cognitive changes, prevent post-injury pneumonia, and manage unhealthy body weight changes can contribute to greater neurological improvement in AIS A–C cases.

Surgical Considerations

Careful consideration should be given to surgical treatment in elderly patients with CSCI without major bone injury, as the prognosis for neurological status is difficult to predict in the acute phase, and these patients are at high risk for complications.

Prognostic Assessment

The severity of paralysis on admission has a major impact on functional outcomes, suggesting early and accurate neurological assessment is critical.

Study Limitations

  • 1
    Retrospective design
  • 2
    Inclusion of inpatients in acute-care hospitals only (no outpatients)
  • 3
    Different indications for surgical treatment including the timing and conservative treatment at each center.

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