The Correlation between Cervical Fusion Length and Functional Outcomes in Patients with Traumatic Spinal Cord Damage—A Registry-Based Cohort Study

J. Clin. Med, 2022 · DOI: 10.3390/jcm11195867 · Published: October 4, 2022

Spinal Cord Injury Surgery Rehabilitation

Simple Explanation

This study investigates the relationship between the length of cervical fusion (number of vertebrae fused) and the success of rehabilitation after a traumatic spinal cord injury. The researchers analyzed data from 199 patients with cervical spinal cord injuries who underwent vertebral fusion and rehabilitation. The study found that longer fusion lengths were associated with reduced gains in functional independence during rehabilitation, suggesting that fusion length can be a predictor of rehabilitation success.

Study Duration

2003 to 2018

Participants

199 patients with traumatic cervical spine injuries and cervical spinal cord damage

Evidence Level

Level 3: Registry-Based Cohort Study

Key Findings

1
Cervical fusion length was identified as an independent predictor of functional outcome, as measured by the Spinal Cord Independence Measure II (SCIM II).
2
Longer fusion lengths correlated with smaller improvements in SCIM II scores between hospital admission and discharge, indicating reduced rehabilitation success.
3
The length of fusion mediates the cervical range of motion and, therefore, has critical functionality in daily tasks that involve movements of the head, such as self-care and mobility.

Research Summary

This study evaluated the length of vertebral fusion as a potential indicator for reduced rehabilitation success in individuals suffering from cervical spinal cord injury. The length of fusion, SCIM at admission and the International Standards for Neurological Classiﬁcation of Spinal Cord Injury (ISNCSCI) values at admission could be identiﬁed as signiﬁcant predictors. The study concludes that a signiﬁcant correlation between length of fusion and patient outcome exists independently of previously established predictors of rehabilitation success, such as the ISNCSCI.

Practical Implications

Rehabilitation Planning

Rehabilitation professionals should routinely assess fusion length in patients with cervical spinal cord injuries and consider it during rehabilitation planning to address mobility impairments associated with longer fusions.

Surgical Decision-Making

Surgeons should consider the potential negative implications of longer fusions on long-term rehabilitation outcomes when making acute treatment decisions, balancing stability with potential impacts on functional recovery.

Personalized Therapy

Physical therapy should address the impairment of mobility associated with vertebral fusions so that daily tasks represented within the SCIM can be performed to a better extent in those with longer fusions.

Study Limitations

1
Monocentric design may be influenced by institutional bias.
2
The study did not account for different surgical approaches due to small case numbers.
3
Moderate model fitness (adjusted R2 = 0.29) suggests the possibility of non-linear correlations not fully captured by the linear regression model.

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