Management of Cervical Spinal Cord Injury without Major Bone Injury in Adults

J. Clin. Med., 2023 · DOI: 10.3390/jcm12216795 · Published: October 27, 2023

Spinal Cord Injury Neurology Spinal Disorders

Simple Explanation

Cervical spinal cord injury (CSCI) without major bone injury is becoming more common, especially in older individuals who may already have a narrowed spinal canal. The best way to manage this type of injury is debated among surgeons. One of the biggest questions is whether surgery is always necessary. Some research suggests early surgery (within 24 hours) is beneficial, but there is limited evidence to prove it is better than non-surgical treatments. Further research is needed to identify factors that can help predict how well a patient will recover and whether surgery is needed. Assessing quality of life, including pain and motor function, is also important in determining the best treatment approach.

Study Duration

January 2010 to July 2023

Participants

Not specified

Evidence Level

Review

Key Findings

1
Pre-existing cervical spinal canal stenosis (CSCS) is a significant risk factor for CSCI without major bone injury, with studies showing a high prevalence of CSCS in patients with this type of injury.
2
Delayed MRI (after 2 weeks) may provide a more accurate assessment of clinical symptom severity compared to acute MRI (within 2 days) due to changes in spinal cord signal intensity and paraspinal high-intensity areas.
3
There is no high evidence-based consensus on whether surgical or conservative treatment is better for CSCI without major bone injury, with some studies showing no significant difference in paralysis improvement between the two approaches.

Research Summary

This review addresses the increasing incidence and management of cervical spinal cord injury (CSCI) without major bone injury, a condition particularly relevant in aging populations often presenting with pre-existing cervical spinal canal stenosis (CSCS). The paper explores the clinical significance of MRI findings, including spinal cord signal intensity and paraspinal soft tissue damage, emphasizing that delayed MRI (after 2 weeks) may more accurately reflect clinical symptom severity than acute MRI. The review concludes that while early surgery has been increasingly recommended, no prospective study has demonstrated its superiority over conservative therapy for CSCI without major bone injury, highlighting the need for improved evaluation methods to predict functional prognosis and select timely treatment strategies.

Practical Implications

Diagnostic Improvements

Delayed MRI (performed >2 weeks post-injury) can give a better indication of injury severity than acute MRI.

Treatment Strategy

Treatment strategies should not only focus on motor function recovery but also on quality-of-life improvements such as managing neuropathic pain and spasticity.

Future Research

Further research is needed to develop methods for predicting functional prognosis at an earlier stage.

Study Limitations

1
Lack of high evidence-based studies
2
Difficulty in predicting prognosis of neurological status in the acute phase
3
Management of CSCI without major bone injury remains largely based on individual decisions

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