Evidence map›Paper›PMID 41813819›Full record

ArticleSpinal cord2026

Impact of delayed diagnosis on surgical management and neurological outcomes in elderly patients with cervical spinal cord injury without radiographic evidence of trauma: a multicenter registry study.

Tomohiro Yamada, Yu Yamato, Tomohiko Hasegawa, Yukihiro Matsuyama, Noriaki Yokogawa, Takeshi Sasagawa, Hiroaki Nakashima, Naoki Segi, Sadayuki Ito, Toru Funayama and 50 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Spinal cord, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

60 authors.

Tomohiro YamadaDepartment of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan. cordial27@gmail.com.ORCID 0000-0002-7220-7321
Yu YamatoDepartment of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.
Tomohiko HasegawaDepartment of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.
Yukihiro MatsuyamaDepartment of Orthopaedic Surgery, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatsu City, Shizuoka, 431-3192, Japan.
Noriaki YokogawaDepartment of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Takeshi SasagawaDepartment of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Hiroaki NakashimaDepartment of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Naoki SegiDepartment of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Sadayuki ItoDepartment of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Toru FunayamaDepartment of Orthopaedic Surgery, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
Fumihiko EtoNHO Mito Medical Center, 280, Sakuranosato, Ibaraki-machi, Higashi Ibaraki-gun, Ibaraki, 311-3193, Japan.
Akihiro YamajiDepartment of Orthopaedic Surgery, Ibaraki Seinan Medical Center Hospital, 2190, Sakaimachi, Sashima, Ibaraki, 306-0433, Japan.
Kota WatanabeDepartment of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Satoshi NoriDepartment of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.ORCID 0000-0002-6406-1836
Kazuki TakedaDepartment of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
Takeo FuruyaDepartment of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
Atsushi YundeDepartment of Orthopaedic Surgery, Graduate school of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan.
Hideaki NakajimaDepartment of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
Yoshinori TerashimaDepartment of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan.
Ryosuke HirotaDepartment of Orthopaedic Surgery, Sapporo Medical University, South 1-West 16-291, Chuo-ku, Sapporo, 060-8543, Japan.
Hidenori SuzukiDepartment of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube city, Yamaguchi, 755-8505, Japan.ORCID 0000-0002-3156-0591
Yasuaki ImajoDepartment of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube city, Yamaguchi, 755-8505, Japan.ORCID 0000-0003-1291-745X
Shota IkegamiDepartment of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
Masashi UeharaDepartment of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.ORCID 0000-0003-0718-6357
Hitoshi TonomuraDepartment of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Munehiro SakataDepartment of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
Ko HashimotoDepartment of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Yoshito OnodaDepartment of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
Kenichi KawaguchiDepartment of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.ORCID 0000-0003-1841-8950
Yohei HarutaDepartment of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi Higashi-ku, Fukuoka, 812-8582, Japan.
Nobuyuki SuzukiDepartment of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
Kenji KatoDepartment of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
Hiroshi UeiDepartment of Orthopaedic Surgery, Nihon University Hospital, 1-6 Kanda-Surugadai, Chiyoda-ku, Tokyo, 101-8393, Japan.
Hirokatsu SawadaDepartment of Orthopaedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo, 173-8610, Japan.
Kazuo NakanishiDepartment of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan.ORCID 0000-0002-5479-581X
Hidetomi TeraiDepartment of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan.
Koji TamaiDepartment of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka-city, Osaka, 545-8585, Japan.ORCID 0000-0003-1467-2599
Akiyoshi KurodaDepartment of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
Gen InoueDepartment of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitazato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.ORCID 0000-0001-6500-9004
Kenichiro KakutaniDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Yuji KakiuchiDepartment of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Katsuhito KiyasuDepartment of Orthopaedic Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505, Japan.
Hiroyuki TominagaDepartment of Orthopaedic Surgery, Graduate School of medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
Yoichi IizukaDepartment of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
Eiji TakasawaDepartment of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.ORCID 0000-0002-7995-6093
Koji AkedaDepartment of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan.
Norihiko TakegamiDepartment of Orthopaedic Surgery, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu city, Mie, 514-8507, Japan.
Haruki FunaoDepartment of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, 852 Hatakeda, Narita, Chiba, 286-0124, Japan.
Yasushi OshimaDepartment of Orthopaedic Surgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Takashi KaitoDepartment of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.ORCID 0000-0003-4882-2997
Daisuke SakaiDepartment of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.ORCID 0000-0003-4189-9270
Toshitaka YoshiiDepartment of Orthopaedic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-Ku, Tokyo, 113-8519, Japan.
Tetsuro OhbaDepartment of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
Bungo OtsukiDepartment of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawaracho, Sakyo-ku, Kyoto, Kyoto, 606-8501, Japan.
Shoji SekiDepartment of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, Toyama, 930-0194, Japan.
Masashi MiyazakiDepartment of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan.
Masayuki IshiharaDepartment of Orthopaedic Surgery, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan.
Seiji OkadaDepartment of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
Shiro ImagamaDepartment of Orthopedic Surgery, Nagoya University, Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
Satoshi KatoDepartment of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.ORCID 0000-0003-4762-5932

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

STUDY

designMulticenter retrospective cohort study.

objectivesTo investigate the impact of delayed diagnosis on treatment decisions and neurological outcomes in elderly patients with cervical spinal cord injury (CSCI) without radiographic evidence of trauma (SCIWORET).

settingNationwide multicenter registry of the Japan Association of Spine Surgeons with Ambition (JASA).

methodsData from patients aged ≥65 years with traumatic cervical SCIWORET treated between 2010 and 2020 were reviewed. Delayed diagnosis was defined as a diagnosis of CSCI made more than 24 hours after injury, either because of (1) physician delay (missed diagnosis despite presentation) or (2) patient delay (injury-to-hospital arrival > 24 hours). Clinical characteristics, radiological findings, treatment strategies, and neurological outcomes (American Spinal Injury Association Impairment Scale, AIS) were compared between early and delayed diagnosis groups.

resultsAmong 613 elderly patients with SCIWORET, 81 (12.8%) experienced delayed diagnosis. These patients were significantly older (p = 0.048), more frequently dependent for ambulation (p < 0.001), and commonly injured by ground-level falls (p < 0.01). Initial AIS grades and radiological findings were comparable between groups. However, patients with delayed diagnosis underwent more frequent surgical intervention at admission (p < 0.001) and more frequent conversion from conservative to surgical management due to neurological deterioration (p < 0.001). Final AIS grades did not differ significantly between groups.

conclusionsDelayed diagnosis of SCIWORET in elderly patients is associated with increased surgical intervention without improved neurological recovery. Early recognition and timely MRI assessment may help reduce potentially avoidable surgery.

Indexed as

Cervical CordDelayed DiagnosisRegistriesSpinal Cord InjuriesAgedAged, 80 and overCervical VertebraeFemaleHumansJapanMaleRetrospective StudiesTreatment DelayTreatment Outcome

Identifiers

PMID41813819

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.