ArticleSpinal cord series and cases2026
A novel classification of patients with cervical spinal cord injury without fracture-dislocation based on imaging features: a multicenter study.
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Abstract
STUDY
designA multicenter retrospective study.
objectiveSeveral classifications of cervical spinal cord injury without fracture-dislocation (CSCIWOFD) have been reported during past decades, but no classification propose suggestions for surgical approach decision. In this study, we aimed to establish a new classification of CSCIWOFD based on imaging features of patients, and to determine the surgical outcomes of the different types of CSCIWOFD after different surgical approaches.
settingAffiliated hospital of University in Nanchang, the Second Hospital of Shanxi Medical University in Taiyuan, Guangdong Provincial People's Hospital in Guangdong and Renji Hospital in Shanghai, China.
methodsThe clinical data of patients with CSCIWOFD who received conservative or surgical treatment at participating centers between January 2018 and December 2022 were retrospectively reviewed. Patients were classified into four types based on preoperative cervical spine X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) characteristics. The reliability and reproducibility of the new classification was evaluated by six observers from different centers at an interval of 4 weeks. All patients were followed up at least 2 years, and the surgical outcomes of the different types were analyzed.
resultsA total of 300 patients with CSCIWOFD were included. Among these patients, 15 received conservative treatment, 169 underwent anterior cervical surgery, 105 underwent posterior cervical surgery, and 11 underwent posterior combined with anterior surgery. The mean Kappa value for inter-observer reproducibility was 0.811, and for intra-observer reliability was 0.893. For Type II patients, the improvement rate of ASIA grade in anterior surgery was significantly higher than that in posterior surgery (P = 0.009). However, for Type III patients, the improvement rate following posterior surgery was higher than that of those undergoing anterior surgery, though no statistically significant difference was observed. In Type IV patients, the combined anterior and posterior approach resulted in a higher improvement rate compared to either the anterior or posterior surgery alone (63.64% vs. 33.33% vs. 16.67%), but again, no statistically significant difference was found.
conclusionsFor patients with CSCIWOFD, a novel classification was developed based on preoperative imaging features, which was proven to be reliable. Type I patients can be treated with conservative treatment or anterior surgery; patients with Type II CSCIWOFD have good neurological outcomes after anterior surgery. For Type III patients, the posterior approach may offer better outcomes, while for Type IV patients, the combined anterior and posterior approach may be more effective.
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