Introduction: The treatment of traumatic subaxial cervical spine injuries remains controversial. In the present study, we evaluated the clinical outcomes of patients (using ASIA scores) who underwent surgical and non-surgical stabilization of the cervical spine after a subaxial injury in an attempt to identify potential predictors of neurologic function after injury and subsequent treatment.
Methods: We performed a retrospective chart review to identify patients that presented with acute non-penetrating subaxial cervical spine injury within the University of Pennsylvania’s Health System between 6/1/2007 and 6/1/2016. Patient demographics, medical co-morbidities, injuries, and treatments were collected. The ASIA spinal cord injury score at time of initial presentation and at three month follow-up were recorded. Logistic regression analysis was used to determine potential predictors of neurological outcome.
Results: We identified 76 patients who met the inclusion criteria and presented for 3 month follow-up. The mean age was 50.6 ± 18.7 and the majority of patients were male (n = 49, 64%). The majority of patients had a stable ASIA score at 3 months (n = 56, 74%). A subset of patients did demonstrate improvement at 3 months (n = 16, 21%), while a small subset of patients had neurological decline at 3 months (n = 4, 5%). In our model, increasing patient age (odds ratio [OR] 1.39, 1.10 – 2.61 95% CI, P < 0.001) and a previous or current diagnosis of cancer (OR 22.4, 1.25 – 820 95% CI, P = 0.04) significantly increased the odds of neurological decline at 3 months. In patients treated surgically, we found that delay in surgical treatment (greater than 24 hours) was associated with a decreased odds of neurological improvement (OR 0.24, 0.05 – 0.99 95% CI, P = 0.048).
Conclusions: Cervical spine injuries are heterogeneous and difficult to manage. We found that increasing patient age and an oncologic history were associated with neurological deterioration while delay in surgical treatment was associated with decreased odds of improvement. These predictors of neurological outcome may be used to guide future prognosis and treatment decisions.
Patient Care: We found that increasing patient age and an oncologic history were associated with neurological deterioration. While these are not modifiable factors, these findings may help guide discussions with patients regarding prognosis. Interestingly, we found that delay in surgical treatment was associated with decreased odds of neurological improvement.
Learning Objectives: By the conclusion of this session, participants should be able to identify what predictors may lead to better or worse outcomes in patients who sustained a subaxial spine injury.