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2022, Vol. 26 ›› Issue (9): 1388-1394Risk factors for traumatic central cord syndrome underlying with cervical spondylotic myelopathyWu Liang1, Wang Qiang2, Wang Wenbo1, Xin Tianwen1, Xi Kun1, Tang Jincheng1, Xu Jingzhi1, Chen Liang1, Gu Yong1
Abstract: BACKGROUND: Some patients with cervical spondylotic myelopathy suffer from certain low-energy trauma or only a single hyperextension movement of the neck, and then their neurological symptoms deteriorate, showing typical symptoms of traumatic central cervical syndrome. Although the overall prognosis is good, many patients still have some sequelae. OBJECTIVE: To analyze the risk factors of traumatic central cervical syndrome in patients with cervical spondylotic myelopathy suffering from low-energy trauma, and the correlation with neurological dysfunction. METHODS: Between January 2012 and December 2016, the clinical data of 181 cervical spondylotic myelopathy patients, treated in the First Affiliated Hospital of Soochow University, with a history of low-energy trauma were retrospectively analyzed. According to whether traumatic central cervical syndrome occurred, patients were divided into appearing group (68 cases) and non-appearing group (113 cases). The potential risk factors and their correlations with the neurological function of traumatic central cervical syndrome were analyzed, including patients’ general condition, clinical manifestations and imaging findings. This study was approved by the Medical Ethics Committee of First Affiliated Hospital of Soochow University (approval No. (2021)053). RESULTS AND CONCLUSION: (1) Average age and gender were not statistically significant between the two groups (P > 0.05). However, the incidence of hyperextension injury in appearing group was more than in non-appearing group (P < 0.05). (2) Ratios of axial pain, weakness of proximal lower limb, proprioception dysfunction and hand sensory dysfunction were not statistically significant between the two groups (P > 0.05). Hand muscle weakness, hypermyotonia, tendon hyperreflexia and positive pathological signs in the appearing group were higher than those in the non-appearing group (P < 0.05). (3) The C2-7 Cobb angle of the appearing group was lower than that of the non-appearing group (P < 0.05), and the proportion of instability, rigid/mixed ratio and “anterior-posterior clamp type” in the appearing group were higher than those in the non-appearing group (P < 0.05). Both spinal stenosis and cervical spinal cord compression were higher in the appearing group than those in the non-appearing group (P < 0.05). With higher proportions of maximum canal compromise >50% and maximum spinal cord compression >25%, the maximum canal compromise and maximum spinal cord compression in the appearing group were both greater than those in the non-appearing group (P < 0.05). The ratio, length and grade 2 of intramedullary high signal intensity in appearing group were higher than those in the non-appearing group (P < 0.05). (4) Logistic regression analysis indicated that the possible risk factors for traumatic central cervical syndrome were hyperextension injury, intrinsic hand strength, hypermyotonia, positive pathological signs, poor cervical curvature, spine instability, compression type, compression source, maximum canal compromise, maximum spinal cord compression and intramedullary high signal intensity. (5) The correlation analysis indicated that age, intrinsic hand muscle strength, lower limb muscle tone, pathological signs, cervical curvature, cervical stability, maximum canal compromise, maximum spinal cord compression and intramedullary high signal intensity were significantly negatively correlated with neurological function scores (P < 0.05). Key words: cervical spondylotic myelopathy, traumatic central cord syndrome, low-energy trauma, spinal injury, neurological dysfunction, risk factors, correlation analysis |