Does displacement of cervical and thoracolumbar dislocation-translation injuries predict spinal cord injury or recovery?

Mark J. LambrechtsDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Nicholas D. D’AntonioDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Brian A. KaramianDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Arun P. KanhereDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Azra DeesDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Bright M. WiafeDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Jose A. CansecoDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Barrett I. WoodsDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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I. David KayeDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Jeffrey RihnDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Mark KurdDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Alan S. HilibrandDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Christopher K. KeplerDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Alexander R. VaccaroDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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Gregory D. SchroederDepartment of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania

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OBJECTIVE

For patients with cervical and thoracolumbar AO Spine type C injuries, the authors sought to 1) identify whether preoperative vertebral column translation is predictive of a complete spinal cord injury (SCI) and 2) identify whether preoperative or postoperative vertebral column translation is predictive of neurological improvement after surgical decompression.

METHODS

All patients who underwent operative treatment for cervical and thoracolumbar AO Spine type C injuries at the authors’ institution between 2006 and 2021 were identified. CT and MRI were utilized to measure vertebral column translation in millimeters prior to and after surgery. A receiver operating characteristic (ROC) curve was generated to predict the probability of sustaining a complete SCI on the basis of the amount of preoperative vertebral column translation. ROC curves were then used to predict the probability of neurological recovery on the basis of preoperative and postoperative vertebral column translation.

RESULTS

ROC analysis of 67 patients identified 6.10 mm (area under the curve [AUC] 0.77, 95% CI 0.650–0.892) of preoperative vertebral column translation as predictive of complete SCI. Additionally, ROC curve analysis found that 10.4 mm (AUC 0.654, 95% CI 0.421–0.887) of preoperative vertebral column translation was strongly predictive of no postoperative neurological improvement. Residual postoperative vertebral column translation after fracture reduction and instrumentation had no predictive value on neurological recovery (AUC 0.408, 95% CI 0.195–0.622).

CONCLUSIONS

For patients with cervical and thoracolumbar AO Spine type C injuries, the amount of preoperative vertebral column translation is highly predictive of complete SCI and the likelihood of postoperative neurological recovery.

ABBREVIATIONS

AIS = American Spinal Injury Association Impairment Scale; AUC = area under the curve; ROC = receiver operating characteristic; SCI = spinal cord injury; STASCIS = Surgical Timing in Acute Spinal Cord Injury Study.

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Illustrations from Hagan et al. (pp 843–850). © Albert Telfeian, published with permission.

  • 1

    Vaccaro AR, Koerner JD, Radcliff KE, et al. AOSpine subaxial cervical spine injury classification system. Eur Spine J. 2016;25(7):21732184.

  • 2

    Vaccaro AR, Oner C, Kepler CK, et al. AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976). 2013;38(23):20282037.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Schnake KJ, Schroeder GD, Vaccaro AR, Oner C. AOSpine classification systems (subaxial, thoracolumbar). J Orthop Trauma. 2017;31(suppl 4):S14S23.

  • 4

    Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic spinal cord injury: an overview of pathophysiology, models and acute injury mechanisms. Front Neurol. 2019;10:282.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Wood KB, Li W, Lebl DR, Ploumis A. Management of thoracolumbar spine fractures. Spine J. 2014;14(1):145164.

  • 6

    Zaveri G, Das G. Management of sub-axial cervical spine injuries. Indian J Orthop. 2017;51(6):633652.

  • 7

    Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(2):e32037.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Ahuja CS, Badhiwala JH, Fehlings MG. "Time is spine": the importance of early intervention for traumatic spinal cord injury. Spinal Cord. 2020;58(9):10371039.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Batchelor PE, Wills TE, Skeers P, et al. Meta-analysis of pre-clinical studies of early decompression in acute spinal cord injury: a battle of time and pressure. PLoS One. 2013;8(8):e72659.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Fehlings MG, Tetreault LA, Aarabi B, et al. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the type and timing of rehabilitation. Global Spine J. 2017;7(3 suppl):231S238S.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Jug M, Kejžar N, Vesel M, et al. Neurological recovery after traumatic cervical spinal cord injury is superior if surgical decompression and instrumented fusion are performed within 8 hours versus 8 to 24 hours after injury: a single center experience. J Neurotrauma. 2015;32(18):13851392.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12

    Burke JF, Yue JK, Ngwenya LB, et al. Ultra-early (<12 hours) surgery correlates with higher rate of American Spinal Injury Association impairment scale conversion after cervical spinal cord injury. Neurosurgery. 2019;85(2):199203.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13

    Lee DY, Park YJ, Song SY, Hwang SC, Kim KT, Kim DH. The importance of early surgical decompression for acute traumatic spinal cord injury. Clin Orthop Surg. 2018;10(4):448454.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Koivikko MP, Myllynen P, Santavirta S. Fracture dislocations of the cervical spine: a review of 106 conservatively and operatively treated patients. Eur Spine J. 2004;13(7):610616.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Katsuura Y, Osborn JM, Cason GW. The epidemiology of thoracolumbar trauma: a meta-analysis. J Orthop. 2016;13(4):383388.

  • 16

    Wilson JR, Tetreault LA, Kwon BK, et al. Timing of decompression in patients with acute spinal cord injury: a systematic review. Global Spine J. 2017;7(3 suppl):95S115S.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17

    Haghnegahdar A, Behjat R, Saadat S, et al. A randomized controlled trial of early versus late surgical decompression for thoracic and thoracolumbar spinal cord injury in 73 patients. Neurotrauma Rep. 2020;1(1):7887.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Van den Berg MEL, Castellote JM, Mahillo-Fernandez I, de Pedro-Cuesta J. Incidence of spinal cord injury worldwide: a systematic review. Neuroepidemiology. 2010;34(3):184192.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19

    Parizel PM, van der Zijden T, Gaudino S, et al. Trauma of the spine and spinal cord: imaging strategies. Eur Spine J. 2010;19(suppl 1):S8S17

  • 20

    Chen Y, He Y, DeVivo MJ. Changing demographics and injury profile of new traumatic spinal cord injuries in the United States, 1972-2014. Arch Phys Med Rehabil. 2016;97(10):16101619.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Fawcett JW, Curt A, Steeves JD, et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007;45(3):190205.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22

    O’Connor PA, McCormack O, Noël J, McCormack D, O’Byrne J. Anterior displacement correlates with neurological impairment in cervical facet dislocations. Int Orthop. 2003;27(3):190193.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23

    Glassman DM, Magnusson E, Agel J, Bellabarba C, Bransford RJ. The impact of stenosis and translation on spinal cord injuries in traumatic cervical facet dislocations. Spine J. 2019;19(4):687694.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Gallagher MJ, Hogg FRA, Zoumprouli A, Papadopoulos MC, Saadoun S. Spinal cord blood flow in patients with acute spinal cord injuries. J Neurotrauma. 2019;36(6):919929.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Frostell A, Hakim R, Thelin EP, Mattsson P, Svensson M. A review of the segmental diameter of the healthy human spinal cord. Front Neurol. 2016;7:238.

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