European Spine Journal

, Volume 22, Issue 10, pp 2228–2231

Clinical relationship between cervical spinal canal stenosis and traumatic cervical spinal cord injury without major fracture or dislocation

  • Tsuneaki Takao
  • Yuichiro Morishita
  • Seiji Okada
  • Takeshi Maeda
  • Fumihiko Katoh
  • Takayoshi Ueta
  • Eiji Mori
  • Itaru Yugue
  • Osamu Kawano
  • Keiichiro Shiba
Original Article

Abstract

Purpose

The purpose of the study was to evaluate the clinical relationship between cervical spinal canal stenosis (CSCS) and incidence of traumatic cervical spinal cord injury (CSCI) without major fracture or dislocation, and to discuss the clinical management of traumatic CSCI.

Methods

Forty-seven patients with traumatic CSCI without major fracture or dislocation (30 out of 47 subjects; 63.83 %, had an injury at the C3–4 segment) and 607 healthy volunteers were measured the sagittal cerebrospinal fluid (CSF) column diameter at five pedicle and five intervertebral disc levels using T2-weighted midsagittal magnetic resonance imaging. We defined the sagittal CSF column diameter of less than 8 mm as CSCS based on the previous paper. We evaluated the relative and absolute risks for the incidence of traumatic CSCI related with CSCS.

Results

Using data from the Spinal Injury Network of Fukuoka, Japan, the relative risk for the incidence of traumatic CSCI at the C3–4 segment with CSCS was calculated as 124.5:1. Moreover, the absolute risk for the incidence of traumatic CSCI at the C3–4 segment with CSCS was calculated as 0.00017.

Conclusions

In our results, the relative risk for the incidence of traumatic CSCI with CSCS was 124.5 times higher than that for the incidence without CSCS. However, only 0.017 % of subjects with CSCS may be able to avoid developing traumatic CSCI if they undergo decompression surgery before trauma. Our results suggest that prophylactic surgical management for CSCS might not significantly affect the incidence of traumatic CSCI.

Keywords

Cervical spinal canal stenosis Traumatic cervical spinal cord injury without major fracture or dislocation MRI Relative risk Absolute risk Prophylactic surgical management 

References

  1. 1.
    Tewari MK, Gifti DS, Singh P, Khosla VK, Mathuriya SN, Gupta SN et al (2005) Diagnosis and prognostication of adult spinal cord injury without radiographic abnormality using magnetic resonance imaging: analysis of 40 patients. Surg Neurol 63:204–209PubMedCrossRefGoogle Scholar
  2. 2.
    Gupta SK, Rajeev K, Khosla VK, Sharma BS, Paramjit SN, Pathak A et al (1999) Spinal cord injury without radiographic abnormality in adults. Spinal Cord 37:726–729PubMedCrossRefGoogle Scholar
  3. 3.
    Kothari P, Freeman B, Grevitt M, Kerslake R (2000) Injury to the spinal cord without radiological abnormality (SCIWORA) in adults. J Bone Joint Surg Br 82:1034–1037PubMedCrossRefGoogle Scholar
  4. 4.
    Wenger M, Adam PJ, Alarcon F, Markwalder TM (2003) Traumatic cervical instability associated with cord oedema and temporary quadriparesis. Spinal Cord 41:521–526PubMedCrossRefGoogle Scholar
  5. 5.
    Koyanagi I, Iwasaki Y, Hida K, Akino M, Imamura H, Abe H et al (2000) Acute cervical cord injury without fracture or dislocation of the spinal column. J Neurosurgery 93:15–20Google Scholar
  6. 6.
    Tator CH (1995) Clinical manifestations of acute spinal cord injury. In: Benzel EC, Tator CH (eds) Contemporary management of spinal cord injury. Park Ridge, American Association of Neurological Surgeons, pp 15–26Google Scholar
  7. 7.
    Harrop JS, Sharan A, Ratliff J (2006) Central cord injury: pathophysiology, management, and outcomes. Spine J 6:198S–206SPubMedCrossRefGoogle Scholar
  8. 8.
    Shimada K, Tokioka T (1995) Sequential MRI studies in patients with cervical cord injury but without bony injury. Paraplegia 33:573–578PubMedCrossRefGoogle Scholar
  9. 9.
    Takahashi M, Harada Y, Inoue H, Shimada K (2002) Traumatic cervical cord injury at C3–4 without radiographic abnormalities: correlation of magnetic resonance findings with clinical feature and outcome. J Orthop Surg (Hong Kong) 10:129–135Google Scholar
  10. 10.
    Morishita Y, Naito M, Wang JC (2011) Cervical spinal canal stenosis: the differences between stenosis at the lower cervical and multiple segment levels. Int Orthop 35:1517–1522PubMedCrossRefGoogle Scholar
  11. 11.
    Morishita Y, Naito M, Hymanson H, Miyazaki M, Wu G, Wang JC (2009) The relationship between the cervical spinal canal diameter and the pathological changes in the cervical spine. Eur Spine J 18:877–883PubMedCrossRefGoogle Scholar
  12. 12.
    Okada Y, Ikata T, Yamada H, Sakamkto R, Katoh S (1993) Magnetic resonance imaging study on the results of surgery for cervical compression myelopathy. Spine 18:2024–2029PubMedCrossRefGoogle Scholar
  13. 13.
    Herzog RJ, Weins JJ, Dillingham MF, Sontag MJ (1991) Normal cervical spine morphometry and cervical spine stenosis in asymptomatic professional football players. Spine 16:178–186CrossRefGoogle Scholar
  14. 14.
    Anderson PA, Steinmetz MP, Eck JC (2006) Head and neck injuries in athletes. In: Spivak JM, Connolly PJ (eds) Orthopaedic knowledge update: Spine 3. Rosemont, AAOS, pp 259–269Google Scholar
  15. 15.
    Sakai H, Ueta T, Shiba K (2010) Current situation of medical care for spinal cord injury in Japan (in Japanese). J Spine Res 1:41–51Google Scholar
  16. 16.
    Edward WC, LaRocca H (1983) The developmental segmental sagittal diameter of the cervical spinal canal in patients with cervical spondylosis. Spine 8:20–27CrossRefGoogle Scholar
  17. 17.
    Gore DR (2001) Roentgenographic findings in the cervical spine in asymptomatic persons: a ten-year follow-up. Spine 26:2463–2466PubMedCrossRefGoogle Scholar
  18. 18.
    Yamazaki T, Yanaka K, Fujita K, Kamezaki T, Uemura K, Nose T (2005) Traumatic central cord syndrome: analysis of factors affecting the outcome. Surg Neurol 63:95–99PubMedCrossRefGoogle Scholar
  19. 19.
    La Rosa G, Conti A, Cardali S, Cacciola F, Tomasello F (2004) Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of literature using a meta-analytical approach. Spinal Cord 42:503–512PubMedCrossRefGoogle Scholar
  20. 20.
    Chen TY, Dickman CA, Eleraky M, Sonntag VKH (1998) The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis. Spine 23:2398–2403PubMedCrossRefGoogle Scholar
  21. 21.
    Bose B, Northrup BE, Osterholm JL, Cotler JM, DiTunno JF (1984) Reanalysis of central cervical cord injury management. Neurosurgery 15:367–372PubMedCrossRefGoogle Scholar
  22. 22.
    Kawano O, Ueta T, Shiba K, Iwamoto Y (2010) Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression: a multicenter prospective study. Spinal Cord 48:548–553PubMedCrossRefGoogle Scholar
  23. 23.
    Itoh Y, Mazaki T, Koshimune K, Morita T, Mizuno S (2011) Randomized controlled study of treatment for acute cervical cord injury with spinal canal stenosis but without radiographic evidence of trauma (SCIWORET): operative or conservative treatment. J Spine Res 2:965–967Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Tsuneaki Takao
    • 1
  • Yuichiro Morishita
    • 1
  • Seiji Okada
    • 2
  • Takeshi Maeda
    • 1
  • Fumihiko Katoh
    • 3
  • Takayoshi Ueta
    • 1
  • Eiji Mori
    • 1
  • Itaru Yugue
    • 1
  • Osamu Kawano
    • 1
  • Keiichiro Shiba
    • 1
  1. 1.Department of Orthopaedic SurgerySpinal Injuries CenterIizukaJapan
  2. 2.Department of Orthopaedic SurgeryKyushu UniversityFukuokaJapan
  3. 3.Department of Orthopaedic SurgeryChubu Rosai HospitalNagoyaJapan

Personalised recommendations