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In-hospital mortality rate in subaxial cervical spinal cord injury patients: a systematic review and meta-analysis

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Abstract

Purpose

To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades.

Methods

We searched MEDLINE and EMBASE to assess the role of the following factors on in-hospital mortality over the last four decades: neurological deficit, age, surgical decompression, use of computed tomography (CT) and magnetic resonance imaging (MRI), use of methylprednisolone in the acute post-injury period, and study location (developing versus developed countries).

Results

Among 3333 papers after deduplication, 21 studies met the eligibility criteria. The mortality rate was 17.88% [95% confidence interval (CI): 12.9–22.87%]. No significant trend in mortality rate was observed over the 42-year period (meta-regression coefficient = 0.317; p = 0.372). Subgroup analysis revealed no significant association between acute subaxial cervical SCI–related mortality when stratified by use of surgery, administration of methylprednisolone, use of MRI and CT imaging, study design (prospective versus retrospective study), and study location. The mortality rate was significantly higher in complete SCI (20.66%, p = 0.002) and American Spinal Injury Association impairment scale (AIS) A (20.57%) and B (9.28%) (p = 0.028).

Conclusion

A very low level of evidence showed that in-hospital mortality in patients with traumatic subaxial cervical SCI did not decrease over the last four decades despite diagnostic and therapeutic advancements. The overall acute mortality rate following subaxial cervical SCI is 17.88%. We recommend reporting a stratified mortality rate according to key factors such as treatment paradigms, age, and severity of injury in future studies.

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References

  1. Ackery A, Tator C, Krassioukov A (2004) A global perspective on spinal cord injury epidemiology. J Neurotrauma 21(10):1355–1370

    Article  PubMed  Google Scholar 

  2. Admasu AK, Buno E (2018) Short-term outcome in subaxial spine injury patients operated on in a resource-limited setting, Addis Ababa, Ethiopia. World Neurosurg 113:e702–e706

    Article  PubMed  Google Scholar 

  3. Alsaleh K, Bednar D, Farrokhyar F (2017) Acute traumatic quadriplegia in adults: predictors of acute in-hospital mortality. Turk Neurosurg 27(6):942–945

    PubMed  Google Scholar 

  4. Moola S, Munn Z, Tufanaru C, Aromataris E, Sears K, Sfetcu R, Currie M, Lisy K, Qureshi R, Mattis P, Mu P (2020) Chapter 7: Systematic reviews of etiology and risk. In: Aromataris E, Munn Z (eds) JBI Manual for Evidence Synthesis. JBI, . Available from https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-08

  5. Asemota AO, Ahmed AK, Purvis TE, Passias PG, Goodwin CR, Sciubba DM (2018) Analysis of cervical spine injuries in elderly patients from 2001 to 2010 using a nationwide database: increasing incidence, overall mortality, and inpatient hospital charges. World Neurosurg 120:e114–e130

    Article  PubMed  Google Scholar 

  6. Bellet FD, Rashid SM, Jusabani MA, Dekker MCJ, Temu RJ (2019) The characteristics of cervical spinal cord trauma at a North Tanzanian Referral Hospital: a retrospective hospital based study. Pan Afr Med J 33:82

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B (2011) The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma 28(8):1401–1411

    Article  PubMed  PubMed Central  Google Scholar 

  8. Bracken MB (2012) Steroids for acute spinal cord injury. Cochrane Database Syst Rev 1(1):CD001046

    PubMed  Google Scholar 

  9. Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, Eisenberg HM, Flamm E, Leo-Summers L, Maroon J (1990) A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the second national acute spinal cord injury study. N Engl J Med 322(20):1405–1411

    Article  CAS  PubMed  Google Scholar 

  10. Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MWG (2015) Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology 44(3):182–198

    Article  PubMed  Google Scholar 

  11. Chen HY, Chen SS, Chiu WT et al (1997) A nationwide epidemiological study of spinal cord injury in geriatric patients in Taiwan. Neuroepidemiology 16(5):241–247

    Article  CAS  PubMed  Google Scholar 

  12. Chhabra HS, Sharawat R, Vishwakarma G (2021) In-hospital mortality in people with complete acute traumatic spinal cord injury at a tertiary care center in India-a retrospective analysis. Spinal Cord 60(3):210–215

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chiu W-T, Lin H-C, Lam C, Chu S-F, Chiang Y-H, Tsai S-H (2010) Review paper: epidemiology of traumatic spinal cord injury: comparisons between developed and developing countries. Asia Pac J Public Health 22(1):9–18

    Article  PubMed  Google Scholar 

  14. Claxton AR, Wong DT, Chung F, Fehlings MG (1998) Predictors of hospital mortality and mechanical ventilation in patients with cervical spinal cord injury. Can J Anaesth 45(2):144–149

    Article  CAS  PubMed  Google Scholar 

  15. Daneshvar P, Roffey DM, Brikeet YA, Tsai EC, Bailey CS, Wai EK (2013) Spinal cord injuries related to cervical spine fractures in elderly patients: factors affecting mortality. Spine J 13(8):862–866

    Article  PubMed  Google Scholar 

  16. de Melo-Neto JS, Vidotto LEL, de Campos Gomes F, de Morais DF, Tognola WA (2017) Characteristics and clinical aspects of patients with spinal cord injury undergoing surgery. Rev Bras Ortop 52(4):479–490

    PubMed  Google Scholar 

  17. Fehlings MG, Tetreault LA, Wilson JR et al (2017) A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (≤24 hours versus >24 hours) of decompressive surgery. Global Spine J 7(3 Suppl):195S-202S

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fehlings M, Wilson J, Tetreault L et al (2017) A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the use of methylprednisolone sodium succinate. Global Spine J. https://doi.org/10.1177/2192568217703085

    Article  PubMed  PubMed Central  Google Scholar 

  19. Fielingsdorf K, Dunn RN (2007) Cervical spine injury outcome–a review of 101 cases treated in a tertiary referral unit. S Afr Med J 97(3):203–207

    CAS  PubMed  Google Scholar 

  20. Fredø HL, Rizvi SAM, Rezai M, Rønning P, Lied B, Helseth E (2016) Complications and long-term outcomes after open surgery for traumatic subaxial cervical spine fractures: a consecutive series of 303 patients. BMC Surg 16(1):56

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gerhart KA (1991) Spinal cord injury outcomes in a population-based sample. J Trauma 31(11):1529–1535

    Article  CAS  PubMed  Google Scholar 

  22. Gerndt SJ, Rodriguez JL, Pawlik JW, Taheri PA, Wahl WL, Micheals AJ, Papadopoulos SM (1997) Consequences of high-dose steroid therapy for acute spinal cord injury. J Trauma 42(2):279–284

    Article  CAS  PubMed  Google Scholar 

  23. Guo H, Zhang P, Xu D, Zuo Q (2002) Cause analysis of death of patients with spinal cord injuries in the acute phase. SHAANXI Med J 31(9):778–779

    Google Scholar 

  24. Hoque MF, Grangeon C, Reed K (1999) Spinal cord lesions in Bangladesh: an epidemiological study 1994–1995. Spinal Cord 37(12):858–861

    Article  CAS  PubMed  Google Scholar 

  25. Inglis T, Banaszek D, Rivers CS et al (2020) In-hospital mortality for the elderly with acute traumatic spinal cord injury. J Neurotrauma 37(21):2332–2342

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jakimovska VM, Biering-Sorensen F, Lidal IB, Kostovski E (2020) Epidemiological characteristics and early complications after spinal cord injury in Former Yugoslav Republic of Macedonia. Spinal Cord 58(1):86–94

    Article  PubMed  Google Scholar 

  27. Kamp O, Jansen O, Lefering R, Aach M, Waydhas C, Dudda M, Schildhauer TA, Hamsen U, TraumaRegister DGU (2021) Survival among patients with severe high cervical spine injuries - a TraumaRegister DGU® database study. Scand J Trauma Resusc Emerg Med 29(1):1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, Perruolo E, Parati G, ESH Working Group on CV Risk in Low Resource Settings (2016) Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One 11(1):e0147601

    Article  PubMed  PubMed Central  Google Scholar 

  29. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med 3(3):e123-130

    PubMed  PubMed Central  Google Scholar 

  30. Munakomi S, Bhattarai B, Cherian I (2017) Prospective observational research on the clinical profile and outcome analysis among a cohort of patients sustaining traumatic cervical spine and cord injury in a peripheral tertiary spine care centre in Nepal. F1000Res 6:1957

    Article  PubMed  PubMed Central  Google Scholar 

  31. Neumann CR, Brasil AV, Albers F (2009) Risk factors for mortality in traumatic cervical spinal cord injury: Brazilian data. J Trauma 67(1):67–70

    PubMed  Google Scholar 

  32. Obalum DC, Giwa SO, Adekoya-Cole TO, Enweluzo GO (2009) Profile of spinal injuries in Lagos. Nigeria Spinal Cord 47(2):134–137

    Article  CAS  PubMed  Google Scholar 

  33. Ojo OA, Poluyi EO, Owolabi BS, Kanu OO, Popoola MO (2017) Surgical decompression for traumatic spinal cord injury in a tertiary center. Niger J Clin Pract 20(11):1455–1460

    Article  CAS  PubMed  Google Scholar 

  34. Pajareya K (1996) Traumatic spinal cord injuries in Thailand: an epidemiologic study in Siriraj Hospital, 1989–1994. Spinal Cord 34(10):608–610

    Article  CAS  PubMed  Google Scholar 

  35. Rabadi MH, Mayanna SK, Vincent AS (2013) Predictors of mortality in veterans with traumatic spinal cord injury. Spinal Cord 51(10):784–788

    Article  CAS  PubMed  Google Scholar 

  36. Santos EAS, Filho WJS, Possatti LL, Bittencourt LRA, Fontoura EAF, Botelho RV (2009) Epidemiology of severe cervical spinal trauma in the north area of São Paulo City: a 10-year prospective study. Clinical article. J Neurosurg Spine 11(1):34–41

    Article  PubMed  Google Scholar 

  37. Selecki BR, Berry G, Kwok B, Mandryk JA, Ring IT, Sewell MF, Simpson DA, Vanderfield GK (1986) Experience with spinal injuries in New South Wales. Aust N Z J Surg 56(7):567–576

    Article  CAS  PubMed  Google Scholar 

  38. Shao J, Zhu W, Chen X, Jia L, Song D, Zhou X, Yan W, Zhang Y (2011) Factors associated with early mortality after cervical spinal cord injury. J Spinal Cord Med 34(6):555–562

    Article  PubMed  PubMed Central  Google Scholar 

  39. Shibahashi K, Nishida M, Okura Y, Hamabe Y (2019) Epidemiological state, predictors of early mortality, and predictive models for traumatic spinal cord injury: a multicenter nationwide cohort study. Spine (Phila Pa 1976) 44(7):479–487

    Article  PubMed  Google Scholar 

  40. Silberstein B, Rabinovich S (1995) Epidemiology of spinal cord injuries in Novosibirsk. Russia Paraplegia 33(6):322–325

    CAS  PubMed  Google Scholar 

  41. Singh A, Tetreault L, Kalsi-Ryan S, Nouri A, Fehlings MG (2014) Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol 6:309–331

    PubMed  PubMed Central  Google Scholar 

  42. Singh DK, Chhabra A, Kumar R, Ahmad F, Yadav K, Kaif M (2018) Outcome analysis of upper versus lower cervical spine injuries. Indian J Neurotrauma 15(02/03):100–105

    Article  Google Scholar 

  43. Sokolowski MJ, Jackson AP, Haak MH, Meyer PR, Sokolowski MS (2007) Acute mortality and complications of cervical spine injuries in the elderly at a single tertiary care center. J Spinal Disord Tech 20(5):352–356

    Article  PubMed  Google Scholar 

  44. Vaccaro AR, Klein GR, Thaller JB, Rushton SA, Cotler JM, Albert TJ (2001) Distraction extension injuries of the cervical spine. J Spinal Disord 14(3):193–200

    Article  CAS  PubMed  Google Scholar 

  45. van den Berg MEL, Castellote JM, de Pedro-Cuesta J, Mahillo-Fernandez I (2010) Survival after spinal cord injury: a systematic review. J Neurotrauma 27(8):1517–1528

    Article  PubMed  Google Scholar 

  46. Zhang B, Chen X, Lin Y, Tan T, Yang Z, Dayao C, Liu L, Jiang R, Zhang J (2011) Impairment of synaptic plasticity in hippocampus is exacerbated by methylprednisolone in a rat model of traumatic brain injury. Brain Res 1382:165–172

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would appreciate Dr. Bizhan Aarabi, who has a great role in the study design, discussion, and editing of the draft. We thank Dr. Munakomi and Dr. Ojo for providing supplementary patient data for meta-analysis.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Lorestan University of Medical Sciences, Khoram-Abad, Iran

    Mohsen Sadeghi-Naini

  2. Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran

    Mahmoud Yousefifard

  3. Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran

    Zahra Ghodsi, Amir Azarhomayoun, Mehdi Golpayegani, Seyed Danial Alizadeh & Vafa Rahimi-Movaghar

  4. Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Amir Azarhomayoun

  5. Department of Anatomy, Alborz University of Medical Sciences, Karaj, Iran

    Fatemeh Kermanian

  6. Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran

    Seyed Danial Alizadeh

  7. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Mostafa Hosseini

  8. King’s Technology Evaluation Centre (KiTEC), School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, London Institute of Healthcare Engineering, King’s College London, London, UK

    Farhad Shokraneh

  9. Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Khalil Komlakh

  10. Department of Orthopedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA, USA

    Alexander R. Vaccaro

  11. Department of Surgery and Spine Program, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, ON, Canada

    Fan Jiang

  12. Department of Surgery, University of Toronto, Toronto, Canada

    Michael G. Fehlings

  13. Krembil Brain Institute and McEwen Centre for Regenerative Medicine, Toronto Western Hospital, University Health Network, Toronto, Canada

    Michael G. Fehlings

  14. Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

    Vafa Rahimi-Movaghar

  15. Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Vafa Rahimi-Movaghar

  16. Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Vafa Rahimi-Movaghar

  17. Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran

    Vafa Rahimi-Movaghar

  18. Visiting Professor, Spine Program, University of Toronto, Toronto, Canada

    Vafa Rahimi-Movaghar

  19. Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, Tehran, 11365-3876, Iran

    Vafa Rahimi-Movaghar

Authors
  1. Mohsen Sadeghi-Naini
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  2. Mahmoud Yousefifard
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  3. Zahra Ghodsi
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  4. Amir Azarhomayoun
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  7. Seyed Danial Alizadeh
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  8. Mostafa Hosseini
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  10. Khalil Komlakh
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  11. Alexander R. Vaccaro
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  14. Vafa Rahimi-Movaghar
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Contributions

Vafa Rahimi-Movaghar: correspondence author who developed the idea and managed the project.

Mohsen Sadeghi-Naini: data extraction and collection, risk of bios assessments and he wrote the draft.

Mahmoud Yousefifard: risk of bios assessments and data analyzing.

Zahra Ghodsi, Amir Azarhomayoun, and Fatemeh Kermanian: data extraction and collection.

Mostafa Hosseini: data analyzing.

Mehdi Golpayegani: writing the discussion section and updating the references.

Khalil Komlakh, Farhad Shokraneh and Seyed Danial Alizadeh: editing the manuscript based on critical feedback and after search updating.

Alexander R Vaccaro, Fan Jiang, and Michael G Fehlings: revision the draft by constructive criticism.

Corresponding author

Correspondence to Vafa Rahimi-Movaghar.

Ethics declarations

Ethical approval

The Ethics Committee of Sina Trauma and Surgery Research Center approved the study, and the reference number is 97–02-38–330.

Competing interests

The authors report no conflict of interest except Alexander R Vaccaro (Appendix 4). This work was supported by Sina Trauma and Surgery Research Center [grant numbers: 97–02-38–39439].

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Mohsen Sadeghi-Naini and Mahmoud Yousefifard have contributed equally to this work.

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Sadeghi-Naini, M., Yousefifard, M., Ghodsi, Z. et al. In-hospital mortality rate in subaxial cervical spinal cord injury patients: a systematic review and meta-analysis. Acta Neurochir 165, 2675–2688 (2023). https://doi.org/10.1007/s00701-023-05720-5

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  • DOI: https://doi.org/10.1007/s00701-023-05720-5

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