Abstract
Study Design:
This was a retrospective observational study.
Objectives:
The objectives were to describe the prognosis of upper extremity function following cervical spinal cord injury (CSCI), and to identify prognostic factors for functional recovery.
Setting:
Spinal Injuries Center, Japan.
Methods:
Sixty patients with C3–4 CSCI without major bone injury participated in the study. Patients were treated nonsurgically and evaluated using the American Spinal Injury Association (ASIA) scales for the upper and lower extremities, their residual cervical motor functions, the modified Frankel grade and an upper extremity function scale. We compared the findings for the upper extremity function scale at 6 months with those for the residual cervical motor functions and modified Frankel grade obtained 3 days after injury.
Results:
Most patients with CSCI who could flex their hip and knee from a supine position (95%) or who showed some active elbow extension (86%) 3 days after their injury could use a spoon at 6 months. We compared patients who used their fingers at 6 months to those who could not, and observed significant differences in age and ASIA scores for the upper and lower extremities obtained 3 days after injury. A strong correlation was observed between the initial motor scores and the extent of functional recovery at 6 months.
Conclusion:
Hip and knee flexion from the supine position and elbow extension 3 days after injury significantly predicted a positive prognosis for upper extremity function. Younger age and higher ASIA motor scores obtained 3 days after injury were factors associated with neurological recovery.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Maeda T, Ueta T, Mori E, Yugue I, Kawano O, Takao T et al. Soft-tissue damage and segmental instability in adult patients with cervical spinal cord injury without major bone injury. Spine 2012; 37: E1560–E1566.
Kawano O, Ueta T, Shiba K, Iwamoto Y . 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 2010; 48: 548–553.
Harrop JS, Sharan A, Ratliff J . Central cord injury: pathophysiology, management, and outcomes. Spine J 2006; 6: 198S–206S.
Koyanagi I, Iwasaki Y, Hida K, Akino M, Imamura H, Abe H . Acute cervical cord injury without fracture or dislocation of the spinal column. J Neurosurg 2000; 93: 15–20.
Shimada K, Tokioka T . Sequential MRI studies in patients with cervical cord injury but without bony injury. Paraplegia 1995; 33: 573–578.
Okada S, Maeda T, Ohkawa Y, Harimaya K, Saiwai H, Kumamaru H et al. Does ossification of the posterior longitudinal ligament affect the neurological outcome after traumatic cervical cord injury? Spine 2009; 34: 1148–1152.
Anderson KD . Targeting recovery: priorities of the spinal cord-injured population. J Neurotraum 2004; 21: 1371–1383.
Snoek GJ, IJzerman MJ, Hermens HJ, Maxwell D, Biering-Sorensen F . Survey of the needs of patients with spinal cord injury: impact and priority for improvement in hand function in tetraplegics. Spinal Cord 2004; 42: 526–532.
Ishida Y, Tominaga T . Predictors of neurologic recovery in acute central cervical cord injury with only upper extremity impairment. Spine 2002; 27: 1652–1658.
Marino RJ, Burns S, Graves DE, Leiby BE, Kirshblum S, Lammertse DP . Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: an update from the national spinal cord injury database. Arch Phys Med Rehab 2011; 92: 369–375.
Association ASI. International Standards for Neurological Classification of Spinal Cord Injury, Revised 2002. American Spinal Injury Association: Chicago, IL. 2002.
Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I. Paraplegia 1969; 7: 179–192.
Ueta TSK, Shirasawa K . Cervical cord injuries with no evidence of bony spine damage. Spine Spinal Cord 1997; 10: 581–590 (in Japanese).
Fukuda F, Ueta T . Prediction of prognosis using modified Frankel classification in cervical spinal cord injured patients. JJRM 2001; 38: 29–33 (in Japanese).
Marino RJ, Ditunno JF Jr., Donovan WH, Maynard F Jr . Neurologic recovery after traumatic spinal cord injury: data from the Model Spinal Cord Injury Systems. Arch Phys Med Rehab 1999; 80: 1391–1396.
Tow AM, Kong KH . Central cord syndrome: functional outcome after rehabilitation. Spinal Cord 1998; 36: 156–160.
Dai L, Jia L, Ni B, Yuan W, Liu H, Hou T et al. Diagnosis and treatment of acute central cervical cord injury. Chin Med J 1998; 111: 351–353.
Diong J, Harvey LA, Kwah LK, Eyles J, Ling MJ, Ben M et al. Incidence and predictors of contracture after spinal cord injury—a prospective cohort study. Spinal Cord 2012; 50: 579–584.
Acknowledgements
We thank Mr R Watanabe, OT, and Mr K Iwahashi, OT, for their suggestions with regard to rehabilitation of the upper extremities.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Hayashi, T., Kawano, O., Sakai, H. et al. The potential for functional recovery of upper extremity function following cervical spinal cord injury without major bone injury. Spinal Cord 51, 819–822 (2013). https://doi.org/10.1038/sc.2013.90
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2013.90
Keywords
This article is cited by
-
Traumatic cervical spinal cord injury after cervical laminoplasty for ossification of posterior longitudinal ligament: a case series
Spinal Cord (2022)
-
A prediction model of functional outcome at 6 months using clinical findings of a person with traumatic spinal cord injury at 1 month after injury
Spinal Cord (2020)
-
Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury
Journal of Orthopaedic Surgery and Research (2019)
-
The neurological outcome of radiotherapy versus surgery in patients with metastatic spinal cord compression presenting with myelopathy
Archives of Orthopaedic and Trauma Surgery (2018)
-
Risk factors for severe dysphagia in acute cervical spinal cord injury
Spinal Cord (2017)
