The neurological outcomes of patients with cervical spinal cord injury treated by closed reduction and surgical stabilisation: a retrospective longitudinal study

Abstract

Background: Cervical spinal cord injury (CSI) from cervical spine dislocation as a result of motor vehicle accidents (MVAs) and low-velocity trauma are common in South Africa. Taking into consideration the pathophysiology of traumatic CSI and the possible neurological benefits of early cervical spinal cord decompression, it remains imperative that patients with CSI post-cervical spine dislocation be managed urgently by early closed reduction, which can be conducted safely. The study aimed to evaluate the neurological outcomes of patients who sustained cervical spine fracture-dislocations or dislocations with CSI who were treated with closed reduction.

Methods: This is a retrospective study of 62 patients who sustained subaxial cervical spine fractures/dislocations with CSI and were managed by closed reduction and surgical stabilisation. We documented the demographics of the patients and the radiologic level of injury. The American Spinal Injury Association (ASIA) scoring system was used to assess neurology at presentation, post-closed reduction, post-surgical stabilisation, and during the follow-up period (one, three, six and 12 months post-operation). Time intervals between injury and closed reduction, and timing between injury and surgical stabilisation, were noted.

Results: Seventy-nine per cent of patients who underwent satisfactory closed reduction experienced neurological improvement by the end of follow-up. Thirty-nine per cent improved within the first 24 hours post-injury. Only 2% of those reduced after 24 hours showed neurological recovery. A statistically significant difference in neurological outcomes was observed (p < 0.001) between patients who underwent closed reduction within 24 hours of injury and those who had reduction after 24 hours of injury, emphasising the urgency of early treatment for optimal recovery in CSIs.

Conclusion: Patients who underwent closed reduction within 24 hours of injury demonstrated significantly better neurological outcomes compared to those treated later, with a statistically significant difference in recovery rates. These results emphasise the critical need for prompt dislocation reduction to optimise neurological recovery in managing CSIs.

Level of evidence: 3