Spinal cord injury in cervical spinal stenosis by minor trauma

Abstract 

Background

The size of the spinal canal is a factor that contributes to the neurologic deficits associated with cervical OPLL and CSM. We investigate the development of neurologic deterioration after minor trauma and the clinical results of decompressive surgery in cervical spinal stenosis retrospectively.

Method

We treated 200 cases (98 cervical OPLLs and 102 CSMs) of cervical spinal stenosis for 8 years. There were 63 (33.5%) minor trauma cases to the cervical spine in 200 patients. Of these 63 patients, 18 developed myelopathy, 13 showed deterioration of preexisting myelopathy, and no neurologic change was observed in 32 patients. The neurologic status was assessed by the JOA score. The patients were divided into 2 groups according to the residual cervical spinal canal diameter: group I (<10 mm cervical spinal canal) and group II (≥10 mm cervical spinal canal).

Results

Neurologic outcome depended on the diameter of the residual spinal canal; 22 of the 25 patients in group I developed neurologic deterioration, whereas that occurred in 8 of the 38 patients in group II (P < .05). After surgical decompression, 8 patients in group I and 30 patients in group II came out with an improved JOA score of more than 50% (P < .05).

Conclusion

Even indirect minor trauma to the neck can cause irreversible changes in the spinal cord if there is marked stenosis of the cervical spinal canal. It may be beneficial to check lateral radiograph of the cervical spine as a screening tool for early detection of cervical spinal stenosis especially in Asian people older than 40 years.

Abbreviations: CSM, cervical spondylotic myelopathy, CT, computed tomography, JOA, Japanese Orthopaedic Association, MRI, magnetic resonance image, OPLL, ossification of the posterior longitudinal ligaments, T2WI, T2-weighted image

Keywords: Cervical spondylotic myelopathy, Long-term surgical outcome, Minor trauma, Ossification of the posterior longitudinal ligament, Spinal canal diameter