Characteristics and Clinical Outcomes of Transition from Conservative Therapy to Surgical Intervention in Older Patients with Cervical Spinal Cord Injury without Major Bone Injury: A Nationwide Retrospective Study.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Yokogawa Noriaki, Sasagawa Takeshi, Hayashi Hiroyuki, Demura Satoru, Nakashima Hiroaki, Segi Naoki, Watanabe Kota, Nori Satoshi, Funayama Toru, Eto Fumihiko, Nakajima Hideaki, Furuya Takeo, Yunde Atsushi, Terashima Yoshinori, Hirota Ryosuke, Yamada Tomohiro, Hasegawa Tomohiko, Suzuki Hidenori, Imajo Yasuaki, Kawaguchi Kenichi, Haruta Yohei, Tonomura Hitoshi, Sakata Munehiro, Terai Hidetomi, Tamai Koji, Inoue Gen, Ikegami Shota, Akeda Koji, Nakanishi Kazuo, Uei Hiroshi, Funao Haruki, Oshima Yasushi, Yoshii Toshitaka, Hashimoto Ko, Iizuka Yoichi, Kiyasu Katsuhito, Ishihara Masayuki, Kaito Takashi, Okada Seiji, Imagama Shiro, Kato Satoshi
Аннотация
METHODS: This nationwide, retrospective study examined data from patients aged ≥65 years with CSCI without major bone injury. The patients were categorized into 3 groups: conservative treatment, planned surgery, and those who switched from conservative treatment to surgery. The study aimed to identify the risk factors for conservative therapy failure that necessitate surgical intervention and to compare the outcomes between patients who had planned surgery and those who required surgery after conservative management failed.
RESULTS: Among 615 patients, 422 (68.6%) received conservative treatment, 193 (31.4%) had planned surgery, and 116 (18.9%) transitioned from conservative to surgical treatment. Transition to surgery was mainly due to poor improvement or progression of neurological deficits. Significant risk factors for transitioning to surgery included younger age, presence of ossification of the posterior longitudinal ligament, and spinal cord signal changes on magnetic resonance imaging. Comparative analysis showed no significant differences in neurological outcomes between patients who had surgery as planned and those who required surgery after failed conservative treatment.
CONCLUSIONS: A significant proportion of older patients with CSCI without major bone injury who were initially managed conservatively eventually required surgery due to insufficient neurological improvement. The outcomes of patients who transitioned to surgery were similar to those who had surgery as initially planned, indicating that careful monitoring of conservative treatment followed by surgery, if necessary, may be an effective approach.