Neurological Recovery Trajectories in Older Patients with Cervical Spinal Cord Injury: A Multicenter Longitudinal Study.
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Hirota Ryosuke, Terashima Yoshinori, Emori Makoto, Teramoto Atsushi, Yokogawa Noriaki, Sasagawa Takeshi, Nakashima Hiroaki, Segi Naoki, Ito Sadayuki, Funayama Toru, Eto Fumihiko, Yamaji Akihiro, Watanabe Kota, Nori Satoshi, Takeda Kazuki, Furuya Takeo, Yunde Atsushi, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Suzuki Hidenori, Imajo Yasuaki, Ikegami Shota, Uehara Masashi, Tonomura Hitoshi, Sakata Munehiro, Hashimoto Ko, Onoda Yoshito, Suzuki Nobuyuki, Kato Kenji, Uei Hiroshi, Sawada Hirokatsu, Nakanishi Kazuo, Misaki Kosuke, Terai Hidetomi, Tamai Koji, Kuroda Akiyoshi, Inoue Gen, Iizuka Yoichi, Takasawa Eiji, Akeda Koji, Takegami Norihiko, Funao Haruki, Oshima Yasushi, Kaito Takashi, Sakai Daisuke, Yoshii Toshitaka, Seki Shoji, Okada Seiji, Imagama Shiro, Kato Satoshi
Аннотация
METHODS: This retrospective multicenter cohort study used registry data from the Japan Association of Spine Surgeons with Ambition. Patients aged ≥65 years with traumatic cervical spinal cord injury and complete International Standards for Neurological Classification of Spinal Cord Injury motor score data at baseline, 6 weeks, and 6 months post-injury, were included (n=222). Neurological assessments included total, upper extremity, and lower extremity motor scores; the American Spinal Injury Association Impairment Scale (AIS) and motor zone of partial preservation. Motor recovery and AIS conversion were analyzed based on baseline and 6-week AIS grades.
RESULTS: Motor recovery occurred predominantly within the first 6 weeks after injury. From baseline to 6 weeks, patients with baseline AIS B and C exhibited significantly greater improvement in total motor score than those with AIS A and D. From 6 weeks to 6 months, measurable recovery persisted in patients with AIS C at 6 weeks, whereas those with AIS A or B demonstrated minimal additional gains. AIS conversion followed a similar pattern: 38.5%, 63.6%, and 82.7% among patients with baseline AIS A, B, and C, respectively, which improved by 6 weeks, whereas conversions beyond 6 weeks were uncommon. Among patients who remained AIS A or B at 6 months, motor zone of partial preservation extension occurred almost exclusively within the first 6 weeks.
CONCLUSIONS: In older patients with cervical spinal cord injury, most neurological recovery under routine clinical practice occurs within the first 6 weeks after injury. The magnitude of motor recovery and AIS conversion in this cohort was comparable to outcomes reported in age-unrestricted populations, suggesting that meaningful early neurological recovery can be observed even in older patients and highlighting the importance of early neurological assessment.