軽症～中等症頚髄損傷における神経機能回復の予後予測因子の検討

抄録

Background: Spinal cord injury (SCI) is one of the poor prognostic factors in relation to head trauma. There are few reports on neurological functional prognosis in patients with cervical SCI. We retrospectively studied the prog­nos­tic factors in mild to moderate cervical SCI (AIS D, E).

Objective: Fifty-nine patients admitted to our department from August 2008 to May 2014 were evaluated in this study, comprising 53 men and 6 women with an age range from 25 to 84 years old (average 62.7 years). Age, sex, high-dose steroid therapy, surgical inter­vention, pain at the time of admission and discharge (evaluated by numeri­cal rating scale [NRS]), and functional evaluation at the time of admission and dis­charge (Functional Independence Measure [FIM]) were evaluated as prognosis-related factors.

Result: In terms of improvement of NRS <3 or >3 points, a significant difference was observed between patients aged <60 years old and those aged ≥70 years. Specifically, NRS improvement was good in patients ≤60 years of age (p=0.003). Pain on admission was higher in patients at 70 years of age (p<0.0001). In patients aged ≥70 years with improvement of <3 points after admission, the FIM scores on admission and at discharge were low (Mann–Whitney U test, p<0.05). Based on these results, in the elderly >70 years old with mild to moderate cervical SCI, improvement of pain might be a significant factor for neurological functional recovery. In other words, pain control is an important factor influencing prognosis. Prognosis was not related to the use of high-dose steroid therapy, surgery, and height of cervical spinal cord damage.

Conclusion: Pain relief in mild to moderate cervical SCI cases will encourage functional recovery, leading to im­prove­ment of FIM. Pain relief, especially in elderly patients >70 years old, is thought to be extremely im­portant.