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The pathophysiology of cervical spinal cord injury: what are the differences between traumatic injury and degenerative disorder

Abstract

Study design

Retrospective comparative clinical study.

Objective

To establish eligible diagnostic criteria for traumatic cervical spinal cord injury (TCSCI) without major fracture or dislocation and create a definitive clinical protocol by comparing the pathophysiology of CSCI in both traumatic and degenerative disorders.

Setting

Fukuoka, Japan.

Methods

A total of 21 TCSCI patients and 16 rapid progressive clinical deterioration of cervical spondylotic myelopathy (rp-CSM: additional cervical spinal cord injury with an existing cervical myelopathy) patients with impairment graded as C or D on the American Spinal Injury Association (ASIA) Impairment Scale were included in the study. Magnetic resonance (MR) images and ASIA motor scores were evaluated for all of the patients at the time of admission and 12 months postoperatively.

Results

The T2-weighted MR images for all patients showed an abnormally high intramedullary signal in the area of the injured segment at the first examination. At 12 months post-surgery, 47.62% of patients with TCSCI and none with rp-CSM had an abnormally low intramedullary signal change on T1-weighted MR images. The neurological improvement with rp-CSM was significantly greater than that with TCSCI at 12 months postoperatively.

Conclusions

Our results suggest that the pathophysiology of CSCI between traumatic injury and degenerative disorder are similar, but not identical. The most important factor in the early pathophysiological differential diagnosis between these two pathologies is the presence of an existing cervical myelopathy. We believe that early prognosis with eligible diagnosis for CSCI may lead to early preparations for social rehabilitation in each case.

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Fig. 1: T1 and T2-weighted MR images before decompression surgery.
Fig. 2: T1 and T2-weighted MR images at 12 months postoperatively.

Data availability

All data supporting the findings of this study are available within the article and its Supplementary Materials.

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Funding

This work was supported by Grant-in-aid for Scientific Research (C) from The Japanese Ministry of Education, Culture, Sports, Science and Technology (Grant Number 19K09662) and ZENKYOREN (National Mutual Insurance Federation of Agricultural Cooperatives).

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OK was responsible for conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results. TM was responsible for drafted or revised the manuscript for important intellectual content, and approved the final version.

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Correspondence to Yuichiro Morishita.

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The authors declare no competing interests.

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Morishita, Y., Kawano, O. & Maeda, T. The pathophysiology of cervical spinal cord injury: what are the differences between traumatic injury and degenerative disorder. Spinal Cord Ser Cases 8, 50 (2022). https://doi.org/10.1038/s41394-022-00517-7

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