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Multicenter Study
. 2023 Oct;32(10):3522-3532.
doi: 10.1007/s00586-023-07828-9. Epub 2023 Jun 27.

Prognostic impact of respiratory dysfunction in elderly patients with cervical spinal cord injury and/or fractures: a multicenter survey

Ryosuke Hirota  1 , Yoshinori Terashima  2   3 , Hirofumi Ohnishi  4 , Toshihiko Yamashita  2 , Noriaki Yokogawa  5 , Takeshi Sasagawa  5   6 , Hiroaki Nakashima  7 , Naoki Segi  7 , Sadayuki Ito  7 , Toru Funayama  8 , Fumihiko Eto  9 , Akihiro Yamaji  10 , Kota Watanabe  11 , Satoshi Nori  11 , Kazuki Takeda  11   12 , Takeo Furuya  13 , Atsushi Yunde  13 , Hideaki Nakajima  14 , Tomohiro Yamada  15   16 , Tomohiko Hasegawa  15 , Hidenori Suzuki  17 , Yasuaki Imajo  17 , Shota Ikegami  18 , Masashi Uehara  18 , Hitoshi Tonomura  19 , Munehiro Sakata  19   20 , Ko Hashimoto  21 , Yoshito Onoda  21 , Kenichi Kawaguchi  22 , Yohei Haruta  22 , Nobuyuki Suzuki  23 , Kenji Kato  23 , Hiroshi Uei  24   25 , Hirokatsu Sawada  25 , Kazuo Nakanishi  26 , Kosuke Misaki  26 , Hidetomi Terai  27 , Koji Tamai  27 , Akiyoshi Kuroda  28 , Gen Inoue  28 , Kenichiro Kakutani  29 , Yuji Kakiuchi  29 , Katsuhito Kiyasu  30 , Hiroyuki Tominaga  31 , Hiroto Tokumoto  31 , Yoichi Iizuka  32 , Eiji Takasawa  32 , Koji Akeda  33 , Norihiko Takegami  33 , Haruki Funao  34   35   36 , Yasushi Oshima  37 , Takashi Kaito  38 , Daisuke Sakai  39 , Toshitaka Yoshii  40 , Tetsuro Ohba  41 , Bungo Otsuki  42 , Shoji Seki  43 , Masashi Miyazaki  44 , Masayuki Ishihara  45 , Seiji Okada  38 , Shiro Imagama  7 , Satoshi Kato  5
Affiliations
Multicenter Study

Prognostic impact of respiratory dysfunction in elderly patients with cervical spinal cord injury and/or fractures: a multicenter survey

Ryosuke Hirota et al. Eur Spine J. 2023 Oct.

Abstract

Purpose: To investigate the impact of early post-injury respiratory dysfunction for neurological and ambulatory ability recovery in patients with cervical spinal cord injury (SCI) and/or fractures.

Methods: We included 1,353 elderly patients with SCI and/or fractures from 78 institutions in Japan. Patients who required early tracheostomy and ventilator management and those who developed respiratory complications were included in the respiratory dysfunction group, which was further classified into mild and severe respiratory groups based on respiratory weaning management. Patient characteristics, laboratory data, neurological impairment scale scores, complications at injury, and surgical treatment were evaluated. We performed a propensity score-matched analysis to compare neurological outcomes and mobility between groups.

Results: Overall, 104 patients (7.8%) had impaired respiratory function. In propensity score-matched analysis, the respiratory dysfunction group had a lower home discharge and ambulation rates (p = 0.018, p = 0.001, respectively), and higher rate of severe paralysis (p < 0.001) at discharge. At the final follow-up, the respiratory dysfunction group had a lower ambulation rate (p = 0.004) and higher rate of severe paralysis (p < 0.001). Twenty-six patients with severe disability required respiratory management for up to 6 months post-injury and died of respiratory complications. The mild and severe respiratory dysfunction groups had a high percentage of severe paraplegic cases with low ambulatory ability; there was no significant difference between them. The severe respiratory dysfunction group tended to have a poorer prognosis.

Conclusion: Respiratory dysfunction in elderly patients with SCI and/or cervical fracture in the early post-injury period reflects the severity of the condition and may be a useful prognostic predictor.

Keywords: Cervical fracture; Cervical spinal cord injury; Elderly patients; Prognostic impact; Respiratory dysfunction.

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