Radiological classification and its credibility assessment of acute cervical spinal cord injury without fracture or dislocation in adults / 中华创伤杂志

ABSTRACT

Objective:To establish a radiological classification system for acute cervical spinal cord injury without fracture or dislocation in adults and evaluate its credibility.Methods:A retrospective case series study was performed to analyze the clinical and radiological data of 132 patients with acute cervical spinal cord injury without cervical fracture or dislocation admitted to Huashan Hospita，Fudan University from January 2010 to December 2018. There were 97 males and 35 females，aged 18-82 years［（57.4±17.8）years］. The radiological classification system of acute cervical spinal cord injury without fracture and dislocation in adults was established based on spinal cord compression and its compressors，and the disco-ligamentous complex（DLC）injury. The number，age and causes of injury of each subtype were further analyzed. Another 24 patients with acute cervical spinal cord injury without fracture and dislocation were collected and assessed to calculate the Kappa coefficient for credibility assessment in the radiological classification by orthopedic surgeons who did not participate in the establishment of the classification.Results:The radiological classification system of acute cervical spinal cord injury without fracture or dislocation in adults included types I-IV. Type I was the cervical spinal cord significantly compressed by the existed pathological factors such as the ossification of the posterior longitudinal ligament of the cervical spine and/or cervical spinal canal stenosis before the injury；Type II was the cervical spinal cord significantly compressed by traumatic disc herniation and/or epidural hematoma；Type III was the spinal cord without obvious compression，but with definite DLC injury；Type IV was the spinal cord without obvious compression，accompanied with no or only suspicious DLC injury. Type I and type II could be with or without DLC injury. Eighty-three patients（62.9%）were classified as type I，with the age of（62.2±15.7）years，and the main cause of injury was fall injury（37 patients，44.6%），followed by traffic injury（31 patients，37.3%）. Seventy patients（12.9%）were classified as type II，with the age of（55.8±13.4）years，and the traffic injury（9 patients，52.9%）and fall injury（5 patients，29.4%）were more common. Twenty-four patients（18.2%）were classified as type III，with the age of（53.6±16.3）years，and the main causes of injury were fall injury（9 patients，37.5%）and traffic injury（8 patients，33.3%）. Eight patients（6.1%）were classified as type IV，with the age of（37.4±11.6）years，and the main causes of injury were traffic injury（4 patients，50.0%）and sports injury（3 patients，37.5%）. The credibility assessment of the radiological classification of acute cervical spinal cord injury without fracture or dislocation in adults showed that the consistency percentage was 79.2%-87.5%（mean，81.2%）among different observers. The Kappa coefficient was 0.691-0.866（mean，0.789），and the credibility was basically credible（0.61-0.80）.Conclusions:The established radiological classification system of acute cervical spinal cord injury without fracture or dislocation in adults has a good degree of credibility. Variances in age and causes of injury of each type suggest a good guidance value for clinical classification of acute cervical spinal cord injury without fracture and dislocation in adults.