Prognostic Factors for Cervical Spinal Cord Injury without Major Bone Injury in Elderly Patients

Hideaki Nakajima, Noriaki Yokogawa, Takeshi Sasagawa, Kei Ando, Naoki Segi, Kota Watanabe, Satoshi Nori, Shuji Watanabe, Kazuya Honjoh, Toru Funayama, Fumihiko Eto, Yoshinori Terashima, Ryosuke Hirota, Takeo Furuya, Tomohiro Yamada, Gen Inoue, Takashi Kaito, Satoshi Kato

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


In the current aging society, there has been a marked increase in the incidence of cervical spinal cord injury (CSCI) without major bone injury. This multi-center study aimed to identify predictors of neurological improvement in elderly patients with CSCI without major bone injury. The participants were 591 patients aged ≥65 years with CSCI without major bone injury and a minimum follow-up period of three months. Neurologic status was defined using the American Spinal Injury Association (ASIA) impairment scale (AIS). Univariate and multi-variate analyses were performed to identify prognostic factors for walking recovery in AIS A-C cases and full upper extremity motor recovery in AIS D cases. In AIS A-C cases, body mass index (odds ratio (OR): 1.112), magnetic resonance imaging signal change (OR: 0.240), AIS on admission (OR: 3.497), comorbidity of dementia/delirium (OR: 0.365), and post-injury pneumonia (OR: 0.194) were identified as independent prognostic factors for walking recovery. The prevalence of ossification of the posterior longitudinal ligament (OR: 0.494) was also found to be an independent prognostic factor in AIS B and C cases only. In AIS D cases, age (OR: 0.937), upper extremity ASIA motor score on admission (OR: 1.230 [per 5 scores]), and operation (OR: 0.519) were independent prognostic factors for full motor recovery. The severity of AIS at admission was the strongest predictor of functional outcomes. Promoting rehabilitation, however, through measures to reduce cognitive changes, post-injury pneumonia, and unhealthy body weight changes can contribute to greater neurological improvement in AIS A-C cases.

Original languageEnglish
Pages (from-to)658-666
Number of pages9
JournalJournal of Neurotrauma
Issue number9-10
Publication statusPublished - 2022 May


  • cervical spinal cord injury
  • elderly patients
  • multi-variate analysis
  • neurological improvement
  • no major bone injury
  • prognostic factor

ASJC Scopus subject areas

  • Clinical Neurology


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