76 - How much benefits do different treatments bring to patients with multilevel cervical canal stenosis without cervical fracture or dislocation of acute traumatic central cord syndrome?

Objective: To compare the efficacy of different treatments for patients with multilevel cervical canal stenosis (CCS) without cervical fracture or dislocation of acute traumatic central cord syndrome (ATCCS).

Methods: From January 2015 to December 2019, 93 patients with CCS sufferring from ATCCS were followed up for at least one year. Among them, 30 patients (Group A) received conservative treatment, 18 patients (Group B) received early surgery (≤7 days), 45 patients (Group C) received late surgery (>7 days). The American Spinal Injury Association (ASIA) grade, Japanese Orthopaedic Association (JOA) score and recovery rate (RR) were evaluated. Multiple linear regression was used to analyze prognostic determinants. Cost-utility analysis was performed based on EQ-5D scale.

Results: The ASIA grade and JOA score all improved with RR over 60% (P < 0.05). During follow-up, the ASIA grade, JOA score and RR of Group B were both better than Group A and Group C (P < 0.05). The EQ-5D scale in Group B was optimal at the last follow-up. The incremental cost utility ratio (ICUR) of Group A was the least, while of Group B versus Group A was less than the threshold of patients' willingness to pay. Age, ASIA grade and treatment type significantly affected the outcomes.

Conclusions: Both conservative and surgical treatment yield good results. Compared with conservative treatment and late surgery, patients who received early surgery had better clinical function and living quality. Even though with higher cost, early surgery can be considered cost-effective compared to conservative treatment. Younger age, better ASIA grade and early surgery were protective factors for better prognosis.