Comparison of Clinical Outcomes between Surgical and Conservative Treatments for Cervical Spinal Cord Injury without Fracture and Dislocation

Objective: To compare the effects of anterior cervical discectomy and fusion(ACDF) and conservative treatment on neurological function recovery in patients with Cervical spinal cord injury without fracture and dislocation(CSCIwoFD) who demonstrate evidence of spinal cord compression on MRI via a retrospective analysis of 90 cases. Methods: A retrospective study was conducted on 90 patients with CSCIwoFD who were treated at our hospital from August 2020 to August 2022. Patients were randomly assigned to either the surgical treatment group (Group A) or the conservative treatment group(Group B). Matched selection was performed using a computer-generated random number table to ensure allocation concealment. The allocation sequence was managed by an independent researcher who was not involved in the clinical treatment process. The JOA score, ASIA motor score, and ASIA sensory score were compared between the two groups. The improvement rates of the JOA score(RR), ASIA motor score(AMSRR), and ASIA sensory score(ASSRR) were also calculated and compared. Additionally, multivariate regression analysis was conducted to adjust for potential confounders such as Methods of treatment, age, genderand initial neurological status. The length of hospital stay, time to return to work post-discharge, in-hospital treatment costs, and patient satisfaction at 2 years post-treatment were also analyzed. Results: At the time of admission, there were no significant differences observed in the JOA, AMS, or ASS scores between the two groups (P > 0.05). During follow-up after treatment, both groups exhibited improvements in the JOA, ASS, and AMS scores compared with the pretreatment values. However, the surgical treatment group demonstrated more significant improvements compared with the conservative treatment group. Multivariate analysis confirmed thatonly Methods of treatment, MSCC, JOA score on admission, ASS on admission and AMS on admission demonstrated a consistent correlation across improvement rates. Spinal cord function recovery occurred at a faster rate in the early stages but was slower in the later stages. Within the first 6 months after treatment, the recovery of the JOA, AMS, and ASS scores was rapid in both groups; however, the rate of recovery slowed after 6 months. There were no significant improvements observed in the scores between 1 year and 2 years post-treatment. Significant differences were observed in the JOA scores and recovery rates(RR) between 1 year and 2 years post-treatment(P < 0.05). The AMS, ASS and AMSRR values were significantly different at 6 months, 1 year, and 2 years or more post-treatment(P < 0.05). The ASSRR was significantly different at 3 months, 6 months, 1 year, and 2 years or more post-treatment(P < 0.05). For the other time points, the differences in the JOA, RR, AMS, AMSRR, ASS and ASSRR values were not statistically significant(P > 0.05). There were significant differences observed in patient satisfaction at 2 years post-treatment and in the time to return to work post-discharge between the two groups(P < 0.05). However, no significant differences were observed in the length of hospital stay or in-hospital treatment costs(P > 0.05). Conclusion: Both surgical and conservative treatments are effective for treating CSCIwoFD. Early outcomes following surgery indicate a faster recovery of motor function, whereas long-term results suggest a more significant recovery of sensory function. The JOA score at 2 years post-treatment provides clinically significant guidance for assessing neurological recovery. Therefore, under the condition that the patient's basic condition permits and with their voluntary consent, we recommend the use of surgical intervention for patients with CSCIwoFD who exhibit evidence of spinal cord compression on cervical MRI.