Nontraumatic Spinal Cord Injury

Study Design. Retrospective cohort study. Objective. To analyze the demographics, clinical features, and long-term outcomes of patients with nontraumatic spinal cord injury (NTSCI) who underwent surgical treatment. Summary of Background Data. The incidence of NTSCI is increasing and exceeds that of traumatic spinal cord injury in some countries, yet the understanding of surgically treated NTSCI patients is limited. Methods. NTSCI patients undergoing surgery between January 2010 and August 2022 were included. The primary outcomes were American Spinal Injury Association Impairment Scale (AIS) grade improvement and overall survival, analyzed using logistic and Cox regression. Results. Among 212 patients (58.0% male, mean age 51.6±14.7 yr), the most common etiology was degenerative cervical myelopathy (52.4%). Preoperatively, AIS grades were predominantly AIS D (65.1%), followed by AIS C (22.6%), AIS B (9.4%), and AIS A (2.8%). Postsurgery, 15.6% improved to AIS E, reducing the proportion of AIS A-C patients from 34.9% to 29.2% ( P <0.001). Hospital-based rehabilitation showed significant AIS improvement ( P <0.001), home-based rehabilitation had marginal improvement ( P =0.057), and no significant change was observed in the nonrehabilitation group ( P =0.183). With a mean follow-up of 102.4±53.6 months, 42% of patients achieved AIS E, while AIS A-C decreased from 34.9% to 24%. The 5-year overall survival was 99.1%, and the 10-year survival was 88.7%. Etiology (OR 0.089, 95% CI=0.018–0.440, P =0.003) and history of operation (OR 0.137, 95% CI=0.042–0.454, P =0.001) were independent factors of AIS improvement, while etiology (OR 0.091, 95% CI=0.018–0.447, P =0.003) and time of worsening (OR 0.212, 95% CI=0.051–0.885, P =0.033) were linked to overall survival. Conclusion. Surgery and rehabilitation significantly improve clinical outcomes in NTSCI patients. Etiology and history of operation are independent prognostic factors for AIS improvement, whereas etiology and time of worsening are independent predictors of overall survival.