Rapana A*, Alfieri A, Guida F, Marcelli M3 and Iaccarino C
Department of Surgery and Traumatology, L. Bonomo Hospital, Italy
Department of Neuroscience, San Sebastiano Hospital, Italy
Department of Neuroscience, Ospedale dell’Angelo, Italy
Department of Emergency, University of Modena and Reggio Emilia, Italy
Objectives: Cervical Spondylosis (CS) is the first cause of myelopathy in adulthood. The concept that
the acquired narrowing of the canal may represent a risk factor for cord lesions also for moderate
trauma is not new; hyperextension of the neck was considered an important mechanism of cord
damage also in absence of bony lesions. Neurological compromising is usually severe with central
cord syndrome as the most common picture. Recently, a better understanding of the path genetic
mechanism of spondylotic disease contributed to the theory that the traumatic damage of spinal
cord could be re conduced to the combined effect of stress and shear with out of plane forces over a
condition of abnormal spinal mobility more than to the narrowness of the spinal canal.
Materials and Methods: The 20 consecutive patients with traumatic cervical cord injuries, whose
radiological examination showed only spondylosis changes in absence of traumatic bony lesions,
were admitted to the Neurosurgical Units of Mestre Hospital (Group A - eight patients) and
Caserta Hospital (Group B - twelve patients) during a two years period. On admission patients were
classified according to JOA classification scale; score ranged from 6 to 13. Grade 3 JOA impairment
was found out in six out of twenty patients (30%), Grade 2 compromising was found in ten patients
(50%) and Grade 1 one resulted in 4 patients (20%). Group A patients were treated conservatively
while group B was spitted into two different subgroups; six patients with single level contusion area
underwent decompression and stabilization while a conservative treatment was chosen for patients
harboring wider contusions (four patients).
Results: Regardless of treatment, a moderate to discrete neurological deficits persisted for all patients
but one who remained unchanged. No patient recovered completely. Conservatively managed
patients showed a mean increase in JOA score consisting of one point. Surgically treated patients
improved 2.25 JOA points (mean values) showing a mild tendency towards a better outcome for
surgically treated patients.
Discussion: Altered spinal motion in spondylosis patients can produce cord damages also after
mild trauma due to abnormal forces and stresses acting over a cord almost tethered by spondylotic
modifications of the spine. There are not clear evidences suggesting which the best treatment is.
Surgical option could be taken into account for patients affected by focal lesions with incomplete
neurological compromising and ligamentous damages. In these cases surgery should be not limited
to decompression but must comprehend surgical stabilization too. Prevention of secondary cord
damage also in case of further traumatic events, facilitation of earlier mobilization, shorter hospital
stays, and reduction of medical complications due to bed rest are possible advantages.
Rapana A, Alfieri A, Guida F, Marcelli M, Iaccarino C. Post-Traumatic Cervical Myelopathy without Traumatic Bony Lesions in Spondylosis Patients Physiopathology, Clinical Picture and Therapeutical Options. Ann Neurol Surg. 2020; 4(1): 1020..