Risk of Post-Traumatic Spinal Cord Injury in Patients with Stenosis of the Cervical Spine: A Systematic Review and Meta-Analysis.

Introduction: Cervical stenosis (CS) is the pathologic narrowing of the central canal of the cervical spine. It is often incidentally discovered. It is unclear whether pre-existing CS can lead to worse outcomes and higher incidences of post-traumatic spinal cord injury (SCI).
Methods: We conducted a systematic review and meta-analysis of studies collected using keywords "cervical stenosis" AND ("trauma" OR "injury"). 381 articles were collected from Pubmed, Embase, and Cochrane, and 2,675 patients from 7 studies were included in the final analyses. Neo-bayesian statistics were used to estimate a number needed to treat (NNT).
Results: In a meta-analysis of studies with internal controls, patients with pre-existing CS are not at a higher risk of post-traumatic SCI (OR 2.73, 95% CI 0.78-9.50). However, CS patients have a greater incidence of SCI (0.41, 95%-CI 0.26-0.56) compared to patients without CS (0.18, 95%-CI 0.14-0.22). Patients with CS were also over-represented in the population of SCI patients (0.46, 95%-CI 0.27; 0.65). Using Neo-bayesian statistics, we estimate that 70 patients with CS must be treated to prevent one SCI. In patients who participate in higher risk physical activities, the NNT may be lower.
Conclusions: Though patients with pre-existing CS do not have higher odds of SCI in studies with internal controls, we find that patients with CS do have higher incidences of SCI and are over-represented in the population of SCI patients. In select CS patients with active lifestyles, close follow-up and consideration of various treatment options may be indicated.
(Copyright © 2024. Published by Elsevier Inc.)