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Study design <p>Multicenter retrospective cohort study.</p> Objectives <p>To investigate the impact of delayed diagnosis on treatment decisions and neurological outcomes in elderly patients with cervical spinal cord injury (CSCI) without radiographic evidence of trauma (SCIWORET).</p> Setting <p>Nationwide multicenter registry of the Japan Association of Spine Surgeons with Ambition (JASA).</p> Methods <p>Data from patients aged ≥65 years with traumatic cervical SCIWORET treated between 2010 and 2020 were reviewed. Delayed diagnosis was defined as a diagnosis of CSCI made more than 24 hours after injury, either because of (1) physician delay (missed diagnosis despite presentation) or (2) patient delay (injury-to-hospital arrival &gt; 24 hours). Clinical characteristics, radiological findings, treatment strategies, and neurological outcomes (American Spinal Injury Association Impairment Scale, AIS) were compared between early and delayed diagnosis groups.</p> Results <p>Among 613 elderly patients with SCIWORET, 81 (12.8%) experienced delayed diagnosis. These patients were significantly older (<i>p</i> = 0.048), more frequently dependent for ambulation (<i>p</i> &lt; 0.001), and commonly injured by ground-level falls (<i>p</i> &lt; 0.01). Initial AIS grades and radiological findings were comparable between groups. However, patients with delayed diagnosis underwent more frequent surgical intervention at admission (<i>p</i> &lt; 0.001) and more frequent conversion from conservative to surgical management due to neurological deterioration (<i>p</i> &lt; 0.001). Final AIS grades did not differ significantly between groups.</p> Conclusions <p>Delayed diagnosis of SCIWORET in elderly patients is associated with increased surgical intervention without improved neurological recovery. Early recognition and timely MRI assessment may help reduce potentially avoidable surgery.</p>

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Impact of delayed diagnosis on surgical management and neurological outcomes in elderly patients with cervical spinal cord injury without radiographic evidence of trauma: a multicenter registry study

  • 期刊论文

  • 发表日期：

    2026年3月11日

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  • Tomohiro Yamada,
  • Yu Yamato,
  • Tomohiko Hasegawa,
  • Yukihiro Matsuyama,
  • Noriaki Yokogawa,
  • Takeshi Sasagawa,
  • Hiroaki Nakashima,
  • Naoki Segi,
  • Sadayuki Ito,
  • Toru Funayama,
  • Fumihiko Eto,
  • Akihiro Yamaji,
  • Kota Watanabe,
  • Satoshi Nori,
  • Kazuki Takeda,
  • Takeo Furuya,
  • Atsushi Yunde,
  • Hideaki Nakajima,
  • Yoshinori Terashima,
  • Ryosuke Hirota,
  • Hidenori Suzuki,
  • Yasuaki Imajo,
  • Shota Ikegami,
  • Masashi Uehara,
  • Hitoshi Tonomura,
  • Munehiro Sakata,
  • Ko Hashimoto,
  • Yoshito Onoda,
  • Kenichi Kawaguchi,
  • Yohei Haruta,
  • Nobuyuki Suzuki,
  • Kenji Kato,
  • Hiroshi Uei,
  • Hirokatsu Sawada,
  • Kazuo Nakanishi,
  • Hidetomi Terai,
  • Koji Tamai,
  • Akiyoshi Kuroda,
  • Gen Inoue,
  • Kenichiro Kakutani,
  • Yuji Kakiuchi,
  • Katsuhito Kiyasu,
  • Hiroyuki Tominaga,
  • Yoichi Iizuka,
  • Eiji Takasawa,
  • Koji Akeda,
  • Norihiko Takegami,
  • Haruki Funao,
  • Yasushi Oshima,
  • Takashi Kaito,
  • Daisuke Sakai,
  • Toshitaka Yoshii,
  • Tetsuro Ohba,
  • Bungo Otsuki,
  • Shoji Seki,
  • Masashi Miyazaki,
  • Masayuki Ishihara,
  • Seiji Okada,
  • Shiro Imagama,
  • Satoshi Kato

摘要

Study design

Multicenter retrospective cohort study.

Objectives

To investigate the impact of delayed diagnosis on treatment decisions and neurological outcomes in elderly patients with cervical spinal cord injury (CSCI) without radiographic evidence of trauma (SCIWORET).

Setting

Nationwide multicenter registry of the Japan Association of Spine Surgeons with Ambition (JASA).

Methods

Data from patients aged ≥65 years with traumatic cervical SCIWORET treated between 2010 and 2020 were reviewed. Delayed diagnosis was defined as a diagnosis of CSCI made more than 24 hours after injury, either because of (1) physician delay (missed diagnosis despite presentation) or (2) patient delay (injury-to-hospital arrival > 24 hours). Clinical characteristics, radiological findings, treatment strategies, and neurological outcomes (American Spinal Injury Association Impairment Scale, AIS) were compared between early and delayed diagnosis groups.

Results

Among 613 elderly patients with SCIWORET, 81 (12.8%) experienced delayed diagnosis. These patients were significantly older (p = 0.048), more frequently dependent for ambulation (p < 0.001), and commonly injured by ground-level falls (p < 0.01). Initial AIS grades and radiological findings were comparable between groups. However, patients with delayed diagnosis underwent more frequent surgical intervention at admission (p < 0.001) and more frequent conversion from conservative to surgical management due to neurological deterioration (p < 0.001). Final AIS grades did not differ significantly between groups.

Conclusions

Delayed diagnosis of SCIWORET in elderly patients is associated with increased surgical intervention without improved neurological recovery. Early recognition and timely MRI assessment may help reduce potentially avoidable surgery.