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

Abstract

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). We conducted a systematic review and meta-analysis of studies collected using the keywords "cervical stenosis" AND ("trauma" OR "injury"). About 381 articles were collected from PubMed, Embase, and Cochrane, and 2675 patients from 7 studies were included in the final analyses. Neo-Bayesian statistics were used to estimate a number needed to treat. In a meta-analysis of studies with internal controls, patients with pre-existing CS are not at a higher risk of post-traumatic SCI (odds ratio 2.73, 95% confidence interval [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 number needed to treat may be lower. 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.