Selection of Surgical Approach and Clinical Significance of Lower Cervical Spine Injuries Guided by SLIC Scoring System

Abstract

Objective : To explore the feasibility and clinical significance of surgical approach selection for cervical spine injury guided by SLIC scoring system. Methods : The clinical data of 75 patients with lower cervical injury surgery from January 2020 to November 2022 were retrospectively analyzed, including 48 males and 27 females. Age: 28 - 65 years old. Causes of injury: 39 cases of traffic accidents, 15 cases of ice and snow sports, 12 cases of falling from high places, 9 cases of heavy objects. There were 12 cases of C3-4, 33 cases of C4-5, 21 cases of C5-6, and 9 cases of C6-7. Time from injury to medical treatment: 4 h - 2 d. Cervical spine X-ray, MRI, MDCT examination and preoperative SLIC score were performed on admission. Anterior approach was performed by subtotal cervical vertebrae resection or discectomy, titanium Cage or cage supported bone grafting and anterior titanium plate fixation. Posterior approach was performed with cervical laminoplasty, lateral mass or pedicle screw fixation and fusion. The combined anterior-posterior operation was performed by the anterior methods+ posterior methods. The time from injury to surgery is 12 h to 3 d. The function before and after operation was evaluated by JOA efficacy evaluation criteria. The correlation between the three surgical approaches and postoperative efficacy and SLIC score was compared. SPSS 22.0 software was used for statistical analysis of the data. Results : In this group of 75 patients, 32 cases of anterior operation, 22 cases of posterior operation and 21 cases of combined operation were followed up for no less than 12 months. There was no significant difference in age, gender, injury cause, injury segment, time from injury to treatment, and time from injury to operation among the three surgical approaches, which were comparable. The SLIC scores of mild, moderate and severe injuries of anterior surgery, posterior surgery and combined anterior and posterior surgery, They were (5.26 ± 1.24, 5.86 ± 1.67, 8.25 ± 0.21), (5.57 ± 1.43, 5.99 ± 1.85, 9.00 ± 0.25), (0, 5.98 ± 0.33, 9.44 ± 0.34), respectively. By comparing the SLIC scores and JOA scores of anterior surgery and posterior surgery, there was no difference in SLIC scores and JOA scores between the two groups for mild and moderate injuries (P > 0.05). However, the JOA scores at 3 months, 6 months and 12 months after surgery were different from those before surgery, and the postoperative efficacy and JOA scores were significantly improved (P & lt; 0.05), indicating that the two surgical methods had the same therapeutic effect, that is, anterior or posterior surgery could be used to treat mild or moderate injuries (P > 0.05). There were differences in SLIC scores among the three surgical approaches for severe injury (P < 0.05), anterior or posterior surgery was selected, and the JOA score at 3 months after surgery was not significantly improved compared with that before surgery (P > 0.05). The postoperative efficacy and JOA score of combined anterior-posterior approach were significantly improved compared with those before operation (P < 0.05), indicating that the combination of anterior-posterior surgery in the treatment of severe injury has better efficacy than anterior or posterior surgery (P < 0.05). Conclusion: SLIC score not only provides accurate judgment for conservative treatment or surgical treatment of cervical spine injury, but also provides evidence-based medical basis and reference value for the selection of surgical approach and surgical method. According to the SLIC score, the surgical approach is safe and feasible. When the SLIC score is 4 - 7, anterior surgery is selected for type A injury, and posterior surgery is selected for type B injury. When the SLIC score is ≥8, combined anterior-posterior surgery should be selected. It is of great significance for clinical formulation of precision treatment strategy.