Nomogram for predicting survival in patients with motor-complete cervical spinal cord injury without fracture-dislocation: a multicenter retrospective study
6 affiliations
- 1Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University
- 2Department of Emergency Medicine, No. 940 Hospital of the PLA Joint Logistics Support Force
- 3Department of Orthopedics, Xijing Hospital, The Fourth Military Medical University
- 4Department of Spine Surgery, The Second Xiangya Hospital of Central South University
- 5Department of Orthopedics, The Fuyang Hospital of Anhui Medical University
- 6Department of Orthopedics, The General Hospital of Northern Theater Command
Abstract
Introduction: Cervical spinal cord injury without fracture-dislocation (CSCIWFD) presents significant diagnostic and therapeutic challenges, particularly in adults with motor-complete lesions. The absence of fractures or dislocations on conventional imaging complicates prognosis and treatment planning. However, no prognostic tools currently exist that are specific to motor-complete CSCIWFD. This study aimed to develop a predictive nomogram for this patient population.
Methods: A multicenter, retrospective cohort study was conducted on 164 adult patients with motor-complete CSCIWFD admitted to five tertiary centers between 2010 and 2021. Demographic, clinical, injury-related, and treatment-specific variables were collected. A multivariable Cox proportional hazards model was used to identify independent factors associated with survival. A nomogram was developed based on these factors and validated internally using bootstrap resampling. Model performance was assessed by discrimination and calibration.
Results: The 5-year mortality rate was 29.9%. Multivariable analysis identified several independent risk factors: Charlson Comorbidity Index ≥2, Injury Severity Score ≥25, organ damage, high neurological level, high-energy injury mechanism, non-surgical or delayed surgical treatment, peri-injury complications, and ventilator support ≥72 h. The resulting nomogram demonstrated excellent predictive accuracy and calibration, with a C-index of 0.89 (95% CI, 0.85–0.92).
Conclusion: This study establishes key predictors of mortality in motor-complete CSCIWFD and presents the disease-specific nomogram for risk stratification. The tool demonstrates high reliability in Chinese patients, and external validation studies are necessary to confirm the universality of our method in the population and treatment practice.
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BibTeX
@article{jiang2026nomogram,
title = {{Nomogram for predicting survival in patients with motor-complete cervical spinal cord injury without fracture-dislocation: a multicenter retrospective study}},
author = {Tao Jiang and Hao Bai and Lei Han and Yufei Ji and Tong Zhang and Ziqun Liu and Xiajun Liang and Yang Zhang and Haiyang Yu and Hailong Yu and Quanchang Tan and Zixiang Wu},
journal = {Frontiers in Neurology},
year = {2026},
month = nov,
doi = {10.3389/fneur.2026.1885226},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1885226/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Nomogram for predicting survival in patients with motor-complete cervical spinal cord injury without fracture-dislocation: a multicenter retrospective study
AU - Tao Jiang
AU - Hao Bai
AU - Lei Han
AU - Yufei Ji
AU - Tong Zhang
AU - Ziqun Liu
AU - Xiajun Liang
AU - Yang Zhang
AU - Haiyang Yu
AU - Hailong Yu
AU - Quanchang Tan
AU - Zixiang Wu
PY - 2026
DA - 2026/11/04
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1885226
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1885226/full
AB - Introduction: Cervical spinal cord injury without fracture-dislocation (CSCIWFD) presents significant diagnostic and therapeutic challenges, particularly in adults with motor-complete lesions. The absence of fractures or dislocations on conventional imaging complicates prognosis and treatment planning. However, no prognostic tools currently exist that are specific to motor-complete CSCIWFD. This study aimed to develop a predictive nomogram for this patient population. Methods: A multicenter, retrospective cohort study was conducted on 164 adult patients with motor-complete CSCIWFD admitted to five tertiary centers between 2010 and 2021. Demographic, clinical, injury-related, and treatment-specific variables were collected. A multivariable Cox proportional hazards model was used to identify independent factors associated with survival. A nomogram was developed based on these factors and validated internally using bootstrap resampling. Model performance was assessed by discrimination and calibration. Results: The 5-year mortality rate was 29.9%. Multivariable analysis identified several independent risk factors: Charlson Comorbidity Index ≥2, Injury Severity Score ≥25, organ damage, high neurological level, high-energy injury mechanism, non-surgical or delayed surgical treatment, peri-injury complications, and ventilator support ≥72 h. The resulting nomogram demonstrated excellent predictive accuracy and calibration, with a C-index of 0.89 (95% CI, 0.85–0.92). Conclusion: This study establishes key predictors of mortality in motor-complete CSCIWFD and presents the disease-specific nomogram for risk stratification. The tool demonstrates high reliability in Chinese patients, and external validation studies are necessary to confirm the universality of our method in the population and treatment practice.
SN - 1664-2295
ER -