Nomogram for predicting survival in patients with motor-complete cervical spinal cord injury without fracture-dislocation: a multicenter retrospective study

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.