title: Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS).
abstract: BACKGROUND
  There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (<24 hours after injury) versus late (≥ 24 hours after injury) decompressive surgery after traumatic cervical SCI.
  
  
  METHODS
  We performed a multicenter, international, prospective cohort study (Surgical Timing In Acute Spinal Cord Injury Study: STASCIS) in adults aged 16-80 with cervical SCI. Enrolment occurred between 2002 and 2009 at 6 North American centers. The primary outcome was ordinal change in ASIA Impairment Scale (AIS) grade at 6 months follow-up. Secondary outcomes included assessments of complications rates and mortality.
  
  
  RESULTS
  A total of 313 patients with acute cervical SCI were enrolled. Of these, 182 underwent early surgery, at a mean of 14.2(± 5.4) hours, with the remaining 131 having late surgery, at a mean of 48.3(± 29.3) hours. Of the 222 patients with follow-up available at 6 months post injury, 19.8% of patients undergoing early surgery showed a ≥ 2 grade improvement in AIS compared to 8.8% in the late decompression group (OR = 2.57, 95% CI:1.11,5.97). In the multivariate analysis, adjusted for preoperative neurological status and steroid administration, the odds of at least a 2 grade AIS improvement were 2.8 times higher amongst those who underwent early surgery as compared to those who underwent late surgery (OR = 2.83, 95% CI:1.10,7.28). During the 30 day post injury period, there was 1 mortality in both of the surgical groups. Complications occurred in 24.2% of early surgery patients and 30.5% of late surgery patients (p = 0.21).
  
  
  CONCLUSIONS
  Decompression prior to 24 hours after SCI can be performed safely and is associated with improved neurologic outcome, defined as at least a 2 grade AIS improvement at 6 months follow-up.
authors.affiliation: Divisions of Neurosurgery and Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada. michael.fehlings@uhn.on.ca
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: Alexander
authors.initials: A
authors.lastname: Vaccaro
authors.forename: Jefferson R
authors.initials: JR
authors.lastname: Wilson
authors.forename: Anoushka
authors.initials: A
authors.lastname: Singh
authors.forename: David
authors.initials: D
authors.lastname: W Cadotte
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Bizhan
authors.initials: B
authors.lastname: Aarabi
authors.forename: Christopher
authors.initials: C
authors.lastname: Shaffrey
authors.forename: Marcel
authors.initials: M
authors.lastname: Dvorak
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
authors.forename: Paul
authors.initials: P
authors.lastname: Arnold
authors.forename: Eric M
authors.initials: EM
authors.lastname: Massicotte
authors.forename: Stephen
authors.initials: S
authors.lastname: Lewis
authors.forename: Raja
authors.initials: R
authors.lastname: Rampersaud
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000293:injuries*; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome