Optimal treatment for spinal cord injury associated with cervical canal stenosis (OSCIS): a study protocol for a randomized controlled trial comparing early versus delayed surgery.
BACKGROUND
The optimal management of acute cervical spinal cord injury (SCI) associated with preexisting canal stenosis remains to be established. The objective of this study is to examine whether early surgical decompression (within 24 hours after admission) would result in greater improvement in motor function compared with delayed surgery (later than two weeks) in cervical SCI patients presenting with canal stenosis, but without bony injury.


METHODS
OSCIS is a randomized, controlled, parallel-group, assessor-blinded, multicenter trial. We will recruit 100 cervical SCI patients who are admitted within 48 hours of injury (aged 20 to 79 years; without fractures or dislocations; American Spinal Injury Association (ASIA) grade C; preexisting spinal canal stenosis). Patients will be enrolled from 36 participating hospitals across Japan and randomly allocated in a 1:1 ratio to either early surgical decompression (within 24 hours after admission) or delayed surgery following at least two weeks of conservative treatment. The primary outcomes include: 1) the change from baseline to one year in the ASIA motor score; 2) the total score of the Spinal Cord Independence Measure and 3) the proportion of patients who are able to walk without human assistance. The secondary outcomes are: 1) the health-related quality of life as measured by the Medical Outcomes Study Short Form 36 and the EuroQol 5 Dimension; 2) the Neuropathic Pain Symptom Inventory and 3) the walking status as evaluated with the Walking Index for Spinal Cord Injury II. The analysis will be on an intention-to-treat basis. The primary analysis will be a comparison of the primary and secondary outcomes one year after the injury.


CONCLUSIONS
The results of this study will provide evidence of the potential benefit of early surgical decompression compared to the current 'watch and wait' strategy.
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. chikuda-tky@umin.ac.jp
Hirotaka
H
Chikuda
Hiroshi
H
Ohtsu
Toru
T
Ogata
Shurei
S
Sugita
Masahiko
M
Sumitani
Yurie
Y
Koyama
Morio
M
Matsumoto
Yoshiaki
Y
Toyama
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D002985:Clinical Protocols; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D007564:Japan; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D011237:Predictive Value of Tests; D011788:Quality of Life; D020127:Recovery of Function; D012107:Research Design; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult