title: The influence of time from injury to surgery on motor recovery and length of hospital stay in acute traumatic spinal cord injury: an observational Canadian cohort study.
abstract: To determine the influence of time from injury to surgery on neurological recovery and length of stay (LOS) in an observational cohort of individuals with traumatic spinal cord injury (tSCI), we analyzed the baseline and follow-up motor scores of participants in the Rick Hansen Spinal Cord Injury Registry to specifically assess the effect of an early (less than 24 h from injury) surgical procedure on motor recovery and on LOS. One thousand four hundred and ten patients who sustained acute tSCIs with baseline American Spinal Injury Association Impairment Scale (AIS) grades A, B, C, or D and were treated surgically were analyzed to determine the effect of the timing of surgery (24, 48, or 72 h from injury) on motor recovery and LOS. Depending on the distribution of data, we used different types of generalized linear models, including multiple linear regression, gamma regression, and negative binomial regression. Persons with incomplete AIS B, C, and D injuries from C2 to L2 demonstrated motor recovery improvement of an additional 6.3 motor points (SE=2.8 p<0.03) when they underwent surgical treatment within 24 h from the time of injury, compared with those who had surgery later than 24 h post-injury. This beneficial effect of early surgery on motor recovery was not seen in the patients with AIS A complete SCI. AIS A and B patients who received early surgery experienced shorter hospital LOS. While the issues of when to perform surgery and what specific operation to perform remain controversial, this work provides evidence that for an incomplete acute tSCI in the cervical, thoracic, or thoracolumbar spine, surgery performed within 24 h from injury improves motor neurological recovery. Early surgery also reduces LOS.
authors.affiliation: 1 Division of Spine, Department of Orthopedics, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.forename: Vanessa K
authors.initials: VK
authors.lastname: Noonan
authors.forename: Nader
authors.initials: N
authors.lastname: Fallah
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
authors.forename: Joel
authors.initials: J
authors.lastname: Finkelstein
authors.forename: Brian K
authors.initials: BK
authors.lastname: Kwon
authors.forename: Carly S
authors.initials: CS
authors.lastname: Rivers
authors.forename: Henry
authors.initials: H
authors.lastname: Ahn
authors.forename: Jérôme
authors.initials: J
authors.lastname: Paquet
authors.forename: Eve C
authors.initials: EC
authors.lastname: Tsai
authors.forename: Andrea
authors.initials: A
authors.lastname: Townson
authors.forename: Najmedden
authors.initials: N
authors.lastname: Attabib
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Bailey
authors.forename: Sean D
authors.initials: SD
authors.lastname: Christie
authors.forename: Brian
authors.initials: B
authors.lastname: Drew
authors.forename: Daryl R
authors.initials: DR
authors.lastname: Fourney
authors.forename: Richard
authors.initials: R
authors.lastname: Fox
authors.forename: R John
authors.initials: RJ
authors.lastname: Hurlbert
authors.forename: Michael G
authors.initials: MG
authors.lastname: Johnson
authors.forename: A G
authors.initials: AG
authors.lastname: Linassi
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D015998:Abbreviated Injury Scale; D002170:Canada; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D020127:Recovery of Function; D012044:Regression Analysis; D013119:Spinal Cord Injuries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: clinical trials; spinal cord injury; surgical decompression; timing of surgery; translational research