title: Timing of surgical decompression for traumatic cervical spinal cord injury.
abstract: OBJECTIVE
  Although there have been numerous studies aimed at determining the effects and safety of early vs. late surgical decompression for traumatic cervical spinal cord injury, controversies still exist regarding the optimal timing of surgery for this serious spinal trauma. This study was conducted to evaluate the effectiveness and safety of early vs. late surgical decompression for lower cervical spine trauma associated with spinal cord injury.
  
  
  METHODS
  A retrospective review of was performed on consecutive patients who underwent surgical decompression for lower cervical (C3-C7) spine trauma associated with spinal cord injury at six institutions across China from January 2007 to January 2012. These patients were analysed according to the timing of surgical intervention. The early group comprised patients who underwent surgery within the first 72 hours after being injured, whilst the late group comprised patients who underwent surgery after the first 72 hours. For analysis of neurologic improvement, patients who had completed a follow-up of at least six months were assessed. Other outcomes analysed were hospitalisation periods, complications and mortality.
  
  
  RESULTS
  A total of 595 patients were identified (456 men and 139 women at an average age of 41.4 years), with 212 in the early group and 383 in the late group. Patients in both groups had made a significant neurologic improvement in the final follow-up, but no statistically significant difference was noted between groups. Patients in the early group had a significantly shorter hospital stay (15.4 vs. 18.3 days, p <0.001) but realised no benefits in terms of intensive care unit length of stay and ventilator days. No significant differences were identified between groups with regards complications (pneumonia, pulmonary embolism, wound infection, sepsis and urinary tract infection). Compared with the late group, the early group had a significantly higher incidence of postoperative neurological deterioration (6.6 vs. 0.7 %, p <0.001) and mortality (7.1 vs. 2.1 %, p = 0.003).
  
  
  CONCLUSIONS
  The timing of surgery for patients sustaining traumatic lower cervical spine injury with neurological involvement did not affect neurological recovery. Early surgical intervention was associated with a higher incidence of mortality and neurological deterioration compared with late surgical intervention, indicating that surgery after the first 72 hours might be relatively safe.
authors.affiliation: Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China.
authors.forename: Chang Gui
authors.initials: CG
authors.lastname: Shi
authors.affiliation: Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China.
authors.forename: Xin Wei
authors.initials: XW
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China.
authors.forename: Hua Jiang
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China.
authors.forename: Ce
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China.
authors.forename: Peng
authors.initials: P
authors.lastname: Cao
authors.affiliation: Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China.
authors.forename: Rui
authors.initials: R
authors.lastname: Gao
authors.affiliation: Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University of China, Chongqing, Peoples' Republic of China.
authors.forename: Xian Jun
authors.initials: XJ
authors.lastname: Ren
authors.affiliation: Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University of China, Xi'an, Peoples' Republic of China.
authors.forename: Zhuo Jing
authors.initials: ZJ
authors.lastname: Luo
authors.affiliation: Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Peoples' Republic of China.
authors.forename: Bing
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, The Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, Peoples' Republic of China.
authors.forename: Jian Guang
authors.initials: JG
authors.lastname: Xu
authors.affiliation: Department of Orthopaedics, The First People's Hospital, Shanghai Jiaotong University, Shanghai, Peoples' Republic of China.
authors.forename: Ji Wei
authors.initials: JW
authors.lastname: Tian
authors.affiliation: Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China. smmuyuanwen@163.com.
authors.forename: Wen
authors.initials: W
authors.lastname: Yuan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D002681:China; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult
keywords: Cervical spine; Spinal cord injury; Surgical treatment; Timing