title: Neurological Recovery after Traumatic Cervical Spinal Cord Injury Is Superior if Surgical Decompression and Instrumented Fusion Are Performed within 8 Hours versus 8 to 24 Hours after Injury: A Single Center Experience.
abstract: A prospective study was performed to evaluate the impact of surgical decompression (SD) and instrumented fusion within 8 h versus 8-24 h after injury on neurological recovery after cervical traumatic spinal cord injury (tSCI) in patients operated on in the UMC Ljubljana, Slovenia. Only patients with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A through C and with MRI-confirmed spinal cord compression were enrolled. The primary outcome was the change in AIS grade at the 6-month follow-up. Of the 48 enrolled patients, 22 patients who underwent surgery within 8 h (group 8 h) and 20 patients who underwent surgery between 8 and 24 h (Group 8-24 h) after injury concluded the study. At admission, there was no statistically significant difference in AIS grade between the study groups. At the 6-month follow-up, an improvement of at least two AIS grades was found in 45.5% of patients in group 8 h and in 10% of patients in group 8-24 h (p=0.017). The median improvement in the ASIA motor score was 38.5 (10.0-61.0) motor points in group 8 h and 15.0 (8.8-34.0) motor points in group 8-24 h (p=0.0468). In a multivariate analysis, adjusted for the preoperative AIS grade and the degree of spinal canal compromise, the odds of an at least two-grade AIS improvement were at least 106% higher for patients in group 8 h than for patients in group 8-24 h (odds ratio=11.08, p=0.004). No statistically significant difference was found in the rate of perioperative complications, pneumonia, and the number of ventilator-dependent days or the mortality between the groups. Our results suggest that the patients with tSCI who undergo SD within 8 h after injury have superior neurological outcomes than patients who undergo SD 8-24 h after injury, without any increase in the rate of adverse effects.
authors: 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia .
authors: Marko
authors: M
authors: Jug
authors: 2 Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana , Slovenia .
authors: Nataša
authors: N
authors: Kejžar
authors: 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia .
authors: Miloš
authors: M
authors: Vesel
authors: 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia .
authors: Said
authors: S
authors: Al Mawed
authors: 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia .
authors: Marko
authors: M
authors: Dobravec
authors: 1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia .
authors: Simon
authors: S
authors: Herman
authors: 3 Institute of Pathophysiology, Faculty of Medicine, University of Ljubljana , Ljubljana, Slovenia .|4 Department of Neurology, University Medical Centre Ljubljana , Ljubljana, Slovenia .
authors: Fajko F
authors: FF
authors: Bajrović
mesh_terms: 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; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D020127:Recovery of Function; D012121:Respiration, Artificial; D013117:Spinal Cord Compression; D013119:Spinal Cord Injuries / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome
keywords: SCI; cervical spine; surgical decompression; timing of surgery; trauma