title: Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India.
abstract: OBJECTIVE
  This study was done with the aim to compare the clinical outcome and patients' quality of life between early versus delayed surgically treated patients of acute subaxial cervical spinal cord injury. The current study was based on the hypothesis that early surgical decompression and fixations in acute subaxial cervical spinal cord trauma is safe and is associated with improved outcome as compared to delayed surgical decompression.
  
  
  METHODS
  A total of 69 patients were recruited and divided into early decompression surgery Group A (operated within 48 h of trauma; n = 23) and late/delayed decompression surgery Group B (operated between 48 h and 7 days of trauma; n = 46). The patients in both groups were followed up, and comparative differences noted in the neurological outcome, quality of life, and bony fusion.
  
  
  RESULTS
  The early surgery group spent lesser days in the intensive care unit and hospital (Group A 28.6 vs. Group B 35 days) had lesser postoperative complications (Group A 43% vs. Group B 61%) and a reduced mortality (Group A 30% vs. Group B 45%). In Group A, 38% patients had 1 American Spinal Injury Association (ASIA) grade improvement while 31% experienced >2 ASIA grade improvement. In Group B, the neurological improvement was 27% and 32%, respectively (P = 0.7). There was a significant improvement in the postoperative quality of life scores in both groups.
  
  
  CONCLUSIONS
  Early surgery in patients with acute subaxial cervical spine injury should be considered strongly in view of the lesser complications, early discharge, and reduced mortality.
authors.affiliation: Department of Neurosurgery, JPN Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, JPN Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Gaurang
authors.initials: G
authors.lastname: Vaghani
authors.affiliation: Department of Neurosurgery, JPN Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Saquib
authors.initials: S
authors.lastname: Siddiqui
authors.affiliation: Department of Anesthesiology, JPN Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Chhavi
authors.initials: C
authors.lastname: Sawhney
authors.affiliation: Department of Neurosurgery, JPN Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India.
authors.forename: Pankaj Kumar
authors.initials: PK
authors.lastname: Singh
authors.affiliation: Department of Radiodiagnosis, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Atin
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Neurosurgery, JPN Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Kale
authors.affiliation: Department of Neurosurgery, JPN Apex Trauma Centre, All Institute of Medical Sciences, New Delhi, India.
authors.forename: B S
authors.initials: BS
authors.lastname: Sharma
keywords: Acute cervical spine injury; delayed surgery; early surgery; neurological outcome