title: Early Decompression (< 8 h) after Traumatic Cervical Spinal Cord Injury Improves Functional Outcome as Assessed by Spinal Cord Independence Measure after One Year.
abstract: There is an ongoing controversy about the optimal timing for surgical decompression after acute traumatic cervical spinal cord injury (SCI). For this reason, we performed a retrospective study of patients who were operated on after traumatic cervical SCI at the Trauma Center Murnau, Germany, and who met inclusion as well as exclusion criteria (n = 70 patients). Follow-up data were collected prospectively according to the European Multicenter Study about Spinal Cord Injury (EMSCI) protocol over a period of 1 year. Early decompression was defined as within the first 8 h after the insult (n = 35 patients). Primary outcome was the difference in the SCIM (Spinal Cord Independence Measure) 1 year after the trauma. After the follow-up period, patients who were decompressed earlier had a significantly higher SCIM difference (45.8 vs. 27.1, p < 0.005). A regression analysis showed that timing of decompression, age, as well as basal AIS (American Spinal Injury Association Impairment Scale) and basal SCIM scores were independent predictors for a better functional outcome (SCIM). Further, patients from the early decompression group had better AIS grades (p < 0.006) and a higher AIS conversion rate (p < 0.029). Additionally, this cohort also had a better total motor performance as well as upper extremity motor function after 1 year (p < 0.025 and p < 0.002). The motor and neurological levels of patients who were operated on within 8 h were significantly more caudal (p < 0.003 and p < 0.014) after 1 year. The present study suggests that early decompression after traumatic cervical SCI might have a positive impact on the functional and neurological outcome of affected individuals.
authors.affiliation: 1 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany .|2 Department of Neurosurgery, Trauma Center Murnau , Germany .|3 Institute of Molecular Regenerative Medicine, Paracelsus Medical University , Austria .|6 Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg , Austria .
authors.forename: Lukas
authors.initials: L
authors.lastname: Grassner
authors.affiliation: 2 Department of Neurosurgery, Trauma Center Murnau , Germany .
authors.forename: Christof
authors.initials: C
authors.lastname: Wutte
authors.affiliation: 3 Institute of Molecular Regenerative Medicine, Paracelsus Medical University , Austria .|6 Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg , Austria .
authors.forename: Barbara
authors.initials: B
authors.lastname: Klein
authors.affiliation: 1 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany .
authors.forename: Orpheus
authors.initials: O
authors.lastname: Mach
authors.affiliation: 1 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany .
authors.forename: Silvie
authors.initials: S
authors.lastname: Riesner
authors.affiliation: 4 Department of Radiology, Trauma Center Murnau , Germany .|5 Institute of Biomechanics, Trauma Center Murnau and Paracelsus Medical University Salzburg , Murnau, Germany .
authors.forename: Stephanie
authors.initials: S
authors.lastname: Panzer
authors.affiliation: 1 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany .
authors.forename: Matthias
authors.initials: M
authors.lastname: Vogel
authors.affiliation: 1 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany .
authors.forename: Volker
authors.initials: V
authors.lastname: Bühren
authors.affiliation: 2 Department of Neurosurgery, Trauma Center Murnau , Germany .
authors.forename: Martin
authors.initials: M
authors.lastname: Strowitzki
authors.affiliation: 1 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany .
authors.forename: Jan
authors.initials: J
authors.lastname: Vastmans
authors.affiliation: 1 Center for Spinal Cord Injuries, Trauma Center Murnau , Germany .
authors.forename: Doris
authors.initials: D
authors.lastname: Maier
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000601:surgery*; D013997:Time Factors
keywords: cervical spine; decompression; outcome; spinal cord injury; spine surgery