Prognostic factor analysis after surgical decompression and stabilization for cervical spinal-cord injury.
BACKGROUND
Several studies have demonstrated the role of decompression surgery in preventing secondary injury and improving the neurological outcome after spinal cord injury (SCI). We retrospectively analyzed the prognostic factors affecting the outcomes of decompression surgery in patients with SCI.


METHODS
We performed one-level decompression and fusion surgery on 73 patients with cervical SCI. We classified all patients based on their interval to decompression, sex, age, surgical level, presence of high signal intensity, American Spinal Injury Association Impairment scale (AIS) before surgery, blood pressure at admission, the amount of cord compression, surgical time, estimated blood loss during surgery, and steroid use. We considered an improvement to have occurred if the patient showed an AIS improvement of ≥1 grade.


RESULTS
Among the 73 patients with SCI we analyzed, 27 and 35 showed ≥1 grade of AIS improvement immediately and 3 months after surgery, respectively. Using multivariate analysis, the mean arterial blood pressure (MAP) was a significant prognostic factor affecting recovery in the SCI patients during the immediate post-operative period. In the late recovery period at 3 months after surgery, the AIS before surgery and the MAP were significant prognostic factors affecting recovery.


CONCLUSIONS
Prognostic factors for AIS improvement include the initial neurological status before surgery and hemodynamic MAP at admission. The interval between decompression surgery and trauma does not affect the neurological outcome.
a Department of Neurological Surgery , Gangneung Asan Hospital, University of Ulsan College of Medicine , Gangneung , Korea.
Jin Hoon
JH
Park
b Department of Neurological Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea.
Jeoung Hee
JH
Kim
b Department of Neurological Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea.
Sung Woo
SW
Roh
b Department of Neurological Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea.
Seung Chul
SC
Rhim
b Department of Neurological Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea.
Sang Ryong
SR
Jeon
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062186:Arterial Pressure; D016063:Blood Loss, Surgical; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000601:surgery; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D013256:Steroids
ASIA grade; Spinal cord injury; blood pressure; prognosis; time interval