Format

Send to

Choose Destination
J Neurotrauma. 2017 Dec 15;34(24):3362-3371. doi: 10.1089/neu.2017.5132. Epub 2017 Aug 10.

Functional Outcomes in Individuals Undergoing Very Early (< 5 h) and Early (5-24 h) Surgical Decompression in Traumatic Cervical Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study.

Author information

1
1 Trauma Center Linz, Teaching Hospital of the Paracelsus Medical University Salzburg , Linz, Austria .
2
2 Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology , Vienna, Austria .
3
3 Department of Orthopaedic Surgery, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgruppe Center of Orthopaedic Excellence, Teaching Hospital of the Paracelsus Medical University Salzburg , Linz, Austria .
4
4 Department of Neurosurgery, Neuromed Campus, Kepler University Linz , Linz, Austria .
5
5 Department of Trauma Surgery, Medcampus III, Kepler University Linz , Linz, Austria .
6
6 Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg , Salzburg, Austria .
7
7 Department for Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch , Feldkirch, Austria .
8
8 Trauma Center Salzburg, Paracelsus Medical University Salzburg , Salzburg, Austria .
9
9 Research Unit for Orthopaedic Sports Medicine and Injury Prevention, ISAG/UMIT , Hall in Tyrol, Austria .
10
10 Department of Trauma Surgery, Medical University of Vienna , Vienna, Austria .
11
11 Research Office of Biostatistics, Paracelsus Medical University Salzburg , Salzburg, Austria .
12
12 Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg , Salzburg, Austria .

Abstract

Our study aim was to assess the neurological outcomes of surgical decompression and stabilization within 5 and 24 h after injury. We performed a multi-center, retrospective cohort study in adolescents and adults 15-85 years of age presenting cervical spinal cord injury (CSCI) at one of 6 Austrian trauma centers participating in the Austrian Spinal Cord Injury Study (ASCIS). Neurological outcomes were measured using the American Spinal Injury Association Impairment Scale (AIS) grade according to the International Standards For Neurological Classification Of Spinal Cord Injury (ISNCSCI) form after at least 6 months of follow-up (FU). Of the 49 enrolled patients with acute CSCI, 33 underwent surgical decompression within 5 h (mean 3.2 h ± 1.1 h; very early group) after injury, and 16 underwent surgical decompression between 5 and 24 h (mean 8.6 h ± 5.5 h; early group). Significant neurological improvement was observed among the entire study population between the preoperative assessment and the FU. We identified a significant difference in the AIS grade at the last FU between the groups the using Jonckheere-Terpstra test for doubly ordered crosstabs (p = 0.011) and significantly different AIS improvement rates in the early group (Poisson model, p = 0.018). Improvement by one AIS grade was observed in 31% and 42% of the patients in the early and very early groups, respectively (p = 0.54). Improvement by two AIS grades was observed in 31% and 6% of the patients in the early and very early groups, respectively (p = 0.03; relative risk [RR], 5.2; 95% CI, 1.1-35). Improvement by three AIS grades was observed in 6% and 3% of patients in the early and very early groups, respectively (p = 1.0). Decompression of the spinal cord within 24 h after SCI was associated with an improved neurological outcome. No additional neurological benefit was observed in patients who underwent decompression within 5 h of injury.

KEYWORDS:

acute spinal cord injury; decompression; spine surgery; time of surgery; traumatic SCI

PMID:
28683592
DOI:
10.1089/neu.2017.5132
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center