Results of Early Versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: A Single Center Prospective Study

Abstract

Objective This study was done with the aim to compare the clinical outcome and patient's quality of life between early (within 24 hours post-injury) versus delayed (after 24 hours to 7 days) surgically treated patients of acute cervical spinal cord injury. The current study was based on the hypothesis that early surgical decompression and fixations in acute cervical spinal cord trauma are safe and are associated with improved outcome as compared with delayed surgical decompression.

Methods A total of 54 patients were recruited and divided into early decompression surgery group A (operated within 24 hours of trauma; n = 25) and late/delayed decompression surgery group B (operated between 24 hours and 7 days of trauma; n = 29). 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 had lesser postoperative complications. In group A, 54.17% patients had 1 American Spinal Injury Association Impairment Scale (AIS) grade improvement, while 29.17% experienced > 2 AIS grade improvement (p = 0.015). In group B, the neurological improvement was 50 and 21.43%, respectively (p = 0.003). There was a significant improvement in the postoperative quality of life scores in early surgery group.

Conclusion Early surgery in patients with acute cervical spinal cord injury should be considered strongly in view of the lesser complications, better neurological recovery, and reduced mortality.

Keywords

acute cervical spine injury - delayed surgery - early surgery - neurological outcome

• References

• 1 Wyndaele M, Wyndaele JJ. Incidence, prevalence and epidemiology of spinal cord injury: what learns a worldwide literature survey?. Spinal Cord 2006; 44 (09) 523-529
• 2 Fehlings M, Sekhon L. Eds. Cellular, Ionic and Biomolecular Mechanisms of the Injury Process. Chicago, IL: American Association of Neurologic Surgeons; 2000: 33-50
• 3 Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurg 1991; 75 (01) 15-26
• 4 Amar AP, Levy ML. Pathogenesis and pharmacological strategies for mitigating secondary damage in acute spinal cord injury. Neurosurgery 1999; 44 (05) 1027-1039 discussion 1039-1040
• 5 Brodkey JS, Richards DE, Blasingame JP, Nulsen FE. Reversible spinal cord trauma in cats. Additive effects of direct pressure and ischemia. J Neurosurg 1972; 37 (05) 591-593
• 6 Carlson GD, Minato Y, Okada A. et al. Early time-dependent decompression for spinal cord injury: vascular mechanisms of recovery. J Neurotrauma 1997; 14 (12) 951-962
• 7 Delamarter RB, Sherman J, Carr JB. Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression. J Bone Joint Surg Am 1995; 77 (07) 1042-1049
• 8 Dimar II JR, Glassman SD, Raque GH, Zhang YP, Shields CB. The influence of spinal canal narrowing and timing of decompression on neurologic recovery after spinal cord contusion in a rat model. Spine 1999; 24 (16) 1623-1633
• 9 Dolan EJ, Tator CH, Endrenyi L. The value of decompression for acute experimental spinal cord compression injury. J Neurosurg 1980; 53 (06) 749-755
• 10 Guha A, Tator CH, Endrenyi L, Piper I. Decompression of the spinal cord improves recovery after acute experimental spinal cord compression injury. Paraplegia 1987; 25 (04) 324-339
• 11 Kobrine AI, Evans DE, Rizzoli HV. Experimental acute balloon compression of the spinal cord. Factors affecting disappearance and return of the spinal evoked response. J Neurosurg 1979; 51 (06) 841-845
• 12 Nyström B, Berglund JE. Spinal cord restitution following compression injuries in rats. Acta Neurol Scand 1988; 78 (06) 467-472
• 13 Tarlov IM. Spinal cord compression studies. III. Time limits for recovery after gradual compression in dogs. AMA Arch Neurol Psychiatry 1954; 71 (05) 588-597
• 14 Tarlov IM, Klinger H. Spinal cord compression studies. II. Time limits for recovery after acute compression in dogs. AMA Arch Neurol Psychiatry 1954; 71 (03) 271-290
• 15 Carlson GD, Gorden CD, Oliff HS, Pillai JJ, LaManna JC. Sustained spinal cord compression: part I: time-dependent effect on long-term pathophysiology. J Bone Joint Surg Am 2003; 85-A (01) 86-94
• 16 Papadopoulos SM, Selden NR, Quint DJ, Patel N, Gillespie B, Grube S. Immediate spinal cord decompression for cervical spinal cord injury: feasibility and outcome. J Trauma 2002; 52 (02) 323-332
• 17 Waters RL, Adkins RH, Yakura JS, Sie I. Effect of surgery on motor recovery following traumatic spinal cord injury. Spinal Cord 1996; 34 (04) 188-192
• 18 Vaccaro AR, Daugherty RJ, Sheehan TP. et al. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine 1997; 22 (22) 2609-2613
• 19 McKinley W, Meade MA, Kirshblum S, Barnard B. Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch Phys Med Rehabil 2004; 85 (11) 1818-1825
• 20 La Rosa G, Conti A, Cardali S, Cacciola F, Tomasello F. Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach. Spinal Cord 2004; 42 (09) 503-512
• 21 Fehlings MG, Rabin D, Sears W, Cadotte DW, Aarabi B. Current practice in the timing of surgical intervention in spinal cord injury. Spine 2010; 35 (21) Suppl) S166-S173
• 22 Burke DA, Linden RD, Zhang YP, Maiste AC, Shields CB. Incidence rates and populations at risk for spinal cord injury: a regional study. Spinal Cord 2001; 39 (05) 274-278
• 23 Sekhon LH, Fehlings MG. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001; 26 (24) Suppl) S2-S12
• 24 Hu R, Mustard CA, Burns C. Epidemiology of incident spinal fracture in a complete population. Spine 1996; 21 (04) 492-499
• 25 Gupta DK, Vaghani G, Siddiqui S. et al. Early versus delayed decompression in acute subaxial cervical spinal cord injury: a prospective outcome study at a Level I trauma center from India. Asian J Neurosurg 2015; 10 (03) 158-165
• 26 Fehlings MG, Vaccaro A, Wilson JR. et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One 2012; 7 (02) e32037