Resume.
Purpose. To assess the relationship between the duration of pathological symptoms developed due to tumor or infectious destruction of the spine, and the medium-term (3 months after surgery) and long-term (1-year) outcomes of operations performed according to urgent indications.
Study design: two-center cohort retrospective; level of evidence IIC [1].
Material and methods. 84 patients with tumor (group 1, n = 43) and infectious (group 2, n = 41) lesions of the spine underwent decompression and stabilization operations according to urgent indications in the period from 2016 to 2018. Neurological status (evaluation method -Frankel scale), pain intensity (evaluation method - visual analogue scale, VAS) and functional independence of patients (evaluation method - Karnofsky scale) were assessed before intervention, 3 months and 1 year after surgery. Statistical relationship between treatment outcomes and duration of the prehospital delay has been studied.
Results. Only 11 out of 84 patients (13.1%), operated on for urgent indications, were hospitalized in the first 72 hours from the onset of vertebral syndrome; 6 (7.1%) of them had neurological disorders. At the time of surgery, 23 patients in each group had neurological disorders (53.5% and 56.1%, respectively), while the average duration of the prehospital period in both groups (Me) was 14.0 days. In patients without neurological disorders, the duration of the prehospital pause for the group of tumor lesions was 22.5 (14.0; 40; 0), for infectious - 14.5 (6.3; 30.0) days (data format - Me (Q25; Q75). After decompression and stabilization operations, positive neurological dynamics observed in patients with tumor lesions both in plegia and paresis (types B - D according to Frankel), while in infectious destruction - only in patients with mild paresis.
An inverse correlation dependence of high strength between the duration of neurological disorders and the possibility of their improvement by 3 months after surgery was revealed in both groups (rs1 = -0.793 and rs2 = -0.828; p 0.001), as well as there was no connection between such outcomes and the duration of the hospital period (the urgency of the operation) (rs1 = -0.257; p = 0.283 and rs2 = -0.218; p = 0.330).
When hospitalized for more than 14 days from the onset of pathological symptoms, the possibility of neurological improvement after surgery ceases to be statistically significant (p1 = 0.083, p2 = 0.157 for both groups, respectively), while the likelihood of a decrease in pain syndrome and functional dependence on others remains independent of the duration of the prehospital period.
Conclusion. In case of tumor and infectious destruction of the vertebrae, urgent decompression and stabilization operations lead to a significant reduction in pain syndrome and an improvement in the functional independence of patients 3 and 12 months after the operation, regardless of the duration of the prehospital period.
The duration of prehospital period of more than 2 weeks is critical for a reliable prognosis of improvement in neurological disorders after urgent surgeries in patients with neoplastic and infectious lesions of the spine.
