Clinical Outcome in Patients with Early versus Delayed Decompression in Cervical Spine Trauma

Abstract

Study DesignProspective observational study.PurposeTo assess the clinical outcome after early versus late decompression for traumatic cervical cord injury.Overview of LiteratureTraumatic spinal cord injury is common globally with the most tragic outcomes in the cervical spine. Although recent studies have shown that early decompression results in more favourable outcome, its authority is yet to be established.MethodsStudy on 98 patients with a traumatic cervical cord injury was conducted over a period of 5 years. The patients who were operated on within 24 hours of the onset of the primary injury (n=34) were classified as the early group, and those who were operated on after 24 hours of the onset of the injury (n=64) were categorized as the late group. The outcome of both the groups was assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at the 6-month follow-up.ResultsThe patients in the early group were operated on at a mean time of 18.4 hours (range, 13-24 hours) while patients were operated on at a mean time of 52.7 hours (range, 31-124 hours) in the late group. At the 6-month follow-up, 7 (23.3%) in the early group and 5 (8.7%) in the late group showed >2 grade improvement in the AIS.ConclusionsThe results of patients undergoing decompression within 24 hours of the injury are better than those who are operated on later. An attempt should be made to decompress the traumatic cervical spine early in all possible cases.

The use of classification tree analysis to assess the influence of surgical timing on neurological recovery following severe cervical traumatic spinal cord injury

“…A cutoff value approximating 19 h was observed for all three outcomes, confirming the relevance of this observation. Our 19-hour surgical delay is in good agreement with previously published studies showing that an early surgical intervention improves the neurological recovery [5,[13][14][15]. For instance, Umerani et al (2014) [15] reported a mean surgical delay of 18 h, which was associated to a greater proportion of patients improving by at least 2 AIS grades as compared with patients operated on average 53 h post SCI.…”

Central cord syndrome: is operative treatment the standard of care?

“…In the past several years, however, the controversy regarding the timing of surgical treatment of CCS has essentially been settled. There is now definitive evidence that early surgery, defined as less than 24 hours, is superior to late decompression [16][17][18][19]24,25]. Earlier studies that had failed to demonstrate a difference were usually flawed by defining ''early'' as being 48 hours, 72 hours, or longer [21,22].…”

An Algorithm for the Management of Concomitant Maxillofacial, Laryngeal, and Cervical Spine Trauma

“…Most studies defined 24 hours as the time limit for "early" surgery, whereas the outcome was usually assessed using the American Spinal Injury Association Impairment Scale. [24][25][26] One patient had cervical spine decompression the day after his admission due to central cord syndrome. Three patients were put on cervical collar, whereas 1 patient had thoracic extension on top of a cervical collar.…”