Early versus delayed decompression for traumatic cervical spinal cord injury: application of the AOSpine subaxial cervical spinal injury classification system to guide surgical timing

Du, Jinpeng; Fan, Yong; Zhang, Jianan; Liu, Jijun; Meng, Yibin; Hao, Dingjun

doi:10.1007/s00586-019-05959-6

Cited by 27 publications

(22 citation statements)

References 21 publications

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“…The authors suggested that type B and type C/F4 fractures should receive early surgical treatment for better clinical outcomes. 30 A web-based multicentre study was conducted where German and Dutch spine surgeons evaluated the computed tomography data of traumatic subaxial fractures. The fractures were classified using the AO spine classification.…”

Section: ) Ao Spine Classification Validity and Reliabilitymentioning

confidence: 99%

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

et al. 2020

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Section: ) Ao Spine Classification Validity and Reliabilitymentioning

confidence: 99%

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

et al. 2020

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“…Burke and colleagues found that for patients with cervical SCI, ultra-early surgery was associated with the best American Spinal Injury Association Impairment Scale (AIS) grade conversion rates [19]. Du and colleagues found that time to surgery in uenced neurological recovery differently according to the AOSpine subaxial cervical SCI classi cation, but mortality was not statistically different between early and late surgery groups [20]. Here, we explored if there was a correlation between age and time to surgery in patients with cervical fractures analyzed by age groups of <65, 65-84, and ≥85 years old.…”

Section: Discussionmentioning

confidence: 99%

Pilot Study: Age As A factor in Time To Surgery For Traumatic Cervical Spine Fracture Patients

Chory

Bank

Sison

et al. 2020

Preprint

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INTRODUCTION: Cervical spine fractures with or without spinal cord injury (SCI) disproportionately impact the elderly, who constitute an increasing percentage of the US population. Early surgical intervention is a safe, modifiable factor that enables early mobilization and subsequent reduction in complications and hospital length of stay. Surgical treatment of the elderly is complex, due to increased comorbidity factors and complications. METHODS: In a pilot study from a Level 1 Trauma Center, we analyzed the number of patients treated with cervical spine fractures with or without SCI by age group (<65, 65-84, 85) and determined the influence of age on time-to-surgery and long-term mortality. Acute in-hospital mortality was calculated and long-term mortality within the study period (2003-2013) was determined from the National Death Index. RESULTS: Data from patients (N=72) with cervical spine fractures treated surgically were analyzed, with nearly equal numbers under or over age 65. Although there was a trend of increasing time to surgery with increasing age, there was no statistical difference between the age groups (p=0.7015). The average time to surgery was less for patients with SCI than for all patients, and less for patients with than without central cord syndrome. The average time to surgery was longer for patients with vertebral fractures than for patients with SCI. There was no statistical difference for in-hospital or long-term mortality for patients with or without SCI or among the time-to-surgery groups. However, this is likely due to the low number of cases in this pilot study. CONCLUSION: Data from this pilot study indicate an association between time to surgery and survival status of patients in any age or time-to-surgery groups examined. This analysis will enable a larger future prospective study and local quality control initiatives to collect additional data on factors influencing time-to-surgery in patients with cervical spine fractures.

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“…There is a controversy about the role of the timing of surgical decompression, reduction, and reconstruction in patients with TSCI. [26][27][28] Some authors have emphasized early surgical interventions 27,29 believing that early surgery can decompress the spinal cord and stabilize the injured level, to prevent further damage to the spinal cord from repeated motion of unstable cervical segments. Furthermore, some studies have demonstrated early surgical intervention can improve the clinical outcomes of these patients.…”

Section: Discussionmentioning

confidence: 99%

Acute traumatic quadriplegia: Predictors of in-hospital and six-month mortality

Alimohammadi

Ahadi

Rezaee

et al. 2020

Trauma

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Background Traumatic spinal cord injury is one of the most disastrous and devastating health burdens all over the world with a high mortality rate. The present study aimed to evaluate the predictors of in-hospital and six-month mortality in these patients. Methods The electronic medical records of 87 consecutive patients with acute complete traumatic quadriplegia were reviewed to extract clinical, radiological, and laboratory data. Simple and multiple logistic regression models were used to estimate crude and adjusted odds with 95% confidence interval (CI) ratios for the predictors of in-hospital mortality and six-month mortality. Results There were 48 males and the mean age was 38.67 ± 12.81; in-hospital and six-month mortality were 21.84% and 11.76%, respectively. Traffic road accidents (67.8%) and falls (12.6%) were the most common causes of injury. The univariate analysis demonstrated advanced age, level of injury, late surgery or no surgical intervention, the lack of methylprednisolone therapy, a higher Charlson comorbidity index, the Injury Severity Score, and the presence of respiratory failure or bradycardia on admission were predictors of in-hospital mortality ( p < 0.05). In the final multiple logistic regression model, the level of injury (OR = 0.02 (0.001,0.35), p = 0.008) and the presence of respiratory failure (OR = 2.37 (0.03,13.88), p = 0.024) were the only predictors of in-hospital mortality. The univariate model showed that the level of injury, respiratory failure on admission, and the Injury Severity Score were the predictors of six-month mortality; however, the level of injury was the only predictor of the six-month mortality (OR = 1.12 (0.99, 1.27), p = 0.028) according to the multiple logistic regression model. Conclusions Several factors could affect in-hospital and six-month mortality in patients with traumatic spinal cord injury. Our findings demonstrated the level of injury and respiratory failure on admission as independent predictors of in-hospital mortality in these patients. Furthermore, the level of injury was the only independent predictor of six-month mortality in the present study.

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Early versus delayed decompression for traumatic cervical spinal cord injury: application of the AOSpine subaxial cervical spinal injury classification system to guide surgical timing

Cited by 27 publications

References 21 publications

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

Pilot Study: Age As A factor in Time To Surgery For Traumatic Cervical Spine Fracture Patients

Acute traumatic quadriplegia: Predictors of in-hospital and six-month mortality

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