Early versus late surgery after cervical spinal cord injury: a Japanese nationwide trauma database study

Abstract

Background The management of cervical spinal cord injury (SCI) has changed drastically in the last decades, and surgery is the primary treatment. However, the optimum timing of early surgical treatment (within 24 h or 72 h after injury) is still controversial. We sought to determine the optimum timing of surgery for cervical SCI, comparing the length of the intensive care unit (ICU) stay and in-hospital mortality in patients who underwent surgical treatments (decompression and stabilization) for cervical SCI within 24 h after injury and within 7 days after injury. Methods This was a retrospective cohort study using Japan Trauma Data Bank (JTDB) which is a nationwide, multicenter database. We selected adult isolated cervical SCI patients who underwent operative management within 7 days after injury, between 2004 and 2015. The main outcome measures were the length of ICU stay and in-hospital mortality. We grouped the patients into two, based on the time from onset of injury to surgery, an early group (within 24 h) and a late group (from 25 h to 7 days). Next, we performed multivariable analyses for analyzing the relevance between the timing of surgery and the length of ICU stay after adjusting for baseline characteristics using propensity score. We also performed the Cox survival analyses to evaluate in-hospital mortality. Results From 236,698 trauma patients registered in JTDB, we analyzed 514 patients. The early group comprised 291 patients (56.6%), and the late group comprised 223 (43.4%). The length of ICU stay did not differ between the two groups (early, 10 days; late, 11 days; p = 0.29). There was no significant difference for length of ICU stay between the early and late group even after adjustment by multivariate analysis ( p = 0.64). There was no significant difference in in-hospital mortality between the two groups (the early group 3.8%, the late group 2.2%, p = 0.32), and no significant difference was found in the Cox survival analysis. Conclusions Our study showed that neither the length of ICU stay nor in-hospital mortality after spinal column stabilization or spinal cord decompression for cervical SCI significantly differed according to the timing of surgery between 24 h and 7 days.

Emergency surgery for traumatic spinal cord injury in a secondary hospital: A case report

“…Surgery within the first 24 h has been addressed as “early surgery”[ 27 ] and has been encouraged in various published studies. [ 11 , 25 , 9 , 28 ] Although there are studies with differing results,[ 24 ] there is a general acceptance on early surgery for SCI. A large study on cervical SCI, on the other hand, found that patients who had early surgery had better odds of 2 AIS grade improvement.…”

A Functional Outcome Prediction Model of Acute Traumatic Spinal Cord Injury Based on Extreme Gradient Boost

“…2) the validity of the linear regression prediction model is limited; and 3) the in uence of the treatment plan is not considered. Many clinical trials have shown that methylprednisolone [2,6] and early surgery [1,4,22,28] improve the prognosis of patients, and these measures have been included in the guidelines. As the most advanced technology in machine learning at present [30] , XGBoost has been widely used in various elds, such as industry, commerce and environmental protection, to construct nonlinear regression models.…”

“…Based on these four principles, we identi ed a total of 6 predictors with three aspects: 1) clinical characteristics, including age, American Spinal Injury Association (ASIA) Impairment Scale (AIS) at admission, level of injury and baseline ASIA motor score (AMS); 2) MR imaging, mainly including Brain and Spinal Injury Center (BASIC) score; 3) surgical timing, speci cally comparing whether surgical decompression was received within 24 hours or not (Table 1A). All six predictors have demonstrated prognostic signi cance in relation to long-term functional outcome after SCI [1,4,5,7,11,15,21,22,27,28] . A professional orthopedic surgeon conducted physical examinations to identify the patients' neurologic level of injury, AMS and AIS at admission.…”

“…However, the prognostic relationship between functional outcome and different indicators is often not a simple linear correlation. At the same time, the in-depth research on SCI treatments, such as methylprednisolone [2,6] and early surgery [1,4,5,22,28] , has indicated that these measures have a signi cant impact on the prognosis of patients with acute SCI.…”

Early and short-segment anterior spinal fusion for cervical spinal cord injury without fracture and dislocation can achieve more significant neurological recovery: a retrospective study based on the current medical system in southern China

“…For patients with CSCIWFD, anterior cervical decompression and fusion (ACDF) is mainly performed to explore the ruptured disc, remove the compressed tissue anterior to the spinal cord, reconstruct the cervical spine, and provide conditions for spinal cord functional recovery and cervical segment stabilization. However, no consensus has been reached regarding the effects of the number of fused segments on postoperative efficacy and adjacent segment degeneration (ASD) [8] or the optimal surgical timing [2, 9, 10] in the academic community.…”