The Influence of Time from Injury to Surgery on Motor Recovery and Length of Hospital Stay in Acute Traumatic Spinal Cord Injury: An Observational Canadian Cohort Study

Abstract

To determine the influence of time from injury to surgery on neurological recovery and length of stay (LOS) in an observational cohort of individuals with traumatic spinal cord injury (tSCI), we analyzed the baseline and follow-up motor scores of participants in the Rick Hansen Spinal Cord Injury Registry to specifically assess the effect of an early (less than 24 h from injury) surgical procedure on motor recovery and on LOS. One thousand four hundred and ten patients who sustained acute tSCIs with baseline American Spinal Injury Association Impairment Scale (AIS) grades A, B, C, or D and were treated surgically were analyzed to determine the effect of the timing of surgery (24, 48, or 72 h from injury) on motor recovery and LOS. Depending on the distribution of data, we used different types of generalized linear models, including multiple linear regression, gamma regression, and negative binomial regression. Persons with incomplete AIS B, C, and D injuries from C2 to L2 demonstrated motor recovery improvement of an additional 6.3 motor points (SE=2.8 p<0.03) when they underwent surgical treatment within 24 h from the time of injury, compared with those who had surgery later than 24 h post-injury. This beneficial effect of early surgery on motor recovery was not seen in the patients with AIS A complete SCI. AIS A and B patients who received early surgery experienced shorter hospital LOS. While the issues of when to perform surgery and what specific operation to perform remain controversial, this work provides evidence that for an incomplete acute tSCI in the cervical, thoracic, or thoracolumbar spine, surgery performed within 24 h from injury improves motor neurological recovery. Early surgery also reduces LOS.

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

“…However, the fundamental demographic, clinical, pathological, biochemical, biological, and management factors important in AIS grade conversion remain elusive. 29,71–82 Factors contributing to favorable neurological outcomes in SCI patients include improvements in cardiopulmonary resuscitation at the scene of an accident and early transfer of victims to trauma centers, 83–86 availability of trauma centers specialized in Advanced Trauma Life Support 87,88 and equipped with CT and MRI, 89–94 early surgical decompression using state-of-the-art instrumentation, 40,77,95–98 and critical care and rehabilitation efforts, including maintenance of mean arterial blood pressure above 85 mm Hg in accordance with the Guidelines for Management of Cervical Spine and Spinal Cord Injuries. 42,99–101 …”

“…40,61,77,95,107–113 The results of the Surgical Timing in Acute Spinal Cord Injury Study 40 suggested a higher chance of AIS grade conversion in patients whose decompression occurs within 24 h of injury. In the present study, we did not find a significant relationship between surgical approach and its timing and AIS grade conversion.…”

Effect of older age on treatment decisions and outcomes among patients with traumatic spinal cord injury

“…Despite some evidence of the benefit of early decompression, particularly in patients with incomplete neurologic injuries, [17][18][19] uncertainty remains with respect to the potential for neurologic improvement, and this uncertainty may be amplified in older patients. Surgical delays may prolong immobilization, increase the risk of medical complications and contribute to higher mortality among older patients.…”

Chinese Angelica Polysaccharide (CAP) Alleviates LPS-Induced Inflammation and Apoptosis by Down-Regulating COX-1 in PC12 Cells

“…Despite great efforts have been paid for improving the treatment of SCI, there still remains limitations [4][5][6].…”