The influence of timing of surgery in the outcome of spinal cord injury without radiographic abnormality (SCIWORA)

Abstract

Background: Spinal cord injury without radiographic abnormality (SCIWORA) is a rare traumatic myelopathy. Although surgery is one of the most important treatments, the surgery for SCIWORA is controversial, especially the time of surgery is a topic of controversy. Here, we investigate the effects of difference in duration from injury to surgery on the outcome of SCIWORA. Methods: This retrospective study was performed in all patients with spinal cord injury admitted to the Third Affiliated Hospital of Hebei Medical University from January 2013 to April 2017. Fifty-seven patients who met the study requirements were divided into 3 groups according to the duration from injury to surgery. Group A (surgery within 3 days of injury) had 18 patients, group B (surgery within 3-7 days) had 18 patients, and group C (surgery later than 7 days) had 21 patients. All the groups were compared with Mann-Whitney U test; the functional improvement of spinal cord was compared and analyzed using the ASIA sports score and ASIA Impairment Scale (AIS). Results: There was a significant improvement in the long-term AIS (final follow-up) in all the 3 groups compared to before surgery. The final follow-up recovery rate of group C was worse than group A and group B. The curative effect of operation within 7 days was significantly better than the surgery done 7 days later. The recovery rate of group C was worse than group A and B. The ASIA sports score showed that recovery was quicker in the early stage and slow in the later stage. Conclusions: The optimal schedule of surgical treatment was 3-7 days after injury, which can significantly improve the short-term and long-term follow-up effects. Longer the time to surgery from the time of injury, the worse was the prognosis.

Clinical outcome following multisegmental cervical spinal fixation in patients who recovered partially following injury

“…The patient subgroup discussed fits in the description of SCIWOCTET. [ 1 2 3 4 5 6 7 ] Considering the aging population, spinal injury in a stenotic cervical spinal has become a more frequent clinical event.…”

“…[ 1 ] Several authors subsequently discussed similar clinical entity in adults and labeled it as spinal cord injury without computed tomography evidence of trauma (SCIWOCTET). [ 2 3 4 5 6 7 ] Evidences of spinal degeneration and presence of “stenotic” cervical spinal canal differentiated imaging in adults from that in children. [ 2 3 4 5 6 7 ] There was no evidence of acute disc herniation or focal neural compression that can be attributed to trauma.…”

“…[ 2 3 4 5 6 7 ] Evidences of spinal degeneration and presence of “stenotic” cervical spinal canal differentiated imaging in adults from that in children. [ 2 3 4 5 6 7 ] There was no evidence of acute disc herniation or focal neural compression that can be attributed to trauma. General observation is that the ultimate clinical outcome of neurological deficits is better in patients having SCIWORA or SCIWOCTET than in those wherein there are evidences of bone or ligamentous disruption that leads to fracture and or dislocation of vertebral segments.…”

SCIWORA/SCIWORET traumático: experiencia de tres años en un hospital especializado

“…La posibilidad de recuperación neurológica de estos pacientes está relacionada en primera instancia con la lesión inicial, el diámetro del canal, la edad del paciente, el tamaño de la lesión y la severidad del cuadro neurológico; es por eso que la cirugía no es el estándar de oro para el tratamiento 3,13,19,20,24,25 . Particularmente en los casos de SCIWORET, el déficit neurológico no presenta lesiones radiográficas traumáticas.…”

“…Mejoría en la escala de ASIA (American Spinal Injury Association) a los seis meses de seguimiento. aconsejarlo salvo en casos extremos 4,25 . Para Saruhashi, et al, aquellos que tenían buena respuesta al tratamiento con corticosteroides eran manejados con inmovilización y los que presentaban cuadros severos o progresivos deberían ser intervenidos quirúrgicamente 8 .…”