Clinical Outcome of Early Versus Late Surgery for Cervical Spinal Cord Injury

Keywords: outcome, surgery, spinal cord injury, Decompression, spinal cord

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     Traumatic spinal cord injury (SCI) is a potentially catastrophic event for individuals who develop motor, sensory, and autonomic deficits. The role and timing of surgical decompression after an acute SCI remains one of the most controversial topics pertaining to spinal surgery. Experimental models strongly suggest a beneficial effect of early decompression but there is little supportive clinical evidence.
     We investigated our cervical SCI series and reviewed previous published papers for the effectiveness of early surgery in SCI patients.
     In our cervical spinal cord injury series, 62 patients with a fracture and 73 with a fracture-dislocation of C3 to C7 cervical vertebrae were treated operatively during the inclusive period January 1994 to December 2010.
     Surgery was performed as soon as the patient''s medical condition allowed, within 72 hours in 75 and more than 72 hours after the injury in 60. MEDLINE search of experimental and clinical studies showing the effect of decompression on neurologic outcome following SCI. We focused on articles published within the last 10 years.
     Only patients with incomplete spinal cord injury had neurological improvement after surgery. There was no statistically significant difference in final neurological outcomes in patients having early as opposed to delayed surgery. 11 clinical studies examined efficacy of early surgical intervention to stabilize and align the spine and to decompress the spinal cord; the most common definitions of early operation used 24 and 72 h after SCI as timelines. A number of studies indicated that patients who undergo early surgical decompression can have similar outcomes to patients who received a delayed decompressive operation. Only two papers reported the better clinical results in early decompressive surgery (less than 10 hours).
     This is a retrospective study.
     Surgical intervention for cervical injuries is safe, as no postoperative neurological deterioration was recorded.
     Timing of surgery does not affect neurological outcome in our series. However, there is evidence to suggest that early surgical intervention is safe and feasible and it is worthy to perform ultra early decompressive surgery for spinal cord injury.


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