Michael G. Fehlings, Divisions of Neurosurgery and Orthopedic Surgery, Department of Surgery, University of TorontoFollow
Alexander Vaccaro, Division of Spinal Disorders, Department of Neurosurgery and Orthopedic Surgery, Thomas Jefferson UniversityFollow
Jefferson R. Wilson, Divisions of Neurosurgery and Orthopedic Surgery, Department of Surgery, University of TorontoFollow
Anoushka Singh, Divisions of Neurosurgery and Orthopedic Surgery, Department of Surgery, University of TorontoFollow
David W. Cadotte, Divisions of Neurosurgery and Orthopedic Surgery, Department of Surgery, University of Toronto
James S. Harrop, Division of Spinal Disorders, Department of Neurosurgery and Orthopedic Surgery, Thomas Jefferson UniversityFollow
Bizhan Aarabi, Department of Neurosurgery, University of MarylandFollow
Christopher Shaffrey, Departments of Neurosurgery and Orthopedic Surgery, University of VirginiaFollow
Marcel Dvorak, Department of Orthopedic Surgery, University of British ColumbiaFollow
Charles Fisher, Department of Orthopedic Surgery, University of British ColumbiaFollow
Paul Arnold, Department of Neurosurgery, University of KansasFollow
Eric M. Massicotte, Divisions of Neurosurgery and Orthopedic Surgery, Department of Surgery, University of TorontoFollow
Stephen Lewis, Divisions of Neurosurgery and Orthopedic Surgery, Department of Surgery, University of TorontoFollow
Raja Rampersaud, Divisions of Neurosurgery and Orthopedic Surgery, Department of Surgery, University of TorontoFollow

Document Type

Article

Publication Date

2-23-2012

Comments

This article has been peer reviewed and is published in PLoS One 2012, 7(2): e32037. The published version is available at DOI: 10.1371/journal.pone.0032037. © Public Library of Science

Abstract

Background: There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (,24 hours after injury) versus late ($24 hours after injury) decompressive surgery after traumatic cervical SCI.

Methods: We performed a multicenter, international, prospective cohort study (Surgical Timing in Acute Spinal Cord Injury Study: STASCIS) in adults aged 16–80 with cervical SCI. Enrolment occurred between 2002 and 2009 at 6 North American centers. The primary outcome was ordinal change in ASIA Impairment Scale (AIS) grade at 6 months follow-up. Secondary outcomes included assessments of complications rates and mortality.

Findings: A total of 313 patients with acute cervical SCI were enrolled. Of these, 182 underwent early surgery, at a mean of 14.2(65.4) hours, with the remaining 131 having late surgery, at a mean of 48.3(629.3) hours. Of the 222 patients with follow-up available at 6 months post injury, 19.8% of patients undergoing early surgery showed a $2 grade improvement in AIS compared to 8.8% in the late decompression group (OR = 2.57, 95% CI:1.11,5.97). In the multivariate analysis, adjusted for preoperative neurological status and steroid administration, the odds of at least a 2 grade AIS improvement were 2.8 times higher amongst those who underwent early surgery as compared to those who underwent late surgery (OR = 2.83, 95% CI:1.10,7.28). During the 30 day post injury period, there was 1 mortality in both of the surgical groups. Complications occurred in 24.2% of early surgery patients and 30.5% of late surgery patients (p = 0.21).

Conclusion: Decompression prior to 24 hours after SCI can be performed safely and is associated with improved neurologic outcome, defined as at least a 2 grade AIS improvement at 6 months follow-up.

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