Rapid Surgery Following Traumatic Cervical Spinal Cord Injury Improves Outcomes

A new study shows that patients who receive surgery less than 24 hours after a traumatic cervical spinal cord injury (SCI) suffer less neural tissue destruction and have improved clinical outcomes.

Researchers at Thomas Jefferson University (Philadelphia, PA, USA), the University of Toronto (Canada), and other institutions participating conducted a study involving 313 patients, 182 of whom underwent surgery less than 24 hours after traumatic cervical SCI and 131 of whom underwent surgery at or after 24 hours post-SCI. For both groups, the degree of neurologic improvement was measured by change in American Spinal Injury Association (ASIA) impairment scale (AIS). Baseline neurological assessments were performed within 24 hours of injury on all subjects; a total of 222 patients were followed to six months postsurgery.

The results showed that in the early surgery group (less than 24 hours postinjury), 42.7% showed no improvement, 36.6% had a one grade improvement, 16.8% had a two-grade improvement, and 3.1% had a three grade improvement. Comparatively, in the late surgery group (surgery performed at 24 hours or more postinjury), 50% showed no improvement, 40.7% had a one grade improvement and 8% had a two grade improvement. Complications occurred in 24.2% of early surgery patients versus 30.5% of late surgery patients. The study was published on February 23, 2012, in PloS One.

“What this tells us is that the odds of a significant (at least two grade) improvement in neurologic status is 2.8 times higher when surgery is performed within 24 hours postinjury. This can be the difference between walking and not for the rest of one's life,” said lead author professor of orthopedics and neurosurgery Alexander Vaccaro, MD, PhD. “Previous research has been inconclusive on the issue, with the common thought among most surgeons that you can wait up to five days postinjury and have the same outcomes. We should not practice that way anymore armed with this new information.”

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Thomas Jefferson University
University of Toronto