scholarly journals Ultra-early surgery in complete cervical spinal cord injury improves neurological recovery: A single-center retrospective study

2019 ◽  
Vol 10 ◽  
pp. 207 ◽  
Author(s):  
Davide Nasi ◽  
Paolo Ruscelli ◽  
Maurizio Gladi ◽  
Fabrizio Mancini ◽  
Maurizio Iacoangeli ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Univariate Analysis ◽  
Cervical Spinal Cord Injury ◽  
Early Surgery ◽  
Surgical Approaches ◽  
Surgical Timing ◽  
Neurological Improvement ◽  
Cord Injury

Background: This study evaluated how the neurological outcome in patients operated on cervical spinal cord injury (SCI) was positively influenced by ultra-early surgery (UES). Methods: Between 2010 and 2017, 81 patients with traumatic cervical SCI were assigned to the UES group (<12 h after injury; UES) and ES group (surgery between 12 and 48 h after injury; ES). Additional variables evaluated for the two groups included; age, sex, comorbidities charlson comorbidity index (CCI), level of trauma, type of fracture, preoperative and ASIA scores, pre- and post-operative neuroradiological examinations, surgical approaches, and complications. Results: Forty-seven of 81 (58.02%) patients exhibited improved neurological function 12 months postoperatively; better outcomes were observed in the UES (29 of 40 [72.5%]) versus ES groups (18 of 41 [43.9%]) (P = 0,009). For the 26 patients with complete cervical SCI (ASIA A), ultra-early surgical decompression was associated with significantly greater neurological improvement versus ES (61.53% vs. 7.69%; P = 0.003). Further, more neurological improvement correlated with the younger age, better ASIA grade at admission, and ultra-early surgical timing (< 12 h) both in the univariate and multivariate analysis (P = 0.037, P = 0.017, and P = 0.005, respectively), while CCI was correlated with improvement only in the univariate analysis (P = 0.005). Conclusion: Ultra-early surgical timing in SCI patients appeared to be the most important factor determining the extent of postoperative neurological improvement, particularly regarding motor function recovery.

scholarly journals Is early surgical intervention effective for traumatic severe cervical spinal cord injury? A retrospective study secondary publication

2021 ◽  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cardiac Arrest ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Early Surgery ◽  
Respiratory Complications ◽  
Inverse Probability ◽  
Cord Injury ◽  
Neurological Prognosis

Although early surgery is known to be effective for the treatment of traumatic cervical spinal cord injury (CSCI), whether it is equally effective in severe CSCI cases remains undetermined. This study aimed to determine whether surgery within 24 h improves the neurological prognosis and reduces the complications associated with surgery for traumatic severe CSCI. The data of 42 patients with traumatic severe CSCI with American Spinal Injury Association Impairment Scale (AIS) grades A–B who underwent surgery between December 2007 and May 2018 were retrospectively reviewed. The participants were classified into early surgery (<24 h) and late surgery (>24 h) groups. Using the inverse probability of treatment weighting with propensity score adjustment for confounding factors, the AIS grades before and 1 month following surgical treatment, which were considered the primary outcomes, were compared. The secondary outcomes were the intensive care unit length of stay (ICU-LOS) and occurrence of respiratory complications and cardiac arrest. In the early surgery group (n = 32, 76%), the average time to surgery was 10.25 h (4–23 h). The inverse probability of treatment weighting analysis indicated significant differences in the neurological improvement according to the AIS grade at 1 month following surgery (odds ratio [OR]: 17.1, 95% confidence interval [Cl]: 1.9–156.7, p = 0.012), the ICU-LOS >7 days (OR: 0.14, 95% Cl: 0.02–0.90, p = 0.04), and the occurrence of respiratory complications (OR: 0.08, 95% Cl: 0.01–0.73, p = 0.03) and cardiac arrest (OR: 0.13, 95% Cl: 0.02–0.85, p = 0.03). Early surgery (within 24 h) for traumatic severe CSCI may improve the neurological prognosis and prevent a long ICU-LOS and postoperative complications.

Is Early Surgical Intervention Effective for Traumatic Severe Cervical Spinal Cord Injury? A Retrospective Study

2021 ◽  
Author(s):  
Koji Yamamoto ◽  
Akinori Okuda ◽  
Naoki Maegawa ◽  
Hironobu Konishi ◽  
Keita Miyazaki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cardiac Arrest ◽  
Cervical Spinal Cord ◽  
Unit Length ◽  
Cervical Spinal Cord Injury ◽  
Early Surgery ◽  
Respiratory Complications ◽  
Cord Injury ◽  
Neurological Prognosis

Abstract Background: Although early surgery is known to be effective for the treatment of traumatic cervical spinal cord injury (CSCI), whether it is equally effective in severe CSCI cases remains undetermined. This study aimed to determine whether surgery within 24 h improves the neurological prognosis and reduces the complications associated with surgery for traumatic severe CSCI.Methods: The data of 42 patients with traumatic severe CSCI with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades A–B who underwent surgery between December 2007 and May 2018 were retrospectively reviewed. The participants were classified into early surgery (<24 h) and late surgery (>24 h) groups. Using the inverse probability of treatment weighting (IPTW) with propensity score adjustment for confounding factors, the AIS grades before and 1 month following surgical treatment, which were considered the primary outcomes, were compared. The secondary outcomes were the intensive care unit length of stay (ICU-LOS) and occurrence of respiratory complications and cardiac arrest.Results: In the early surgery group (n = 32, 76%), the average time to surgery was 10.25 h (4–23 h). The IPTW analysis indicated significant differences in the neurological improvement according to the AIS grade at 1 month following surgery (odds ratio [OR]: 17.1, 95% confidence interval [Cl]: 1.9–156.7, p = 0.012), the ICU-LOS >7 days (OR: 0.14, 95% Cl: 0.02–0.90, p = 0.04), and the occurrence of respiratory complications (OR: 0.08, 95% Cl: 0.01–0.73, p = 0.03) and cardiac arrest (OR: 0.13, 95% Cl: 0.02–0.85, p = 0.03).Conclusions: Early surgery (within 24 h) for traumatic severe CSCI may improve the neurological prognosis and prevent a long ICU-LOS and postoperative complications.

scholarly journals Sequential neurological improvements after conservative treatment in patients with complete motor paralysis caused by cervical spinal cord injury without bone and disc injury

2018 ◽  
Vol 29 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Eiji Mori ◽  
Takayoshi Ueta ◽  
Takeshi Maeda ◽  
Ryousuke Ideta ◽  
Itaru Yugué ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Conservative Treatment ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Neurological Improvement ◽  
Motor Paralysis ◽  
Cord Injury ◽  
Disc Injury

OBJECTIVEThis study investigated neurological improvements after conservative treatment in patients with complete motor paralysis caused by acute cervical spinal cord injury (SCI) without bone and disc injury.METHODSThis study was retrospective. The authors evaluated neurological outcomes after conservative treatment of 62 patients with complete motor paralysis caused by cervical SCI without bone and disc injury within 72 hours after trauma. The sequential changes in their American Spinal Injury Association Impairment Scale (AIS) grades were reviewed at follow-up 24–72 hours, 1 week, and 1, 3, and 6 months after treatment.RESULTSOf the 31 patients with a baseline AIS grade of A, 2 (6.5%) patients improved to grade B, 5 (16.1%) improved to grade C, and 2 (6.5%) improved to grade D by the 6-month follow-up. The 22 (71.0%) patients who remained at AIS grade A 1 month after injury showed no neurological improvement at the 6-month follow-up. Of the 31 patients with a baseline AIS grade of B, 12 (38.7%) patients showed at least a 1-grade improvement at the 1-month follow-up; 11 (35.5%) patients improved to grade C and 16 (51.6%) patients improved to grade D at the 6-month follow-up.CONCLUSIONSEven in patients with complete motor paralysis caused by cervical SCI without bone and disc injury within 72 hours after trauma, approximately 30% of the patients with an AIS grade of A and 85% of the patients with an AIS grade B improved neurologically after conservative treatment. It is very important to recognize the extent of neurological improvement possible with conservative treatment, even for severe complete motor paralysis.

scholarly journals Is early surgical intervention effective for traumatic severe cervical spinal cord injury?

2021 ◽  
Author(s):  
Koji Yamamoto ◽  
akinori okuda ◽  
Naoki Maegawa ◽  
Hironobu Konishi ◽  
Keita Miyazaki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cardiac Arrest ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Early Surgery ◽  
Secondary Outcome ◽  
Respiratory Complications ◽  
Cord Injury ◽  
Neurological Prognosis

Abstract Background This study aimed to determine whether surgery within 24 h improves the neurological prognosis and reduces the complications associated with surgery for traumatic severe cervical spinal cord injury (CSCI). Methods The data of 42 patients with traumatic severe CSCI with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A–B who underwent surgery between December 2007 and May 2018 were retrospectively reviewed. The participants were divided into early surgery (< 24 h) and late surgery (> 24 h) groups. Using inverse probability of treatment weighting (IPTW) with propensity score adjustment for confounding factors, the AIS grade before and 1 month following surgical treatment as the primary outcome were compared. The secondary outcome was the intensive care unit length of stay (ICU-LOS) and occurrence of respiratory complications and cardiac arrest. Results In the early surgery group (n = 32, 76%), the average time to surgery was 10.25 h (4–23 h). The IPTW analysis indicated significant differences in neurological improvement according to the AIS grade at 1 month following surgery (odds ratio [OR]: 17.1 95% confidence interval [Cl]: 1.9–156.7, p = 0.012), ICU-LOS > 7 days (OR: 0.14 95% Cl: 0.02–0.90, p = 0.04), respiratory complications (OR: 0.08 95% Cl: 0.01–0.73, p = 0.03), and cardiac arrest (OR: 0.13 95% Cl: 0.02–0.85, p = 0.03). Conclusions Early surgery (within 24 h) for traumatic severe CSCI may be effective in improving the neurological prognosis, and preventing a long ICU-LOS and postoperative complications.

scholarly journals Is Early Surgical Intervention Effective for Traumatic Severe Cervical Spinal Cord Injury?

2021 ◽  
Author(s):  
Koji Yamamoto ◽  
Akinori Okuda ◽  
Naoki Maegawa ◽  
Hironobu Konishi ◽  
Keita Miyazaki ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cardiac Arrest ◽  
Cervical Spinal Cord ◽  
Cervical Spinal Cord Injury ◽  
Early Surgery ◽  
Secondary Outcome ◽  
Respiratory Complications ◽  
Cord Injury ◽  
Neurological Prognosis

Abstract Background: It is unclear whether early surgery for traumatic severe cervical spinal cord injury (CSCI) improves neurological outcomes and reduces complications. This study aimed to determine whether surgery within 24 h improves the neurological prognosis of and reduces the complications associated with surgery for traumatic severe CSCI.Methods: The data of 42 patients with traumatic severe CSCI with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A–B who underwent surgery between December 2007 and May 2018 were retrospectively reviewed. The participants were divided into early surgery (< 24 h) and late surgery (> 24 h) groups. With inverse probability of treatment weighting (IPTW) using a propensity score adjusted for confounding factors, we compared the AIS grade before and 1 month after surgical treatment as the primary outcome. The secondary outcome was the intensive care unit length of stay (ICU-LOS) and occurrence of respiratory complications and cardiac arrest.Results: In the early surgery group (n = 32, 76%), the average time to surgery was 10.25 h (4–23 h). The IPTW analysis indicated significant differences in neurological improvement according to the AIS grade at 1 month after surgery (odds ratio [OR]: 17.1 95% confidence interval [Cl]: 1.9–156.7, p = 0.012), ICU-LOS > 7 days (OR: 0.14 95% Cl: 0.02–0.90, p = 0.04), respiratory complications (OR: 0.08 95% Cl: 0.01–0.73, p = 0.03), and cardiac arrest (OR: 0.13 95% Cl: 0.02–0.85, p = 0.03).Conclusion: Early surgery (within 24 h) for traumatic severe CSCI may be effective in improving the neurological prognosis and preventing a long ICU-LOS and postoperative complications.

scholarly journals Window of opportunity for surgical decompression in patients with acute traumatic cervical spinal cord injury

2020 ◽  
Vol 32 (5) ◽  
pp. 633-641 ◽  
Author(s):  
Marko Jug ◽  
Nataša Kejžar ◽  
Matej Cimerman ◽  
Fajko F. Bajrović
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Neurological Recovery ◽  
Optimal Timing ◽  
Neurological Improvement ◽  
Severity Of Injury ◽  
Cord Injury

OBJECTIVEThe objective of this prospective study was to determine the optimal timing for surgical decompression (SD) in patients with acute traumatic cervical spinal cord injury (tSCI) within the first 24 hours of injury.METHODSIn successive patients with fracture and/or dislocation of the subaxial cervical spine and American Spinal Injury Association Impairment Scale (AIS) grades A–C, receiver operating characteristic curve analysis was used to determine the optimal timing for SD within the first 24 hours of cervical tSCI to obtain a neurological recovery of at least two AIS grades. Multivariate logistic regression was used to model significant neurological recovery with time to SD, degree of spinal canal compromise (SCC), and severity of injury.RESULTSIn this cohort of 64 patients, the optimal timing for SD to obtain a significant neurological improvement was within 4 hours of injury (95% confidence interval 4–9 hours). Increasing the delay from injury to SD or the degree of SCC significantly reduced the likelihood of significant neurological improvement. Due to the strong correlation with SCC, the severity of injury was a marginally significant predictor of neurological recovery.CONCLUSIONSThese findings indicate that in patients with acute cervical tSCI and AIS grades A–C, the optimal timing for SD is within the first 4–9 hours of injury, depending on the degree of SCC and the severity of injury. Further studies are required to better understand the interrelationships among the timing of SD, injury severity, and degree of SCC in these patients.

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