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Early decompressive surgery in patients with traumatic spinal cord injury improves neurological outcome

  • Original Article - Spine trauma
  • Published:
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Abstract

Background

The role and timing of a decompressive surgical intervention in patients with traumatic spinal cord injury (SCI) remain controversial. Given the impact of SCI on the individual and society, decompressive surgery to reduce the extent of tissue destruction and improving neurological outcome after initial spinal cord trauma are needed.

Objective

To evaluate any possible correlation between the time of a decompressive procedure after traumatic SCI and end-neurologic outcome for traumatic SCI patients.

Methods

A retrospective cohort study on patients with traumatic SCI in Western Denmark from 2010 to 2017. Data on date and time of injury and time of surgery and data on neurologic status at admission and one-year post-trauma were found in the Electronic Patients Journal (EPJ) and in paper journals. Patients were divided into 4 groups (< 6 h, < 12 h, < 24 h, and > 24 h) based on the time between injury and surgery. Further, patients were separated into two groups depending on whether they did or did not achieve neurological improvement one-year post-trauma. We used Fisher’s exact test to compare the abovementioned groups to examine an eventual correlation between time from injury to operation and change in neurological outcome one-year post-trauma.

Results

Patients undergoing surgery < 24 h after trauma obtained a significantly better neurological outcome as compared with patients who underwent surgery > 24 h after trauma (p < 0.001). This result did not change for subgroups of incomplete SCI patients (p = 0.002). However, complete SCI patients operated < 24 h as compared with > 24 h did not obtain better outcome (p = 0.14). We did not find a statistically significant correlation when time from trauma to surgery was reduced further to < 6 or < 12 h post-trauma. Furthermore, stratification on patients undergoing surgery before and after 24 h was made regarding gender, completeness, and years of age. The groups did not differ concerning gender and SCI completeness, but significant difference in age was found (44 and 58 years of age, respectively, p < 0.001). The chance of improved outcome was significantly higher for patients < 50 years of age (42% versus 24%, p = 0.05). Patients under the age of 50 seemed to benefit from early intervention (50% improvement versus 23%); however, difference was not statistically significant (p = 0.08). In patients aged above 50, the trend was similar, but significant correlation was found (40% versus 16%, p = 0.05).

Conclusion

The present study reports a beneficial effect of early decompression surgery, especially for incomplete SCI patients; however, surgical decision-making is complex, and all cases of acute spinal cord injury should be cautiously interpreted and handled on an individual basis.

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Authors and Affiliations

  1. CENSE-Spine, Department of Neurosurgery, Aarhus University Hospital, Palle-Juel Jensens Boulevard 164, 8000, Aarhus, Denmark

    Mette Haldrup & Mikkel Mylius Rasmussen

  2. Department of Neurosurgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus, Denmark

    Mette Haldrup

  3. DANDRITE-Danish Research Institute of Translational Neuroscience, Nordic EMBL Partnership for Molecular Medicine & Department of Biomedicine, Aarhus University, Aarhus, Denmark

    Ole Søndergaard Schwartz

  4. Spinal Cord Injury Centre of Western Denmark, Viborg Regional Hospital, Viborg, Denmark

    Helge Kasch

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  1. Mette Haldrup
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  2. Ole Søndergaard Schwartz
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  4. Mikkel Mylius Rasmussen
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Contributions

  

1. Conceived and/or designed the work that led to the submission, acquired data, and/or played an important role in interpreting the results

2. Drafted or revised the manuscript

3. Approved the final version

4. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

1

Mette Haldrup

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Ole Søndergaard Schwartz

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Helge Kasch

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Mikkel Mylius Rasmussen

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Corresponding author

Correspondence to Mette Haldrup.

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For this type of study, formal consent is not required. This article does not contain any studies with human participants performed by any of the authors.

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The authors declare that they have no conflict of interest.

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This article is part of the Topical Collection on Spine trauma

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Haldrup, M., Schwartz, O.S., Kasch, H. et al. Early decompressive surgery in patients with traumatic spinal cord injury improves neurological outcome. Acta Neurochir 161, 2223–2228 (2019). https://doi.org/10.1007/s00701-019-04031-y

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  • DOI: https://doi.org/10.1007/s00701-019-04031-y

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