Yang Liu1, Chang Gui Shi1, Xin Wei Wang1, Hua Jiang Chen1, Ce Wang1, Peng Cao1, Rui Gao1, Xian Jun Ren2, Zhuo Jing Luo3, Bing Wang4, Jian Guang Xu5, Ji Wei Tian6, Wen Yuan7. 1. Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China. 2. Department of Orthopaedics, Xinqiao Hospital, The Third Military Medical University of China, Chongqing, Peoples' Republic of China. 3. Department of Orthopaedics, Xijing Hospital, The Fourth Military Medical University of China, Xi'an, Peoples' Republic of China. 4. Department of Orthopaedics, The Second Xiangya Hospital of Central South University, Changsha, Peoples' Republic of China. 5. Department of Orthopaedics, The Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, Peoples' Republic of China. 6. Department of Orthopaedics, The First People's Hospital, Shanghai Jiaotong University, Shanghai, Peoples' Republic of China. 7. Department of Orthopaedics, Changzheng Hospital, The Second Military Medical University of China, 415 Fengyang Road, Shanghai, 200003, Peoples' Republic of China. smmuyuanwen@163.com.
Abstract
PURPOSE: Although there have been numerous studies aimed at determining the effects and safety of early vs. late surgical decompression for traumatic cervical spinal cord injury, controversies still exist regarding the optimal timing of surgery for this serious spinal trauma. This study was conducted to evaluate the effectiveness and safety of early vs. late surgical decompression for lower cervical spine trauma associated with spinal cord injury. METHODS: A retrospective review of was performed on consecutive patients who underwent surgical decompression for lower cervical (C3-C7) spine trauma associated with spinal cord injury at six institutions across China from January 2007 to January 2012. These patients were analysed according to the timing of surgical intervention. The early group comprised patients who underwent surgery within the first 72 hours after being injured, whilst the late group comprised patients who underwent surgery after the first 72 hours. For analysis of neurologic improvement, patients who had completed a follow-up of at least six months were assessed. Other outcomes analysed were hospitalisation periods, complications and mortality. RESULTS: A total of 595 patients were identified (456 men and 139 women at an average age of 41.4 years), with 212 in the early group and 383 in the late group. Patients in both groups had made a significant neurologic improvement in the final follow-up, but no statistically significant difference was noted between groups. Patients in the early group had a significantly shorter hospital stay (15.4 vs. 18.3 days, p <0.001) but realised no benefits in terms of intensive care unit length of stay and ventilator days. No significant differences were identified between groups with regards complications (pneumonia, pulmonary embolism, wound infection, sepsis and urinary tract infection). Compared with the late group, the early group had a significantly higher incidence of postoperative neurological deterioration (6.6 vs. 0.7 %, p <0.001) and mortality (7.1 vs. 2.1 %, p = 0.003). CONCLUSION: The timing of surgery for patients sustaining traumatic lower cervical spine injury with neurological involvement did not affect neurological recovery. Early surgical intervention was associated with a higher incidence of mortality and neurological deterioration compared with late surgical intervention, indicating that surgery after the first 72 hours might be relatively safe.
PURPOSE: Although there have been numerous studies aimed at determining the effects and safety of early vs. late surgical decompression for traumatic cervical spinal cord injury, controversies still exist regarding the optimal timing of surgery for this serious spinal trauma. This study was conducted to evaluate the effectiveness and safety of early vs. late surgical decompression for lower cervical spine trauma associated with spinal cord injury. METHODS: A retrospective review of was performed on consecutive patients who underwent surgical decompression for lower cervical (C3-C7) spine trauma associated with spinal cord injury at six institutions across China from January 2007 to January 2012. These patients were analysed according to the timing of surgical intervention. The early group comprised patients who underwent surgery within the first 72 hours after being injured, whilst the late group comprised patients who underwent surgery after the first 72 hours. For analysis of neurologic improvement, patients who had completed a follow-up of at least six months were assessed. Other outcomes analysed were hospitalisation periods, complications and mortality. RESULTS: A total of 595 patients were identified (456 men and 139 women at an average age of 41.4 years), with 212 in the early group and 383 in the late group. Patients in both groups had made a significant neurologic improvement in the final follow-up, but no statistically significant difference was noted between groups. Patients in the early group had a significantly shorter hospital stay (15.4 vs. 18.3 days, p <0.001) but realised no benefits in terms of intensive care unit length of stay and ventilator days. No significant differences were identified between groups with regards complications (pneumonia, pulmonary embolism, wound infection, sepsis and urinary tract infection). Compared with the late group, the early group had a significantly higher incidence of postoperative neurological deterioration (6.6 vs. 0.7 %, p <0.001) and mortality (7.1 vs. 2.1 %, p = 0.003). CONCLUSION: The timing of surgery for patients sustaining traumatic lower cervical spine injury with neurological involvement did not affect neurological recovery. Early surgical intervention was associated with a higher incidence of mortality and neurological deterioration compared with late surgical intervention, indicating that surgery after the first 72 hours might be relatively safe.
Authors: John R Dimar; Leah Y Carreon; Joseph Riina; David G Schwartz; Mitchel B Harris Journal: Spine (Phila Pa 1976) Date: 2010-10-01 Impact factor: 3.468
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Authors: L F Marshall; S Knowlton; S R Garfin; M R Klauber; H M Eisenberg; D Kopaniky; M E Miner; K Tabbador; G L Clifton Journal: J Neurosurg Date: 1987-03 Impact factor: 5.115
Authors: Bizhan Aarabi; Joshua Olexa; Timothy Chryssikos; Samuel M Galvagno; David S Hersh; Aaron Wessell; Charles Sansur; Gary Schwartzbauer; Kenneth Crandall; Kathirkamanathan Shanmuganathan; J Marc Simard; Harry Mushlin; Mathew Kole; Elizabeth Le; Nathan Pratt; Gregory Cannarsa; Cara D Lomangino; Maureen Scarboro; Carla Aresco; Brian Curry Journal: J Neurotrauma Date: 2018-10-09 Impact factor: 5.269