Yann Facchinello1,2, Andréane Richard-Denis2,3, Marie Beauséjour1,4, Cynthia Thompson2, Jean-Marc Mac-Thiong5,6,7. 1. Department of Surgery, Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, S-749, C.P. 6128, succ. Centre-ville, Montreal, Quebec, H3C 3J7, Canada. 2. Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boul. West, Montreal, Quebec, H4J 1C5, Canada. 3. Department of Medicine, Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, S-749, C.P. 6128, succ. Centre-ville, Montreal, Quebec, H3C 3J7, Canada. 4. Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, Quebec, H3T 1C5, Canada. 5. Department of Surgery, Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, S-749, C.P. 6128, succ. Centre-ville, Montreal, Quebec, H3C 3J7, Canada. macthiong@gmail.com. 6. Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boul. West, Montreal, Quebec, H4J 1C5, Canada. macthiong@gmail.com. 7. Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, Quebec, H3T 1C5, Canada. macthiong@gmail.com.
Abstract
STUDY DESIGN: Post hoc analysis of prospectively collected data. OBJECTIVES: Assess the influence of surgical timing on neurological recovery using classification tree analysis in patients sustaining cervical traumatic spinal cord injury. SETTING: Hôpital du Sacré-Coeur de Montreal METHODS: 42 patients sustaining cervical SCI were followed for at least 6 months post injury. Neurological status was assessed from the American Spinal Injury Association impairment scale (AIS) and neurological level of injury (NLI) at admission and at follow-up. Age, surgical timing, AIS grade at admission and energy of injury were the four input parameters. Neurological recovery was quantified by the occurrence of improvement by at least one AIS grade, at least 2 AIS grades and at least 2 NLI. RESULTS: Proportion of patients that improved at least one ASIA grade was higher in the group that received early surgery (75 vs. 41 %). The proportion of patients that improved two AIS grades was also higher in the group that received early surgery (67 vs. 38 %). Finally, 30 % of the patients that received early decompression improved two NLI as compared with 0% in the other group. Early surgery was also associated with a non-statistically significant improvement in functional recovery. CONCLUSIONS: Neurological recovery of patients sustaining cervical traumatic spinal cord injury can be improved by early decompression surgery performed within 19 h post trauma. SPONSORSHIP: U.S. Army Medical Research and Material Command, Rick Hansen Institute.
STUDY DESIGN: Post hoc analysis of prospectively collected data. OBJECTIVES: Assess the influence of surgical timing on neurological recovery using classification tree analysis in patients sustaining cervical traumatic spinal cord injury. SETTING: Hôpital du Sacré-Coeur de Montreal METHODS: 42 patients sustaining cervical SCI were followed for at least 6 months post injury. Neurological status was assessed from the American Spinal Injury Association impairment scale (AIS) and neurological level of injury (NLI) at admission and at follow-up. Age, surgical timing, AIS grade at admission and energy of injury were the four input parameters. Neurological recovery was quantified by the occurrence of improvement by at least one AIS grade, at least 2 AIS grades and at least 2 NLI. RESULTS: Proportion of patients that improved at least one ASIA grade was higher in the group that received early surgery (75 vs. 41 %). The proportion of patients that improved two AIS grades was also higher in the group that received early surgery (67 vs. 38 %). Finally, 30 % of the patients that received early decompression improved two NLI as compared with 0% in the other group. Early surgery was also associated with a non-statistically significant improvement in functional recovery. CONCLUSIONS: Neurological recovery of patients sustaining cervical traumatic spinal cord injury can be improved by early decompression surgery performed within 19 h post trauma. SPONSORSHIP: U.S. Army Medical Research and Material Command, Rick Hansen Institute.
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