José Ramírez-Villaescusa1, Jesús López-Torres Hidalgo2, David Ruiz-Picazo1, Antonio Martin-Benlloch3, Pedro Torres-Lozano4, Eloy Portero-Martinez1. 1. Department of Orthopaedics Surgery and Traumatology, Spine Unit, Complejo Hospitalario Universitario de Albacete, Albacete, Spain. 2. Health Care Service of Castilla-La Mancha (Sescam), University of Castilla-La Mancha, Albacete, Spain. 3. Hospital Universitario Dr. Peset. Orthopedics Department, Chief Spine Unit, Valencia, Spain. 4. Department of Orthopaedics Surgery and Traumatology, Hospital General de Almansa, Albacete, Spain.
Abstract
BACKGROUND: We carried out an observational longitudinal retrospective study between 2000 and 2009 in 28 patients who underwent surgery for unstable vertebral fractures with neurologic deficits. METHODS: For the statistical analysis, we used the Chi2-test to compare proportions in independent groups and the exact Fisher test and the Wilcoxon test for repeated measures, and we compared the mean values using the Mann-Whitney U test at a significance level of P<0.05. Timing to surgical intervention (urgent ≤8 vs. >8 h), and neurologic status using the American Spinal Injury Association (ASIA) Impairment Scale at baseline and at the end of follow-up were assessed. We tested the ASIA score improvement at the end of follow-up using multiple regression analysis, adjusted by variables such as ISS, timing of intervention, location, approach and type of fracture. RESULTS: Twenty-eight patients were included in the analysis. Of the total, 11 (39.2%) underwent surgery urgently (≤8 h) and 17 (60.8%) in >8 h. The mean difference in the neurologic improvement in all patients was 0.97 (95% CI, 0.51-1.42) and was statistically significant (P=0.001). The mean difference in the neurologic improvement in patients with incomplete lesions was 1.59 (95% CI, 1.01-2.17, P=0.001). In these patients, the mean improvement for those intervened in less than 8 h was 1.73 compared to those operated on after more than 8 h (mean improve 0.47) with a difference statistically significant (P=0.007). CONCLUSIONS: Urgent surgery was associated with neurologic improvement in patients with spinal cord injury (SCI). This improvement was mainly observed in patients with an incomplete lesion.
BACKGROUND: We carried out an observational longitudinal retrospective study between 2000 and 2009 in 28 patients who underwent surgery for unstable vertebral fractures with neurologic deficits. METHODS: For the statistical analysis, we used the Chi2-test to compare proportions in independent groups and the exact Fisher test and the Wilcoxon test for repeated measures, and we compared the mean values using the Mann-Whitney U test at a significance level of P<0.05. Timing to surgical intervention (urgent ≤8 vs. >8 h), and neurologic status using the American Spinal Injury Association (ASIA) Impairment Scale at baseline and at the end of follow-up were assessed. We tested the ASIA score improvement at the end of follow-up using multiple regression analysis, adjusted by variables such as ISS, timing of intervention, location, approach and type of fracture. RESULTS: Twenty-eight patients were included in the analysis. Of the total, 11 (39.2%) underwent surgery urgently (≤8 h) and 17 (60.8%) in >8 h. The mean difference in the neurologic improvement in all patients was 0.97 (95% CI, 0.51-1.42) and was statistically significant (P=0.001). The mean difference in the neurologic improvement in patients with incomplete lesions was 1.59 (95% CI, 1.01-2.17, P=0.001). In these patients, the mean improvement for those intervened in less than 8 h was 1.73 compared to those operated on after more than 8 h (mean improve 0.47) with a difference statistically significant (P=0.007). CONCLUSIONS: Urgent surgery was associated with neurologic improvement in patients with spinal cord injury (SCI). This improvement was mainly observed in patients with an incomplete lesion.
Authors: R John Hurlbert; Mark N Hadley; Beverly C Walters; Bizhan Aarabi; Sanjay S Dhall; Daniel E Gelb; Curtis J Rozzelle; Timothy C Ryken; Nicholas Theodore Journal: Neurosurgery Date: 2013-03 Impact factor: 4.654
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Authors: Peter E Batchelor; Taryn E Wills; Peta Skeers; Camila R Battistuzzo; Malcolm R Macleod; David W Howells; Emily S Sena Journal: PLoS One Date: 2013-08-23 Impact factor: 3.240
Authors: Joaquin Alfaro-Micó; José Ramirez-Villaescusa; Maria Dolores Martinez-Lozano; Rosa Maria Sanchez-Honrubia; David Ruiz-Picazo Journal: Trauma Case Rep Date: 2020-04-16