Christof Wutte1, Johannes Becker2, Barbara Klein3, Orpheus Mach4, Stephanie Panzer5, Fabian Maria Stuby4, Martin Strowitzki6, Doris Maier4, Claudius Thomé7, Lukas Grassner8. 1. Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany; Department of Neurosurgery, Trauma Center Murnau, Murnau, Germany. 2. Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany; Institute of Biomechanics, Trauma Center Murnau, Germany and Paracelsus Medical University, Salzburg, Austria. 3. Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria; SCI-TReCS (Spinal Cord Injury and Tissue Regeneration Center Salzburg), Salzburg, Austria. 4. Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany. 5. Department of Radiology, Trauma Center Murnau, Murnau, Germany; Institute of Biomechanics, Trauma Center Murnau, Germany and Paracelsus Medical University, Salzburg, Austria. 6. Department of Neurosurgery, Trauma Center Murnau, Murnau, Germany. 7. Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria. 8. Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany; Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria; SCI-TReCS (Spinal Cord Injury and Tissue Regeneration Center Salzburg), Salzburg, Austria; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria. Electronic address: lukas.grassner@googlemail.com.
Abstract
BACKGROUND: There is accumulating evidence of a potential beneficial effect of early surgical intervention after acute cervical spinal cord injury (SCI). However, around one third of all SCIs affect the thoracic spine. This cohort has not been extensively investigated, mainly because of less sensitive clinical readout measures. Apart from regaining full sensorimotor function, improvements in bladder and bowel management remain of the highest priority for patients with chronic paraplegia. Therefore, this study investigates the effect of early decompression (here defined as <8 hours) versus delayed management on neurologic and functional outcome. METHODS: We retrospectively analyzed data from the institutional database, in which follow-up data were collected prospectively according to the European Multicenter Study about Spinal Cord Injury standards. Within a 13-year period, we identified 43 patients who met inclusion and exclusion criteria. Of these, 32 (74%) were managed surgically within the first 8 hours. There was a trend toward a higher rate of patients with clinically complete SCI in the early group at baseline. RESULTS: After 1 year, we did not observe a benefit on the neurologic outcome as assessed via the American Spinal Injury Association Impairment Scale grade. Functional outcome was evaluated using the Spinal Cord Independence Measure (SCIM). The early decompressed group demonstrated significantly improved SCIM 6 (i.e., bladder management) (P < 0.045) and SCIM 9-11 subitems (i.e., mobility, transfer) (P < 0.019). CONCLUSIONS: Early decompression was an independent predictor for improved functional bladder outcome and mobility after 1 year. This effect needs to be studied in future prospective, multicenter studies.
BACKGROUND: There is accumulating evidence of a potential beneficial effect of early surgical intervention after acute cervical spinal cord injury (SCI). However, around one third of all SCIs affect the thoracic spine. This cohort has not been extensively investigated, mainly because of less sensitive clinical readout measures. Apart from regaining full sensorimotor function, improvements in bladder and bowel management remain of the highest priority for patients with chronic paraplegia. Therefore, this study investigates the effect of early decompression (here defined as <8 hours) versus delayed management on neurologic and functional outcome. METHODS: We retrospectively analyzed data from the institutional database, in which follow-up data were collected prospectively according to the European Multicenter Study about Spinal Cord Injury standards. Within a 13-year period, we identified 43 patients who met inclusion and exclusion criteria. Of these, 32 (74%) were managed surgically within the first 8 hours. There was a trend toward a higher rate of patients with clinically complete SCI in the early group at baseline. RESULTS: After 1 year, we did not observe a benefit on the neurologic outcome as assessed via the American Spinal Injury Association Impairment Scale grade. Functional outcome was evaluated using the Spinal Cord Independence Measure (SCIM). The early decompressed group demonstrated significantly improved SCIM 6 (i.e., bladder management) (P < 0.045) and SCIM 9-11 subitems (i.e., mobility, transfer) (P < 0.019). CONCLUSIONS: Early decompression was an independent predictor for improved functional bladder outcome and mobility after 1 year. This effect needs to be studied in future prospective, multicenter studies.