Early decompression strategy is effective in thoracolumbar traumatic spinal cord injury with lower grade residual spinal canal compression
Goulet J, Mac-Thiong J
Université de Montréal, Montreal, Quebec, Canada
After traumatic spinal cord injury (tSCI) at the thoracolumbar level, the potential for neurological recovery and related prognostic factors are subject to many studies and controversies. Early spinal canal decompression tends to favor neurological outcome, but no study evaluated the role of residual spinal canal compression in early surgery strategies. The objective of this study is to determine the influence of surgical timing on neurological recovery in relationship with the residual spinal canal compression documented after tSCI.
A prospective cohort of 42 patients that had sustained a tSCI from T10 to L2, and consecutively admitted to a single Level 1 SCI-specialized trauma center between April 2010 and September 2016 was studied. Patients were stratified in subgroups of surgical timing (<24h or >24h post-trauma). Maximum Canal Compromise (MCC) and Maximum Spinal Cord Compression (MSCC) were calculated for all patients. Neurologic recovery as dependant variable was dichotomised and considered present if improvement was documented on the ISNCSI ASIA scale at a minimum of 6 months of follow-up. Non-parametric tests were applied to assess for difference in prevalence of neurological recovery in different subgroups.
There was no difference in neurological recovery between patients operated < 24 h and patients operated > 24 h from trauma. MCC and MSCC alone did not influence neurological outcome. When operated < 24 h, patients that had a lower level of MCC (< 50 %) showed comparable neurological recuperation with patients with higher level of compression (> 50 %). Similar results were obtained when repeating the analyses with a > 66 % threshold, as well as when using MCC as a continuous variable. Neurologic recovery in patients operated < 24 h did not differ according to different levels of MSCC.
With demonstration of similar neurologic outcomes at 6 months, patients with low grade residual spinal canal compression benefit from early decompression strategy alike patients with higher grade residual compression. Prevalence of neurologic recovery was not different in groups operated < 24 h regardless of stratification for level of MCC or MSCC.
Fonds de Recherche Quebec-Sante
Fondation de Recherche et d'Education en Orthopedie de Montreal
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