Efficacy of early surgery for neurological improvement in spinal cord injury without radiographic evidence of trauma in the elderly

• Published in: World neurosurgery 2017-09, Vol.105, p.790-795
• Main Authors: Inoue, Tomoo, MD, PhD, Suzuki, Shinsuke, MD, PhD, Endo, Toshiki, MD, PhD, Uenohara, Hiroshi, MD, PhD, Tominaga, Teiji, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cervical Vertebrae - surgery; Decompression, Surgical - methods; Degenerative cervical spine disorders; Early surgery; Elderly; Female; Humans; JOA score; Male; Neurosurgery; SCIWORET; Spinal Cord Compression - surgery; Spinal Cord Injuries - surgery; Time Factors; Treatment Outcome
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.06.070

Abstract Object The optimal timing for surgery for patients with spinal cord injury without radiographic evidence of trauma (SCIWORET) remains unclear. This is especially true in the elderly, because most studies are done with younger patients to avoid age-related comorbidities. We therefore aimed to compare the efficacy of early (less than 24 hours post-injury) versus late (more than 24 hours post-injury) surgery in patients with SCIWORET aged 65 years or older. Methods We identified patients aged 65 years or older who underwent surgery for SCIWORET between January 1995 and February 2016. The primary outcome was change in the Japanese Orthopaedic Association (JOA) score at discharge, with a recovery of more than 50% defined as a favorable neurological outcome. Logistic regression analysis was performed and model fit was assessed using the Hosmer–Lemeshow test. Results Eighty patients aged 65 years or older with SCIWORET underwent surgery were enrolled: favorable neurological outcomes were seen in 43.3% of those who underwent early surgery, but only in 18.0% of those who underwent late surgery. Logistic regression analysis, adjusted for age, sex, comorbidities (Charlson Comorbidity Index), and JOA score, revealed that early surgery independently predicted favorable outcomes (odds ratio, 4.06; 95% confidence interval, 1.25–13.20), with excellent calibration (Hosmer–Lemeshow, p = 0.857). Conclusions The present study indicated that early surgery within 24 hours of injury for elderly patients with SCIWORET could lead to more favorable neurological improvements. We believe that chronological age alone should not be considered sufficient justification to deny patients early surgical decompression for SCIWORET.