Neurologic outcome of early versus late surgery for cervical spinal cord injury

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 1997-11, Vol.22 (22), p.2609-2613
• Main Authors: VACCARO, A. R, DAUGHERTY, R. J, SHEEHAN, T. P, DANTE, S. J, COTLER, J. M, BALDERSTON, R. A, HERBISON, G. J, NORTHRUP, B. E
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Cervical Vertebrae - injuries; Female; Follow-Up Studies; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Neurologic Examination; Orthopedic surgery; Prospective Studies; Spinal Cord Injuries - mortality; Spinal Cord Injuries - rehabilitation; Spinal Cord Injuries - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/00007632-199711150-00006

A prospective analysis evaluating neurologic outcome after early versus late surgery for cervical spinal cord trauma. The study was conducted to determine whether neurologic and functional outcome is improved in traumatic cervical spinal cord-injured patients (C3-T1, American Spinal Injury Association grades A-D) who had early surgery (5 days after spinal cord injury). There is considerable controversy as to the appropriate timing of surgical decompression and stabilization for cervical spinal cord trauma. There have been numerous retrospective studies, but no prospective studies, to determine whether neurologic outcome is best after early versus late surgical treatment for cervical spinal cord injury. Patients meeting appropriate inclusion criteria were randomized to an early (5 days after spinal cord injury) surgical treatment protocol. The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow-up. Comparison of the two groups showed no significant difference in length of acute postoperative intensive care stay, length of inpatient rehabilitation, or improvement in American Spinal Injury Association grade or motor score between early (mean, 1.8 days) versus late (mean, 16.8 days) surgery. The results of this study reveal no significant neurologic benefit when cervical spinal cord decompression after trauma is performed less than 72 hours after injury (mean, 1.8 days) as opposed to waiting longer than 5 days (mean, 16.8 days).