Efficacy of Ultra-Early (< 12 h), Early (12-24 h), and Late (>24-138.5 h) Surgery with Magnetic Resonance Imaging-Confirmed Decompression in American Spinal Injury Association Impairment Scale Grades A, B, and C Cervical Spinal Cord Injury

• Published in: Journal of neurotrauma Vol. 37; no. 3; pp. 448 - 457
• Main Authors: Aarabi, Bizhan, Akhtar-Danesh, Noori, Chryssikos, Timothy, Shanmuganathan, Kathirkamanathan, Schwartzbauer, Gary T, Simard, J Marc, Olexa, Joshua, Sansur, Charles A, Crandall, Kenneth M, Mushlin, Harry, Kole, Matthew J, Le, Elizabeth J, Wessell, Aaron P, Pratt, Nathan, Cannarsa, Gregory, Lomangino, Cara, Scarboro, Maureen, Aresco, Carla, Oliver, Jeffrey, Caffes, Nicholas, Carbine, Stephen, Mori, Kanami
• Format: Journal Article
• Language: English
• Published: United States Mary Ann Liebert, Inc 01.02.2020; Mary Ann Liebert, Inc., publishers
• Subjects: Analgesics; Anesthesia; Decompression; Fractures; Magnetic resonance imaging; Multiple regression analysis; Original; Spinal cord injuries; Statistical analysis; Studies; Surgery; Trauma; SCI; decompression; timing of surgery; MRI; outcome
• ISSN: 0897-7151; 1557-9042
• DOI: 10.1089/neu.2019.6606

In cervical traumatic spinal cord injury (TSCI), the therapeutic effect of timing of surgery on neurological recovery remains uncertain. Additionally, the relationship between extent of decompression, imaging biomarker evidence of injury severity, and outcome is incompletely understood. We investigated the effect of timing of decompression on long-term neurological outcome in patients with complete spinal cord decompression confirmed on postoperative magnetic resonance imaging (MRI). American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade conversion was determined in 72 AIS grades A, B, and C patients 6 months after confirmed decompression. Thirty-two patients underwent decompressive surgery ultra-early (< 12 h), 25 underwent decompressive surgery early (12-24 h), and 15 underwent decompressive surgery late (> 24-138.5 h) after injury. Age, gender, injury mechanism, intramedullary lesion length (IMLL) on MRI, admission ASIA motor score, and surgical technique were not statistically different among groups. Motor complete patients (  = 0.009) and those with fracture dislocations (  = 0.01) tended to be operated on earlier. Improvement of one grade or more was present in 55.6% of AIS grade A, 60.9% of AIS grade B, and 86.4% of AIS grade C patients. Admission AIS motor score (  = 0.0004) and pre-operative IMLL (  = 0.00001) were the strongest predictors of neurological outcome. AIS grade improvement occurred in 65.6%, 60%, and 80% of patients who underwent decompression ultra-early, early, and late, respectively (  = 0.424). Multiple regression analysis revealed that IMLL was the only significant variable predictive of AIS grade conversion to a better grade (odds ratio, 0.908; confidence interval [CI], 0.862-0.957;  < 0.001). We conclude that in patients with post-operative MRI confirmation of complete decompression following cervical TSCI, pre-operative IMLL, not the timing of surgery, determines long-term neurological outcome.