Timing of Operative Intervention in Traumatic Spine Injuries Without Neurological Deficit

• Published in: Neurosurgery Vol. 83; no. 5; pp. 1015 - 1022
• Main Authors: Kim, Elliott J, Wick, Joseph B, Stonko, David P, Chotai, Silky, Freeman Jr, Thomas H, Douleh, Diana G, Mistry, Akshitkumar M, Parker, Scott L, Devin, Clinton J
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.11.2018; Copyright by the Congress of Neurological Surgeons; Wolters Kluwer Health, Inc
• Subjects: Analysis; Health risk assessment; Neurosurgery; Psychic trauma; Surgery; Ventilators; Timing; Operative intervention; Spine; Trauma; Outcomes
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1093/neuros/nyx569

Abstract BACKGROUND Numerous studies have demonstrated the benefits of early decompression and stabilization in unstable spine injuries with incomplete neurological deficits. However, a clear consensus on timing to operative intervention still does not exist in those with a normal neurological exam and unstable spine. OBJECTIVE To determine the optimal timing of operative intervention in traumatic spine injuries without neurological deficit. METHODS Retrospective chart review at a single institution was performed including patients with traumatic spine injuries without neurological deficit admitted from December 2001 to August 2012. Estimated intraoperative blood loss (EBL), in-hospital complications, postoperative hospital length of stay (HLOS), intensive care unit length of stay (ICULOS), and ventilator days were recorded. Delayed surgery was defined as surgery 72 h after admission. RESULTS A total of 456 patients were included for analysis. There was a trend towards statistical significance between the time to operative intervention and EBL in bivariate analysis (P = .07). In the risk-adjusted multivariable analysis delayed vs early surgery was not associated with increased EBL or complications. Delayed surgery was associated with increased ICULOS (odds ratio [OR] = 2.19; 95% confidence interval [CI]: 1.38-3.51; P = .001), ventilator days (OR = 2.09; 95% CI: 1.28-3.43; P = .004), and increased postoperative HLOS (OR = 1.84; 95% CI: 1.22-2.76; P = .004). CONCLUSION Earlier operative intervention was associated with decreased ICULOS, ventilator days, and postoperative HLOS and did not show a statistically significant increase in EBL or complications. Earlier operative intervention for traumatic spine injuries without neurological deficit provides better outcomes compared to delayed surgery.