Healio
Healio
March 26, 2012
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Surgery less than 24 hours after cervical spinal cord injury yields improved outcomes

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Researchers at the Rothman Institute at Jefferson have found that patients who receive surgery less than 24 hours after a traumatic cervical spine injury suffer less neural tissue destruction and improved clinical outcomes, according to a study published in PLoS One.

The multicenter, international, prospective cohort Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) investigated adult patients aged 16 years to 80 years who demonstrated cervical spinal cord injury (SCI), with enrollment occurring at six North American centers from 2002 to 2009, according to the study abstract.

The abstract also noted the researchers used a primary outcome of ordinal change in ASIA Impairment Scale (AIS) grade at the 6-month follow-up mark. Complication rates and mortality were considered secondary outcomes.

In all, according to the abstract, Alexander Vaccaro, MD, PhD, and his team looked at 313 patients with acute cervical SCI — including 182 patients who underwent early surgery at a mean of 14.2 hours and 131 patients who underwent late surgery at a mean of 48.3 hours.

According to the study results, 222 patients were available for the 6-month follow-up, with 19.8% of those patients who underwent early surgery displaying a 2-grade or higher improvement in AIS, compared to a rate of 8.8% in the late surgery group.

“What [the study findings] tell us is that the odds of a significant (at least two-grade) improvement in neurologic status is 2.8 times higher when surgery is performed within 24 hours post-injury,” Vaccaro stated in a Jefferson news release. “This can be the difference between walking and not for the rest of one’s life.”

“Previous research has been inconclusive on the issue, with the common thought among most surgeons that you can wait up to five days post-injury and have the same outcomes,” Vaccaro added in the release. “We should not practice that way anymore, armed with this new information.”

Reference:
  • Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for the traumatic cervical spinal cord injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012. doi:10.1371/journal.pone.0032037

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