Early surgery for spinal cord injuries may accelerate motor recovery vs. delayed surgery
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CHICAGO — Compared with delayed surgery, early surgery of motor-incomplete cervical spinal cord injuries may yield accelerated motor recovery 6 months after injury but similar recovery at 1 year after injury, results presented here showed.
Hirotaka Chikuda, MD, PhD, and colleagues randomly assigned 70 patients aged 20 to 79 years with motor-incomplete cervical spinal cord injuries and preexisting canal stenosis to undergo either early surgery within 24 hours of admission (n=37) or delayed surgery with at least 2 weeks of conservative treatment (n=33).
“Primary endpoints included improvements in [American Spinal Cord Injury Association] ASIA motor score, total score of the spinal cord independence measure and the proportion of patients able to walk independently at 1 year after injury,” Chikuda said in his presentation at the North American Spine Society Annual Meeting.
During the first 6 months after surgery, Chikuda noted both groups had major improvements in motor recovery, with patients in the early surgery group recovering faster vs. patients in the delayed surgery group. However, Chikuda said the difference between the two groups gradually decreased over time.
“Taking a closer look, the early surgery group showed better motor recovery than the delayed surgery group at 2 weeks, 3 months and 6 months after injury,” Chikuda said.
In a subgroup analysis of patients with and those without central cord syndrome, Chikuda said patients without central cord syndrome had excellent recovery after early surgery compared with patients who had central cord syndrome.
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Michael G. Fehlings, MD, PhD, FRCSC
There is increasing evidence that early surgical intervention (within 24 hours) after spinal cord injury improves neurological and functional recovery. The small, randomized controlled trial by Hirotaka Chikuda, MD, PhD, and colleagues provides evidence that early surgery improves outcomes for patients with motor-incomplete cervical cord injury. This work is complemented by our own propensity-matched study of 186 patients that showed early surgical intervention improves the outcome of patients with motor-incomplete cervical cord injury or “central cord syndrome.” This work was presented in the same “Best Papers” session at the North American Spine Society Annual Meeting as the paper by Chikuda and colleagues. T
The work of Chikuda and colleagues adds to the mounting evidence in support of the concept “Time is spine.” This is reflected by the current AOSpine guidelines favoring early surgery for spinal cord injury. Moreover, the AOSpine guidelines are being revised in light of mounting evidence favoring early surgery for spinal cord injury.
References:
Badhiwala JH, et al. JAMA Surg. 2022;doi:10.1001/jamasurg.2022.4454.
Fehlings MG, et al. Global Spine J. 2017;doi:10.1177/2192568217706367.
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Chikuda H, et al. Paper 21. Presented at: North American Spine Society Annual Meeting; Oct. 12-15, 2022; Chicago.
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