Introduction: Consensus regarding the optimal timing of surgical stabilization for SCI has not been reached. Clinical evidence supports early surgery (<72hours from injury). Our practice is to take patients with SCI, regardless of ASIA score, to the operating room emergently and only operate in a delayed fashion when circumstances (arrival at hospital or other injuries) preclude emergent surgery. The goal of this study is to validate the efficacy, safety & neurological recovery after early surgical decompression and stabilization (<72hrs) versus delayed (72hoursto7days), along with examining the results of hyper-acute (<12hrs) and acute (<24hrs) intervention.
Methods: A single surgeon’s experience in a large academic tertiary referral centre of 112 consecutive patients undergoing surgery for acute, unstable cervical or thoracolumbar fracture between January 00 and December 11 was recorded. Patient demographics and co-morbidities/co-injuries, ASIA grade, time of injury to surgery, hospital length of stay, ICU stay, intra-operative blood loss and pulmonary complications were recorded.
Results: Patients operated on <72hours in comparison to the delayed group (72hrsto7days) had shorter hospital stays (10.66,13.88 days) shorter ICU stays (3.8,7.2 days) and greater improvements in ASIA grades on follow up (ave. 68 weeks).
Despite worse initial ASIA grades, patients operated hyper-acutely (n=17) had a significantly shorter overall hospital (9 vs. 13.9 days) and intensive care unit stay (3.9vs.7.2 days) than the delayed group. The hyper-acute group had a similar rate of pneumonia (11%vs.12.5%). Though a small number of patients the hyper-acute group had markedly better follow up ASIA grades than the delayed group with 3 ASIA A patients improving at least 2 grades. No ASIA A patients improved in the delayed group.
Conclusions: Corroborating previous studies, our study shows a trend towards better neurological outcome, decreased hospital stays and thus financial costs with early versus late surgery. Hyper acute stabilization can be associated with improved ASIA grades even in complete injuries.
Patient Care: Our research confirms the possibility of improvement of spinal cord injury if a stabilization is carried out expeditiously even in complete injuries.
Learning Objectives: Hyper acute stabilization can be both safe and efficacious if carried out on medically stable patients and may even lead to improvements in patients with complete injuries. A neurosurgeon must endeavor to deal with this devastating injury as soon as possible and arrange hospital logistical facilities in such a way to facilitate this.