Introduction: Our understanding of the optimal surgical and medical management of traumatic spinal cord injury (SCI) continues to evolve. Case series have suggested improved neurologic outcome with augmentation of the mean arterial pressure (MAP) = 85 mm Hg for 5–7 days post-SCI. Other studies have suggested improved outcomes for patients undergoing early surgical intervention (defined as <24 hours postinjury)
Methods: This retrospective study sought to investigate the extent to which these interventions affected neurological recovery utilizing internal control groups for comparison of outcomes. We further evaluated the incidence of complications related to SCI that could impede recovery including venous thromboembolism and pressure ulcers, and probed different risk factors that underlie their occurrence. We identified 94 patients with SCI. Follow-up data available at 3 different time points (average of 26.7, 115.0, and 252.0 days postinjury) enabled descriptions of the natural history of SCI.
Results: Patients with MAP <85 mm Hg for at least 2 consecutive hours during the 5-day period postinjury were 11.7 times less likely to have an improvement in the American Spine Injury Association (ASIA) Impairment Scale (AIS) when compared to patients with MAP =85 mm Hg (P = 0.006). This association was independent of early surgery or the severity of SCI. At a mean of 252.0 days postinjury, a significantly greater proportion of SCI patients treated with early surgical decompression improved neurologically, compared to patients in the late surgery group (P = 0.031). VTE and pressure ulcers occurred at a rate of 11.7% and 16%, respectively.
Conclusions: This study suggests that there may be improved neurologic outcomes in SCI patients who undergo early surgical decompression and maintenance of MAP =85 mm Hg for at least 5 consecutive days post-SCI, and emphasizes the role of clinical vigilance for potential post-operative SCI sequelae including VTE and pressure ulcers.
Patient Care: Our study provides data supporting early surgical decompression and hypertensive treatment during the acute phase of traumatic spinal cord injury with significant impact on the neurologic outcome of patients with spinal cord injury. It also describes the natural history of spinal cord injury and the rate of potential life-threatening complications such as pressure ulcers and venous thromboembolism with strategies to prevent them.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe the natural history and prognosis of different types of spinal cord injury based on the location and severity of injury
2) Discuss, in small groups, the potential complications encountered in patients with spinal cord injury during their acute admission in hospital and strategies to prevent them
3) Identify an effective treatment protocol for acute traumatic spinal cord injury that highlights the importance of early surgical decompression and optimal mean arterial pressure support during the acute phase of injury