Efficacy of Ultra-Early (< 12 h), Early (12–24 h), and Late (>24–138.5 h) Surgery with Magnetic Resonance Imaging-Confirmed Decompression in American Spinal Injury Association Impairment Scale Grades A, B, and C Cervical Spinal Cord Injury
| Autor: | Jeffrey Oliver, Harry Mushlin, Noori Akhtar-Danesh, Kenneth M. Crandall, Gary Schwartzbauer, Charles A. Sansur, Nathan Pratt, Maureen Scarboro, Nicholas Caffes, Matthew J Kole, Joshua Olexa, Kanami Mori, Bizhan Aarabi, Gregory Cannarsa, Cara D Lomangino, Kathirkamanathan Shanmuganathan, Stephen Carbine, Elizabeth Le, J. Marc Simard, Aaron Wessell, Carla Aresco, Timothy Chryssikos |
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| Rok vydání: | 2020 |
| Předmět: |
musculoskeletal diseases
Adult Male decompression 030506 rehabilitation medicine.medical_specialty Time Factors Traumatic spinal cord injury Decompression Cohort Studies Young Adult timing of surgery 03 medical and health sciences 0302 clinical medicine Humans Medicine Prospective Studies Societies Medical Spinal Cord Injuries Aged Retrospective Studies Trauma Severity Indices medicine.diagnostic_test business.industry Therapeutic effect American Spinal Injury Association Cervical Cord Magnetic resonance imaging Original Articles Middle Aged Decompression Surgical Magnetic Resonance Imaging United States Surgery SCI Cervical spinal cord injury outcome Female Neurology (clinical) 0305 other medical science business 030217 neurology & neurosurgery Follow-Up Studies MRI |
| Zdroj: | Journal of Neurotrauma |
| ISSN: | 1557-9042 0897-7151 |
| DOI: | 10.1089/neu.2019.6606 |
| Popis: | In cervical traumatic spinal cord injury (TSCI), the therapeutic effect of timing of surgery on neurological recovery remains uncertain. Additionally, the relationship between extent of decompression, imaging biomarker evidence of injury severity, and outcome is incompletely understood. We investigated the effect of timing of decompression on long-term neurological outcome in patients with complete spinal cord decompression confirmed on postoperative magnetic resonance imaging (MRI). American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade conversion was determined in 72 AIS grades A, B, and C patients 6 months after confirmed decompression. Thirty-two patients underwent decompressive surgery ultra-early (< 12 h), 25 underwent decompressive surgery early (12–24 h), and 15 underwent decompressive surgery late (> 24–138.5 h) after injury. Age, gender, injury mechanism, intramedullary lesion length (IMLL) on MRI, admission ASIA motor score, and surgical technique were not statistically different among groups. Motor complete patients (p = 0.009) and those with fracture dislocations (p = 0.01) tended to be operated on earlier. Improvement of one grade or more was present in 55.6% of AIS grade A, 60.9% of AIS grade B, and 86.4% of AIS grade C patients. Admission AIS motor score (p = 0.0004) and pre-operative IMLL (p = 0.00001) were the strongest predictors of neurological outcome. AIS grade improvement occurred in 65.6%, 60%, and 80% of patients who underwent decompression ultra-early, early, and late, respectively (p = 0.424). Multiple regression analysis revealed that IMLL was the only significant variable predictive of AIS grade conversion to a better grade (odds ratio, 0.908; confidence interval [CI], 0.862–0.957; p |
| Databáze: | OpenAIRE |
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