Is early surgical intervention effective for traumatic severe cervical spinal cord injury? A retrospective study secondary publication

Abstract

Although early surgery is known to be effective for the treatment of traumatic cervical spinal cord injury (CSCI), whether it is equally effective in severe CSCI cases remains undetermined. This study aimed to determine whether surgery within 24 h improves the neurological prognosis and reduces the complications associated with surgery for traumatic severe CSCI. The data of 42 patients with traumatic severe CSCI with American Spinal Injury Association Impairment Scale (AIS) grades A–B who underwent surgery between December 2007 and May 2018 were retrospectively reviewed. The participants were classified into early surgery (<24 h) and late surgery (>24 h) groups. Using the inverse probability of treatment weighting with propensity score adjustment for confounding factors, the AIS grades before and 1 month following surgical treatment, which were considered the primary outcomes, were compared. The secondary outcomes were the intensive care unit length of stay (ICU-LOS) and occurrence of respiratory complications and cardiac arrest. In the early surgery group (n = 32, 76%), the average time to surgery was 10.25 h (4–23 h). The inverse probability of treatment weighting analysis indicated significant differences in the neurological improvement according to the AIS grade at 1 month following surgery (odds ratio [OR]: 17.1, 95% confidence interval [Cl]: 1.9–156.7, p = 0.012), the ICU-LOS >7 days (OR: 0.14, 95% Cl: 0.02–0.90, p = 0.04), and the occurrence of respiratory complications (OR: 0.08, 95% Cl: 0.01–0.73, p = 0.03) and cardiac arrest (OR: 0.13, 95% Cl: 0.02–0.85, p = 0.03). Early surgery (within 24 h) for traumatic severe CSCI may improve the neurological prognosis and prevent a long ICU-LOS and postoperative complications.