Optimization of the mean arterial pressure and timing of surgical decompression in traumatic spinal cord injury: a retrospective study.

Abstract

A retrospective comparative study. This study aims to investigate the extent to which early surgical decompression and maintenance of MAP ⩾85 mm Hg for 5 days postinjury affected neurological recovery utilizing internal controls for comparison of outcomes in patients with traumatic spinal cord injury. Acute trauma center, Halifax, Nova Scotia, Canada. We identified 94 cases of traumatic SCI. Follow-up data were available at an average of 26.7±19.5, 115.0±69.3, and 252.0±152.8 days postinjury for 61, 48, and 47 patients, respectively. Neurological recovery was assessed using the American Spinal Cord Injury Association (ASIA) Impairment Scale (AIS). Patients with MAP <85 mm Hg for at least 2 consecutive hours during the 5-day period postinjury were 11 times less likely to have an improvement in the AIS grade when compared with 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 (within 24 h) improved neurologically (P=0.031). Our data demonstrated that there may be improved neurologic outcomes in patients with SCI who undergo early surgical decompression. Maintenance of MAP ⩾85 mm Hg for 5 consecutive days post-SCI was also associated with higher rates of AIS grade improvement at mean 26.7 days without a statistically significance difference at prolonged follow-up although a higher rate of neurological recovery persisted in patients with MAP ⩾85 mm Hg.