Poster 185: Outcomes of surgical versus nonsurgical spine interventions after acute spinal cord injury.

Abstract

Objective: To compare neurologic, medical, and functional outcomes of patients with acute spinal cord injury (SCI) undergoing early (days 1–3) and later (after day 3) surgical spine intervention as well as nonsurgical management. Design: Case series comparing outcomes by surgical and nonsurgical groups at admission and discharge to rehabilitation and at 1-year follow-up. Setting: Multicenter national Spinal Cord Injury Model System database. Participants: Consecutive patients with acute, nonpenetrating, traumatic SCI from 1993 to 2002, admitted within the first 24 hours after injury. Intervention: Surgery (early vs late) versus nonsurgery. Main Outcome Measures: Changes in neurologic outcomes (motor and sensory levels of injury, motor index score), medical complications (surgical revision, wound infections, pressure ulcers, deep venous thrombosis [DVT], pulmonary embolism [PE], pneumonia, 1-year rehospitalization), and functional outcomes (acute and rehabilitation length of stay [LOS], hospital charges, FIM™ instrument motor efficiency changes, discharge disposition). Results: Persons in the early surgery group were more likely ( P<.01) to be women, have an SCI because of a motor vehicle collision, and have shorter acute and rehabilitation LOS. No differences between groups were found for changes in neurologic levels, FIM motor efficiency, American Spinal Injury Association motor index, or discharge disposition. Both surgical groups had an increased acute care incidence of pneumonia and DVT and PE. Conclusion: Although shorter LOSs were shown, this study did not support the benefits of early spinal surgery for enhancing neurologic or functional outcome.