Abstract
PurposeThe optimal surgical timeframe for neurological recovery in traumatic spinal cord injury (tSCI) still remains unknown. Recent guidelines have recommended performing surgery within 24 h for all patients with tSCI regardless of initial neurological deficit. It remains unclear whether patients with complete, incomplete tSCI, or traumatic central cord injury (TCCI) will experience the same degree of improvement after urgent surgical intervention. We investigated if the severity of initial neurological injury influenced surgeons on their decision-making of surgical timing in tSCI.MethodsWith a web-based survey, we investigated the current opinion in The Netherlands on timing of surgical decompression and stabilization, depending on the initial degree of neurological injury.ResultsSurgeons prefer to perform more urgent surgery for incomplete tSCI compared to complete tSCI. In addition, 43% of patients with complete tSCI are not preferably operated within the recommended 24 h. Even though TCCI is the most common form of incomplete tSCI, these patients are preferably managed less urgently than patients with other types of incomplete tSCI.ConclusionThe severity of initial neurological injury seems to play an important role in the urgency of surgical timing for tSCI. A substantial number of patients with complete tSCI are not preferably treated within the recommended surgical timeframe, while patients with incomplete tSCI are preferably operated far more urgent than recommended in the current guidelines.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Traumatic spinal cord injury is a devastating event, affecting a patient’s life in innumerable ways [1]
Patients with complete traumatic spinal cord injury (tSCI) and traumatic central cord injury (TCCI) are preferably managed less urgent than patients with incomplete tSCI. 3
A distinction in surgical timing is made based upon the initial neurological injury, since only 57% prefer to perform surgery within 24 h for complete ASIA A tSCI patients in comparison to 75% for ASIA B and 78% for ASIA C/D (Fig. 1)
Summary
Traumatic spinal cord injury (tSCI) is a devastating event, affecting a patient’s life in innumerable ways [1]. Surgical decompression seems to have a beneficial effect on the neurological outcome in the acutely injured spinal cord [2, 3]. This study showed a beneficial effect on neurological outcome when surgical decompression and stabilization was performed within 24 h after injury compared to surgery performed after 24 h, in both patients with complete and incomplete tSCI. Some smaller studies have confirmed that neurological recovery is limited to patients with incomplete tSCI [7, 8]. This effect was seen in complete tSCI when surgery was performed urgently [4]. Recent international guidelines recommend performing surgery within 24 h for tSCI regardless of initial neurological status [9, 10]
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