Early decompressive surgery in patients with traumatic spinal cord injury improves neurological outcome.

Background: The role and timing of a decompressive surgical intervention in patients with traumatic spinal cord injury (SCI) remain controversial. Given the impact of SCI on the individual and society, decompressive surgery to reduce the extent of tissue destruction and improving neurological outcome after initial spinal cord trauma are needed.

Objective: To evaluate any possible correlation between the time of a decompressive procedure after traumatic SCI and end-neurologic outcome for traumatic SCI patients.

Methods: A retrospective cohort study on patients with traumatic SCI in Western Denmark from 2010 to 2017. Data on date and time of injury and time of surgery and data on neurologic status at admission and one-year post-trauma were found in the Electronic Patients Journal (EPJ) and in paper journals. Patients were divided into 4 groups (< 6 h, < 12 h, < 24 h, and > 24 h) based on the time between injury and surgery. Further, patients were separated into two groups depending on whether they did or did not achieve neurological improvement one-year post-trauma. We used Fisher's exact test to compare the abovementioned groups to examine an eventual correlation between time from injury to operation and change in neurological outcome one-year post-trauma.

Results: Patients undergoing surgery < 24 h after trauma obtained a significantly better neurological outcome as compared with patients who underwent surgery > 24 h after trauma (p < 0.001). This result did not change for subgroups of incomplete SCI patients (p = 0.002). However, complete SCI patients operated < 24 h as compared with > 24 h did not obtain better outcome (p = 0.14). We did not find a statistically significant correlation when time from trauma to surgery was reduced further to < 6 or < 12 h post-trauma. Furthermore, stratification on patients undergoing surgery before and after 24 h was made regarding gender, completeness, and years of age. The groups did not differ concerning gender and SCI completeness, but significant difference in age was found (44 and 58 years of age, respectively, p < 0.001). The chance of improved outcome was significantly higher for patients < 50 years of age (42% versus 24%, p = 0.05). Patients under the age of 50 seemed to benefit from early intervention (50% improvement versus 23%); however, difference was not statistically significant (p = 0.08). In patients aged above 50, the trend was similar, but significant correlation was found (40% versus 16%, p = 0.05).

Conclusion: The present study reports a beneficial effect of early decompression surgery, especially for incomplete SCI patients; however, surgical decision-making is complex, and all cases of acute spinal cord injury should be cautiously interpreted and handled on an individual basis.