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The Influence of Timing of Surgical Decompression for Acute Spinal Cord Injury: A pooled Analysis of Individual Patient Data

By Currents Editor posted 20 days ago

  

The Lancet Neurology (02/01/21) Vol. 20, No. 2, P. 117 DOI: 10.1016/S1474-4422(20)30406-3

Badhiwala, Jetan H; Wilson, Jefferson R; Witiw, Christopher D; et al.

https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30406-3/fulltext

Recovery of sensorimotor function was greater among patients who underwent surgical decompression within 24 hours of acute spinal cord injury (SCI), a new study shows. The pooled analysis used data from more than 1,000 patients between December 1991 and March 2017. At one year after spinal injury, the patients who underwent early surgical decompression — within the first 24 hours — had improved recovery compared with patients who had late decompression surgery. Overall, patients in the early surgery group saw greater improvements in motor scores, light touch scores, and pin prick scores compared with the late surgery group. Additionally, as an indication of less severe impairment, those in the early decompression group had better ASIA Impairment Scale grades one year post-surgery, compared with the later decompression group. When looking at time to surgical decompression as a continuous variable, the sharp decrease in change in total motor score correlated with increasing time in the first 24-36 hours after injury, while the change in total motor score plateaued after 36 hours. The findings, say the researchers, highlight the importance of the first 24-36 hours after injury "to achieve optimal neurological recovery with decompressive surgery following acute SCI."

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