Document Detail

The influence of time from injury to surgery on motor recovery and length of hospital stay in acute traumatic spinal cord injury: an observational Canadian cohort study.
MedLine Citation:
PMID:  25333195     Owner:  NLM     Status:  Publisher    
Objective: To determine the influence of time from injury to surgery on neurological recovery and length of stay in an observational cohort of individuals with traumatic spinal cord injury. Design: We analyzed the baseline and follow-up motor scores of participants in the Rick Hansen Spinal Cord Injury Registry, to specifically assess the effect of early (less than 24 hours from injury) surgery on motor recovery and on length of stay. Methods: One thousand four hundred and ten patients who sustained acute traumatic spinal cord injuries with baseline AIS grades A, B, C, or D and were treated surgically were analyzed to determine the effect of the timing of surgery (24, 48, or 72 hours from injury) on motor recovery and length of stay. Depending upon the type of data available, we employed different types of generalized linear models, including multiple linear regression, gamma regression and negative binomial regression. Results: Individuals with incomplete AIS B, C, and D injuries from C2 to L2 demonstrated motor recovery improvement of an additional 6.3 motor points (SE=2.8 p<0.03) when they underwent surgical treatment within 24 hours from the time of injury, as compared to those who had surgery later than 24 hours post-injury. This beneficial effect of early surgery on motor recovery was not seen in the patients with AIS A complete SCI. AIS A and B patients who received early surgery experienced shorter hospital LOS. Conclusion: While the issues of when to perform surgery and what specific operation to perform remain controversial, this work provides evidence that for an incomplete acute traumatic spinal cord injury in the cervical, thoracic or thoracolumbar spine, surgery performed within 24 hours from injury improves motor neurological recovery. Early surgery also reduces LOS.
Marcel F Dvorak; Vanessa Noonan; Nader Fallah; Charles G Fisher; Joel Finkelstein; Brian K Kwon; Carly S Rivers; Henry Ahn; Jérôme Paquet; Eve Tsai; Andrea Townson; Najmedden Attabib; Christopher Bailey; Sean Christie; Brian Drew; Daryl R Fourney; Richard Fox; R John Hurlbert; Michael G Johnson; Gary Linassi; Stefan Parent; Michael Fehlings
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-10-21
Journal Detail:
Title:  Journal of neurotrauma     Volume:  -     ISSN:  1557-9042     ISO Abbreviation:  J. Neurotrauma     Publication Date:  2014 Oct 
Date Detail:
Created Date:  2014-10-21     Completed Date:  -     Revised Date:  2014-10-22    
Medline Journal Info:
Nlm Unique ID:  8811626     Medline TA:  J Neurotrauma     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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