A prospective study was performed to evaluate the impact of surgical decompression (SD) and instrumented fusion within 8 h versus 8-24 h after injury on neurological recovery after cervical traumatic ...spinal cord injury (tSCI) in patients operated on in the UMC Ljubljana, Slovenia. Only patients with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A through C and with MRI-confirmed spinal cord compression were enrolled. The primary outcome was the change in AIS grade at the 6-month follow-up. Of the 48 enrolled patients, 22 patients who underwent surgery within 8 h (group 8 h) and 20 patients who underwent surgery between 8 and 24 h (Group 8-24 h) after injury concluded the study. At admission, there was no statistically significant difference in AIS grade between the study groups. At the 6-month follow-up, an improvement of at least two AIS grades was found in 45.5% of patients in group 8 h and in 10% of patients in group 8-24 h (p=0.017). The median improvement in the ASIA motor score was 38.5 (10.0-61.0) motor points in group 8 h and 15.0 (8.8-34.0) motor points in group 8-24 h (p=0.0468). In a multivariate analysis, adjusted for the preoperative AIS grade and the degree of spinal canal compromise, the odds of an at least two-grade AIS improvement were at least 106% higher for patients in group 8 h than for patients in group 8-24 h (odds ratio=11.08, p=0.004). No statistically significant difference was found in the rate of perioperative complications, pneumonia, and the number of ventilator-dependent days or the mortality between the groups. Our results suggest that the patients with tSCI who undergo SD within 8 h after injury have superior neurological outcomes than patients who undergo SD 8-24 h after injury, without any increase in the rate of adverse effects.
Zlomi prsno-ledvene hrbtenice (PLH) predstavljajo širok spekter poškodb. Zdravljenje je odvisno od vrste poškodbe, splošnega stanja poškodovanca ter morebitnih pridruženih bolezni hrbtenice. Skupna ...ocena teh dejavnikov narekuje strategijo zdravljenja, ki je zaradi nejasnih in včasih nasprotujočih si podatkov v literaturi nemalokrat težavna. Kljub številnim odprtim vprašanjem pa v mnogih primerih lahko le hitra in usklajena veriga postopkov od začetne oskrbe na terenu do končne rehabilitacije zagotovi dober izid zdravljenja. Prispevek zato predstavi priporočila Vertebrološkega združenja Slovenije za obravnavo bolnikov z zlomom PLH. Zajemajo celotno verigo oskrbe, od oskrbe na terenu in v urgentnem centru do diagnostičnih postopkov in klasifikacije ter kirurškega zdravljenja, končno po do rehabilitacije in ambulantnega spremljanja zdravstvenega stanja poškodovanca. Posebna pozornost se posveča poškodbam z nevrološko prizadetostjo, osteoporotičnim zlomom in zlomom pri ankilozirajočih boleznih hrbtenice, ki so zaradi starajočega se prebivalstva v porastu. Namen priporočil je postaviti minimalne standarde oskrbe zlomov PLH v slovenskem prostoru. Zato priporočila temeljijo na empiričnih znanjih, upoštevajo pa tudi regionalne posebnosti slovenskega prostora.
Introduction
Traumatic spinal cord injury (tSCI) is a catastrophic event with enormous personal, social and economic impact. Despite recent progress in understanding the pathophysiology of acute tSCI ...and the positive effects of acute spinal cord decompression on neurological recovery reported in standardized preclinical studies, neurological benefits of early surgical decompression (SD) remain elusive in the clinical setting.
Material and Methods
A prospective study was performed to evaluate the impact of SD and instrumented fusion within 8 hour versus 8–24 hour after injury on neurological recovery after cervical tSCI in patients operated on in the UMC Ljubljana, Slovenia. Only patients with the ASIA Impairment Scale (AIS) grades of A through C and with MRI-confirmed spinal cord compression were enrolled. The primary outcome was the change in AIS grade at the six-month follow-up.
Results
Of the 48 enrolled patients, 22 patients who underwent surgery within 8h (Group-8h) and 20 patients who underwent surgery between 8 and 24h (Group-8–24h) after injury concluded the study. At admission, there was no statistically significant difference in AIS grade between the study groups. At the six-month follow-up, an improvement of at least two AIS grades was found in 45.5% of patients in Group-8h and in 10% of patients in Group-8–24h (p = 0.017). In a multivariate analysis, adjusted for the preoperative AIS grade and the degree of spinal canal compromise, the odds of an at least two-grade AIS improvement were at least 106% higher for patients in Group-8h than for patients in Group-8–24h (OR = 11.08, p = 0.004). No statistically significant difference was found in the rate of pneumonia, the number of ventilator-dependent days or the mortality between the groups.
Conclusion
Our results suggest that the patients with tSCI who undergo SD within 8h after injury have superior neurological outcomes than patients who undergo SD 8 to 24h after injury, without any increase in the rate of adverse effects.
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