Clinical Outcome in Patients with Early versus Delayed Decompression in Cervical Spine Trauma

Abstract

Study design: Prospective observational study.

Purpose: To assess the clinical outcome after early versus late decompression for traumatic cervical cord injury.

Overview of literature: Traumatic spinal cord injury is common globally with the most tragic outcomes in the cervical spine. Although recent studies have shown that early decompression results in more favourable outcome, its authority is yet to be established.

Methods: Study on 98 patients with a traumatic cervical cord injury was conducted over a period of 5 years. The patients who were operated on within 24 hours of the onset of the primary injury (n=34) were classified as the early group, and those who were operated on after 24 hours of the onset of the injury (n=64) were categorized as the late group. The outcome of both the groups was assessed using the American Spinal Injury Association (ASIA) Impairment Scale (AIS) at the 6-month follow-up.

Results: The patients in the early group were operated on at a mean time of 18.4 hours (range, 13-24 hours) while patients were operated on at a mean time of 52.7 hours (range, 31-124 hours) in the late group. At the 6-month follow-up, 7 (23.3%) in the early group and 5 (8.7%) in the late group showed >2 grade improvement in the AIS.

Conclusions: The results of patients undergoing decompression within 24 hours of the injury are better than those who are operated on later. An attempt should be made to decompress the traumatic cervical spine early in all possible cases.

Keywords: Spinal cord injuries; Spinal fixation; Spinal fractures; Surgical decompression; Treatment outcome.

Fig. 1

Magnetic resonance imaging cervical spine T2-weighted image showing retropulsion of the C7 vertebral body with severe canal compromise along with signal changes in the cord. There is also a hyperintense signal of a haematoma in front of the body extending up to T2.

Fig. 2

X-ray cervical spine lateral view of the same patient showing the alignment of the cervical spine with reduction of the retropulsed C7 body after application of cervical tongs with adequate weights attached.

Fig. 3

Computed tomography scan cervical spine of the same patient performed after reduction.

Fig. 4

Magnetic resonance imaging cervical spine T2-weighted image performed after reduction showing traumatic disc disruption at C6-7 level. A hyperintense signal is seen extending from C5 to T1 signifying cord contusion. There is also evidence of trauma to the posterior ligamentous complex.

Fig. 5

Postoperative X-ray cervical spine anteroposterior and lateral views showing fusion and fixation at C6-7.