Results of Early and Late Surgical Decompression and Stabilization for Acute Traumatic Cervical Spinal Cord Injury in Patients with Concomitant Chest Injuries

Abstract

Background: The benefits of early surgical decompression and stabilisation (within 24 hours of injury) for patients with acute traumatic spinal cord injury (SCI) is unclear. The study objective was to investigate the effects of early (<24 hours of injury) versus late (>24 hours of injury) decompressive and stabilisation surgery for traumatic cervical SCI in patients with concomitant chest injuries.

Methods: This was a retrospective study including adults aged 16 years or over with traumatic cervical SCI, Glasgow Coma Scale score >13, and concomitant chest injuries (e.g. hemopneumothoraces, flail chest and pulmonary contusions) necessitating intensive care unit (ICU) admission. Forty patients who met the inclusion criteria and underwent decompressive surgery within 24 hours were compared with 55 patients who underwent decompressive surgery after 24 hours. Primary outcomes were ordinal change in the ASIA Impairment Scale (AIS) at 6 months and duration of ICU stay. Secondary outcomes included complications occurring within 30 days.

Results: In the early surgery group, 21 patients (52.5%) showed no improvement in ASIA grade, 13 (32.5%) had a 1-grade improvement, and 6 (15%) had a 2-grade improvement. The median length of ICU stay was 14 days (range, 2-68). 42.5% of patients developed a complication and 45% required a tracheostomy. In the late surgery group, AIS grade improvement was as follows: 32 (58%) no improvement, 19 (34.5%) had a 1 grade improvement, 3 (5.5%) had a 2 grade improvement and 1 (2%) had a 3 grade improvement. Mean ICU stay was 23 days (4-68). 53% of patients developed a complication and 55% required a tracheostomy. There was one mortality in the late surgery group.

Conclusions: For patients with acute traumatic cervical SCI and concomitant chest trauma, early surgical decompression and stabilisation was associated with reduced ICU stay and a lower complication rate. Neurological recovery was more likely in younger patients and those with an incomplete SCI.

Keywords: Cervical; Chest; Rehabilitation; Spinal cord injury; Surgery; Trauma.