Better surgical results for spinal cord injury seen within 24 hours


US researchers have proved that surgery performed within 24 hours of a traumatic spinal cord injury gives patients more chance of recovery.

Spinal Cord Injury

Rapid procedure causes less neural tissue destruction and improves patients' clinical outcomes, argues Dr Alexander Vaccaro of Thomas Jefferson University.

"This practice-changing study is the first to show that the timing of surgery after traumatic spinal cord injury (SCI) matters," Dr Vaccaro said.

Of the 313 patients studied, 182 had surgery less than 24 hours after traumatic spinal cord injury, with 131 undergoing procedures at or after 24 hours post-SCI.

With all patients neurologically assessed within 24 hours of injury, improvement for the 2 groups was determined by change in the American Spinal Injury Association Impairment Scale (AIS). After surgery, a 2-grade improvement in AIS scores was associated with better neurologic outcomes.

Monitoring continued on 222 subjects for 6 months following the procedures. In the group receiving surgery less than 24 hours post-injury, 42.7% did not improve, 36.6% had a 1-grade improvement, 16.8% improved by 2 grades and 3.1% were better by 3 grades.

By comparison, the later surgery group showed no improvement for 50%, while 40.7 percent had a 1-grade improvement and 8.8 percent improved by 2 grades.

Dr Vaccaro noted that if surgery is performed within a day of a spinal cord injury, the odds of neurologic status being substantially bettered is 2.8 times higher.

"This can be the difference between walking and not for the rest of one's life," he said. "Previous research has been inconclusive on the issue, with the common thought among most surgeons that you can wait up to 5 days post-injury and have the same outcomes. We should not practice that way anymore armed with this new information."

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