Article

A multicenter Canadian cohort study. The objective of
this study is to evaluate the impact of early versus late surgical decompression
on motor neurological recovery after traumatic spinal cord injury
(SCI).Setting:Canadian acute care and SCI rehabilitation facilities. METHODS: A
prospective cohort study of patients within the Ontario Spinal Cord Injury
Registry program was performed. We considered SCI patients with an admission
American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade of A
through D, with magnetic resonance imaging-confirmed spinal cord compression.
Grouped analysis was performed comparing the cohort of patients who received
early surgery (<24 h after SCI) to those receiving delayed surgery (<24 h after
SCI). The primary outcome was the change in ASIA motor score (AMS) occurring
between hospital admission and rehabilitation discharge. RESULTS: A total of 35
(41.7%) patients underwent early surgery and 49 (58.3%) underwent late surgery.
At admission, there was a greater proportion of patients within the early surgery
group with more severe AIS grade A injuries. Of the 55 patients with neurological
exam available at rehabilitation discharge, a greater proportion had at least a
two-grade AIS improvement in the early-surgery group (P=0.01). The mean
improvement in AMS at rehabilitation discharge was 20 points amongst
early-surgery patients and 15 points amongst late-surgery patients (P=0.46). In
the analysis investigating AMS improvement, adjusted for preoperative status and
neurological level, there was a positive effect estimate for early surgical
therapy that was statistically significant (P=0.01). CONCLUSION: The results here
add weight to the growing body of literature, which supports the principle of
early intervention in the setting of spinal trauma and SCI.

Langue : ANGLAIS