Functional Outcomes in Individuals Undergoing Very Early (< 5h) and Early (5-24h) Surgical Decompression in Traumatic Cervical Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study

被引：53

作者：

Mattiassich, Georg ^{[1
,2
,3
]}

Gollwitzer, Maria ^{[4
]}

Gaderer, Franz ^{[5
]}

Blocher, Martina ^{[6
]}

Osti, Michael ^{[10
]}

Lill, Markkus ^{[7
]}

Ortmaier, Reinhold ^{[2
,11
]}

Haider, Thomas ^{[12
]}

Hitzl, Wolfgang ^{[8
]}

Resch, Herbert ^{[9
]}

Aschauer-Wallner, Stephanie ^{[9
]}

机构：

[1] Paracelsus Med Univ Salzburg, Trauma Ctr Linz, Teaching Hosp, Garnisonstr 7, A-4010 Linz, Austria

[2] Paracelsus Med Univ Salzburg, Dept Orthopaed Surg, Ordensklinikum Barmherzige Schwestern Linz, Vinzenzgrp Ctr Orthopaed Excellence,Teaching Hosp, Linz, Austria

[3] Ludwig Boltzmann Inst Expt & Clin Traumatol, Vienna, Austria

[4] Kepler Univ Linz, Dept Neurosurg, Neuromed Campus, Linz, Austria

[5] Kepler Univ Linz, Dept Trauma Surg, Medcampus 3, Linz, Austria

[6] Paracelsus Med Univ Salzburg, Dept Orthopaed & Traumatol, Salzburg, Austria

[7] Paracelsus Med Univ Salzburg, Trauma Ctr Salzburg, Salzburg, Austria

[8] Paracelsus Med Univ Salzburg, Res Off Biostat, Salzburg, Austria

[9] Paracelsus Med Univ Salzburg, Spinal Cord Injury & Tissue Regenerat Ctr Salzbur, Salzburg, Austria

[10] Acad Hosp Feldkirch, Dept Trauma Surg & Sports Traumatol, Feldkirch, Austria

[11] ISAG UMIT, Res Unit Orthopaed Sports Med & Injury Prevent, Hall In Tirol, Austria

[12] Med Univ Vienna, Dept Trauma Surg, Vienna, Austria

来源：

JOURNAL OF NEUROTRAUMA | 2017年 / 34卷 / 24期

关键词：

acute spinal cord injury; decompression; spine surgery; time of surgery; traumatic SCI; OF-THE-LITERATURE; DELAYED DECOMPRESSION; RECOVERY; SURGERY; MULTICENTER; PATHOPHYSIOLOGY; HOSPITALIZATION; STRATEGIES; FIXATION; LENGTH;

D O I：

10.1089/neu.2017.5132

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Our study aim was to assess the neurological outcomes of surgical decompression and stabilization within 5 and 24 h after injury. We performed a multi-center, retrospective cohort study in adolescents and adults 15-85 years of age presenting cervical spinal cord injury (CSCI) at one of 6 Austrian trauma centers participating in the Austrian Spinal Cord Injury Study (ASCIS). Neurological outcomes were measured using the American Spinal Injury Association Impairment Scale (AIS) grade according to the International Standards For Neurological Classification Of Spinal Cord Injury (ISNCSCI) form after at least 6 months of follow-up (FU). Of the 49 enrolled patients with acute CSCI, 33 underwent surgical decompression within 5 h (mean 3.2 h +/- 1.1h; very early group) after injury, and 16 underwent surgical decompression between 5 and 24 h (mean 8.6 h +/- 5.5h; early group). Significant neurological improvement was observed among the entire study population between the preoperative assessment and the FU. We identified a significant difference in the AIS grade at the last FU between the groups the using Jonckheere-Terpstra test for doubly ordered crosstabs (p = 0.011) and significantly different AIS improvement rates in the early group (Poisson model, p = 0.018). Improvement by one AIS grade was observed in 31% and 42% of the patients in the early and very early groups, respectively (p = 0.54). Improvement by two AIS grades was observed in 31% and 6% of the patients in the early and very early groups, respectively (p = 0.03; relative risk [RR], 5.2; 95% CI, 1.1-35). Improvement by three AIS grades was observed in 6% and 3% of patients in the early and very early groups, respectively (p = 1.0). Decompression of the spinal cord within 24 h after SCI was associated with an improved neurological outcome. No additional neurological benefit was observed in patients who underwent decompression within 5 h of injury.

引用

页码：3362 / 3371

页数：10

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Functional Outcomes in Individuals Undergoing Very Early (&lt; 5h) and Early (5-24h) Surgical Decompression in Traumatic Cervical Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study

Functional Outcomes in Individuals Undergoing Very Early (< 5h) and Early (5-24h) Surgical Decompression in Traumatic Cervical Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study