Pursuing more aggressive timelines in the surgical treatment of traumatic spinal cord injury (TSCI)

• Verfasst von: Bock, Tobias [VerfasserIn]
• Verfasst von: Heller, Raban [VerfasserIn]
• Verfasst von: Haubruck, Patrick [VerfasserIn]
• Verfasst von: Raven, Tim Friedrich [VerfasserIn]
• Verfasst von: Pilz, Maximilian [VerfasserIn]
• Verfasst von: Moghaddam-Alvandi, Arash [VerfasserIn]
• Verfasst von: Biglari, Bahram [VerfasserIn]
• Titel: Pursuing more aggressive timelines in the surgical treatment of traumatic spinal cord injury (TSCI)
• Titelzusatz: a retrospective cohort study with subgroup analysis
• Verf.angabe: Tobias Bock, Raban Arved Heller, Patrick Haubruck, Tim Friedrich Raven, Maximilian Pilz, Arash Moghaddam, Bahram Biglari
• E-Jahr: 2021
• Jahr: 20 December 2021
• Umfang: 16 S.
• Fussnoten: Gesehen am 24.06.2022
• Titel Quelle: Enthalten in: Journal of Clinical Medicine
• Ort Quelle: Basel : MDPI, 2012
• Jahr Quelle: 2021
• Band/Heft Quelle: 10(2021), 24, Artikel-ID 5977, Seite 1-16
• ISSN Quelle: 2077-0383
• DOI: doi:10.3390/jcm10245977
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: AIS
• Sach-SW: biomarker
• Sach-SW: decompressive surgery
• Sach-SW: laminectomy
• Sach-SW: neurological outcome
• Sach-SW: neurological recovery
• Sach-SW: timing
• Sach-SW: traumatic spinal cord injury
• K10plus-PPN: 180775796X

Abstract

Background: The optimal timing of surgical therapy for traumatic spinal cord injury (TSCI) remains unclear. The purpose of this study is to evaluate the impact of “ultra-early” (<4 h) versus “early” (4-24 h) time from injury to surgery in terms of the likelihood of neurologic recovery. Methods: The effect of surgery on neurological recovery was investigated by comparing the assessed initial and final values of the American Spinal Injury Association (ASIA) Impairment Scale (AIS). A post hoc analysis was performed to gain insight into different subgroup regeneration behaviors concerning neurological injury levels. Results: Datasets from 69 cases with traumatic spinal cord injury were analyzed. Overall, 19/46 (41.3%) patients of the “ultra-early” cohort saw neurological recovery compared to 5/23 (21.7%) patients from the “early” cohort (p = 0.112). The subgroup analysis revealed differences based on the neurological level of injury (NLI) of a patient. An optimal cutpoint for patients with a cervical lesion was estimated at 234 min. Regarding the prediction of neurological improvement, sensitivity was 90.9% with a specificity of 68.4%, resulting in an AUC (area under the curve) of 84.2%. In thoracically and lumbar injured cases, the estimate was lower, ranging from 284 (thoracic) to 245 min (lumbar) with an AUC of 51.6% and 54.3%. Conclusions: Treatment within 24 h after TSCI is associated with neurological recovery. Our hypothesis that intervention within 4 h is related to an improvement in the neurological outcome was not confirmed in our collective. In a clinical context, this suggests that after TSCI there is a time frame to get the right patient to the right hospital according to advanced trauma life support (ATLS) guidelines.