Abstract
Background
Although previous studies have demonstrated the advantages of early surgery for traumatic
spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs)
without bone injury remains controversial. Here, we investigated the influence of
relatively early surgery within 48 h of injury on the neurological recovery of elderly
patients with CSCI and no bone injury.
Methods
In this retrospective multicenter study, we reviewed data from 159 consecutive patients
aged ≥65 years with CSCI without bone injury who underwent surgery in participating
centers between 2010 and 2020. Patients were followed up for at least 6 months following
CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared
between them. Multivariate analysis was performed to identify factors associated with
neurological recovery.
Results
The relatively early surgery group demonstrated a lower prevalence of cardiac disease,
poorer baseline American Spinal Injury Association (ASIA) impairment scale grade,
and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery
group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury
was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery
did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated
with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement.
Conclusions
Although further validation by future studies is required, relatively early surgery
did not show a positive influence on neurological recovery after CSCI without bone
injury in the elderly.
Keywords
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Article info
Publication history
Published online: January 29, 2023
Accepted:
January 12,
2023
Received in revised form:
January 7,
2023
Received:
July 14,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
