Anterior decompression in cervical spine trauma: Does the timing of surgery affect the outcome?

L. Levi, A. Wolf, D. Rigamonti, J. Ragheb, S. Mirvis, W. L. Robinson, F. C. Wagner

Research output: Contribution to journalArticle

Abstract

To clarify the ideal timing of anterior decompression and stabilization for all patients with cervical spine trauma as well as its efficacy for patients with complete deficits, we reviewed the records of 103 consecutive patients with cervical spine trauma (50 incomplete deficits, Group A; 53 complete deficits, Group B) who underwent this procedure during a 5-year period at the Shock Trauma Center. We subdivided each group according to time of surgery: early and delayed (<24 and >24 hours past injury, respectively). In Group A, 10 patients underwent early surgery and 40 patients underwent delayed surgery (range, 2 to 77 days past injury; mean, 13 days). One patient (2.5%) in the delayed group died. The following data refer to the early and delayed subgroups, respectively: average acute hospitalization, 20 and 22 days; patient motor score improvement (at discharge), 37.2 and 45.0%; functional grade improvement (at discharge), 5 (50.0%) and 9 (22.5%) patients. At 1-year follow-up, every patient who had had a deficit had progressed to a higher functional grade. In Group B, 35 patients underwent early surgery and 18 underwent delayed surgery (range, 2 to 45 days past injury; mean, 13 days). One patient (2.9%) in the early group died. The following data refer to the early and delayed subgroups, respectively: average acute hospitalization, 38.7 and 45.2 days (P < 0.05); respiratory care (number of daily suction procedures), 6.0 and 9.86 (P < 0.05); patient motor score improvement (at discharge), 3.9 and 4.5%; functional grade improvement (at discharge), 4 (11.4%) and 1 (5.6%) patients. At 1-year follow-up, 16 (45.7%) and 7 (38.9%) patients, respectively, had progressed to a higher functional grade (mean motor score improvement, 15.0 and 16.7%, respectively). Only 5 patients (14.3%) did not gain the function of at least one more segment. Although our study demonstrated no statistically significant difference in outcome between early surgery and delayed surgery subgroups, we feel early anterior decompression and stabilization is appropriate for selected patients because this process has a comparable adverse sequelae rate to that of delayed surgery; it provides superior ease of patient care, it facilitates earlier transfer to rehabilitation (an important parameter in decreasing medical expenses), and it may benefit even patients with complete deficits diagnosed on the first day.

Original languageEnglish (US)
Pages (from-to)216-222
Number of pages7
JournalNeurosurgery
Volume29
Issue number2
DOIs
StatePublished - Jan 1 1991
Externally publishedYes

Keywords

  • Caspar plates
  • cervical spine injury
  • functional recovery
  • spinal decompression

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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