Spinal cord injury (SCI) is a serious public health concern that commonly results in death or permanent disability. About one-third of SCIs occur in the cervical spinal cord region, which typically results in the most severe injuries with the highest degree of paralysis. SCI is irreversible, but surgical intervention to decompress and stabilize the injury can improve outcomes. However, clinicians disagree about the optimal timing of surgery. Conclusive evidence about the timing of surgical intervention is necessary to establish a standard protocol for treating SCI.
A recent study investigated outcomes in 81 patients with cervical SCI who received ultra-early surgery (within 12 hours of injury) versus early surgery (within 12 to 48 hours of injury). Half of these patients received ultra-early surgical intervention, while the other half received early surgical intervention. When the researchers compared results from each patient group, they found that 61 percent of patients who received ultra-early decompression surgery showed improved neurological outcomes, compared to only 8 percent of patients who received early decompression surgery. Furthermore, patients who received ultra-early surgery showed significantly greater improvements in motor function, sensation, and movement than patients who received early surgery.
Current clinical guidelines recommend surgery within 24 hours of SCI. The results of this study suggest that surgery within a smaller time frame (12 hours) can significantly improve outcomes, even for patients who have sustained severe, disabling injuries. Because cervical SCI can seriously and permanently reduce an individual’s quality of life, there is a need to develop intervention protocols that give patients the highest chance of recovering full neurological function. Ultra-early surgery is a promising method for providing SCI patients with the highest standard of care.
Nasi D, Ruscelli P, Gladi M, et al. Ultra-early surgery in complete cervical spinal cord injury improves neurological recovery: A single-center retrospective study. Surgical Neurology International. (October 2019).