Jug Marko, Kejžar Nataša, Vesel Miloš, Al Mawed Said, Dobravec Marko, Herman Simon, Bajrović Fajko F
1 Spine Unit, Department of Traumatology, University Medical Centre Ljubljana , Ljubljana, Slovenia .
2 Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana , Slovenia .
J Neurotrauma. 2015 Sep 15;32(18):1385-92. doi: 10.1089/neu.2014.3767. Epub 2015 Apr 22.
A prospective study was performed to evaluate the impact of surgical decompression (SD) and instrumented fusion within 8 h versus 8-24 h after injury on neurological recovery after cervical traumatic spinal cord injury (tSCI) in patients operated on in the UMC Ljubljana, Slovenia. Only patients with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A through C and with MRI-confirmed spinal cord compression were enrolled. The primary outcome was the change in AIS grade at the 6-month follow-up. Of the 48 enrolled patients, 22 patients who underwent surgery within 8 h (group 8 h) and 20 patients who underwent surgery between 8 and 24 h (Group 8-24 h) after injury concluded the study. At admission, there was no statistically significant difference in AIS grade between the study groups. At the 6-month follow-up, an improvement of at least two AIS grades was found in 45.5% of patients in group 8 h and in 10% of patients in group 8-24 h (p=0.017). The median improvement in the ASIA motor score was 38.5 (10.0-61.0) motor points in group 8 h and 15.0 (8.8-34.0) motor points in group 8-24 h (p=0.0468). In a multivariate analysis, adjusted for the preoperative AIS grade and the degree of spinal canal compromise, the odds of an at least two-grade AIS improvement were at least 106% higher for patients in group 8 h than for patients in group 8-24 h (odds ratio=11.08, p=0.004). No statistically significant difference was found in the rate of perioperative complications, pneumonia, and the number of ventilator-dependent days or the mortality between the groups. Our results suggest that the patients with tSCI who undergo SD within 8 h after injury have superior neurological outcomes than patients who undergo SD 8-24 h after injury, without any increase in the rate of adverse effects.
在斯洛文尼亚卢布尔雅那大学医学中心接受手术的颈椎创伤性脊髓损伤（tSCI）患者中，进行了一项前瞻性研究，以评估受伤后8小时内与8 - 24小时内进行手术减压（SD）和器械融合对神经恢复的影响。仅纳入美国脊髓损伤协会（ASIA）损伤分级（AIS）为A至C级且MRI证实存在脊髓压迫的患者。主要结局是6个月随访时AIS分级的变化。48名纳入研究的患者中，22名在受伤后8小时内接受手术的患者（8小时组）和20名在受伤后8至24小时接受手术的患者（8 - 24小时组）完成了研究。入院时，研究组之间的AIS分级无统计学显著差异。在6个月随访时，8小时组45.5%的患者和8 - 24小时组10%的患者AIS分级至少提高了两级（p = 0.017）。ASIA运动评分的中位数改善在8小时组为38.5（10.0 - 61.0）运动点数，在8 - 24小时组为15.0（8.8 - 34.0）运动点数（p = 0.0468）。在多变量分析中，校正术前AIS分级和椎管狭窄程度后，8小时组患者AIS至少提高两级的几率比8 - 24小时组患者至少高106%（比值比 = 11.08，p = 0.004）。两组之间围手术期并发症发生率、肺炎、呼吸机依赖天数或死亡率均未发现统计学显著差异。我们的结果表明，受伤后8小时内接受SD的tSCI患者比受伤后8 - 24小时接受SD的患者具有更好的神经学结局，且不良反应发生率没有增加。
