Bock Tobias, Heller Raban Arved, Haubruck Patrick, Raven Tim Friedrich, Pilz Maximilian, Moghaddam Arash, Biglari Bahram
Heidelberg Trauma Research Group, Centre for Orthopaedics, Trauma Surgery and Paraplegiology, Heidelberg University Hospital, 69118 Heidelberg, Germany.
Department of Anesthesiology and Intensive Care, Leipzig University Hospital, Liebigstraße 20, 04103 Leipzig, Germany.
J Clin Med. 2021 Dec 20;10(24):5977. doi: 10.3390/jcm10245977.
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.
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.
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 ( = 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%.
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.
创伤性脊髓损伤（TSCI）手术治疗的最佳时机仍不明确。本研究的目的是评估从受伤到手术的“超早期”（<4小时）与“早期”（4 - 24小时）时间对神经恢复可能性的影响。
通过比较美国脊髓损伤协会（ASIA）损伤量表（AIS）的初始评估值和最终值，研究手术对神经恢复的影响。进行事后分析以深入了解不同亚组关于神经损伤水平的再生行为。
分析了69例创伤性脊髓损伤病例的数据集。总体而言，“超早期”队列中的19/46（41.3%）患者出现神经恢复，而“早期”队列中的5/23（21.7%）患者出现神经恢复（P = 0.112）。亚组分析显示，根据患者的神经损伤水平（NLI）存在差异。估计颈椎损伤患者的最佳切点为234分钟。关于神经功能改善的预测，敏感性为90.9%，特异性为68.4%，曲线下面积（AUC）为84.2%。在胸段和腰段损伤病例中，估计值较低，从胸段的284分钟到腰段的245分钟，AUC分别为51.6%和54.3%。
TSCI后24小时内进行治疗与神经恢复相关。我们关于4小时内进行干预与神经功能结果改善相关的假设在我们的研究群体中未得到证实。在临床环境中，这表明TSCI后存在一个时间框架，可根据高级创伤生命支持（ATLS）指南将合适患者送至合适医院。
