Carr Matthew T, Bhimani Abhiraj D, Lara-Reyna Jacques, Hickman Zachary L, Margetis Konstantinos
Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA.
Cureus. 2024 Feb 10;16(2):e53971. doi: 10.7759/cureus.53971. eCollection 2024 Feb.
Early surgical decompression within 24 hours for traumatic spinal cord injury (SCI) is associated with improved neurological recovery. However, the ideal timing of decompression is still up for debate. The objective of this study was to utilize our retrospective single-institution series of ultra-early (<5 hours) decompression to determine if ultra-early decompression led to improved neurological outcomes and was a feasible target over previously defined early decompression targets. Retrospective data on patients with SCI who underwent ultra-early (<5 hours) decompression at a level one metropolitan trauma center were extracted and collected from 2015-2018. American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade improvement was the primary outcome, with ASIA Motor score improvement and complication rate as secondary outcomes. Four individuals met the criteria for inclusion in this case series. All four suffered thoracolumbar SCI. All patients improved neurologically by AIS grade, and there were no complications directly related to ultra-early surgery. Given the small sample size, there was no statistically significant difference in outcomes compared to a control group who underwent early (5-24 hour) decompression in the same period. Ultra-early decompression is a feasible and safe target for thoracolumbar SCI and may lead to improved neurological outcomes without increased risk of complications. This case series can help create the foundation for future, larger studies that may definitively show the benefit of ultra-early decompression.
创伤性脊髓损伤（SCI）在24小时内进行早期手术减压与神经功能恢复改善相关。然而，减压的理想时机仍存在争议。本研究的目的是利用我们回顾性单机构的超早期（<5小时）减压系列病例，以确定超早期减压是否能改善神经功能结果，以及相对于先前定义的早期减压目标，超早期减压是否是一个可行的目标。从2015年至2018年，在一家一级大都市创伤中心提取并收集了接受超早期（<5小时）减压的SCI患者的回顾性数据。美国脊髓损伤协会（ASIA）损伤量表（AIS）分级改善是主要结局，ASIA运动评分改善和并发症发生率为次要结局。有4名个体符合纳入本病例系列的标准。所有4人均为胸腰段SCI。所有患者的神经功能按AIS分级均有改善，且无直接与超早期手术相关的并发症。鉴于样本量较小，与同期接受早期（5 - 24小时）减压的对照组相比，结局无统计学显著差异。超早期减压是胸腰段SCI可行且安全的目标，可能会改善神经功能结果而不增加并发症风险。这个病例系列可为未来更大规模的研究奠定基础，这些研究可能会明确显示超早期减压的益处。
