Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study

Satoshi Nori, Kota Watanabe, Kazuki Takeda, Junichi Yamane, Hitoshi Kono, Noriaki Yokogawa, Takeshi Sasagawa, Kei Ando, Hiroaki Nakashima, Naoki Segi, Toru Funayama, Fumihiko Eto, Akihiro Yamaji, Takeo Furuya, Atsushi Yunde, Hideaki Nakajima, Tomohiro Yamada, Tomohiko Hasegawa, Yoshinori Terashima, Ryosuke HirotaHidenori Suzuki, Yasuaki Imajo, Shota Ikegami, Masashi Uehara, Hitoshi Tonomura, Munehiro Sakata, Ko Hashimoto, Yoshito Onoda, Kenichi Kawaguchi, Yohei Haruta, Hiroshi Uei, Hirokatsu Sawada, Kazuo Nakanishi, Kosuke Misaki, Hidetomi Terai, Koji Tamai, Eiki Shirasawa, Gen Inoue, Katsuhito Kiyasu, Yoichi Iizuka, Eiji Takasawa, Haruki Funao, Takashi Kaito, Toshitaka Yoshii, Masayuki Ishihara, Seiji Okada, Shiro Imagama, Satoshi Kato

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)

Abstract

Background: Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. Methods: In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. Results: The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. Conclusions: Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.

Original languageEnglish
Pages (from-to)480-485
Number of pages6
JournalJournal of Orthopaedic Science
Volume29
Issue number2
DOIs
Publication statusPublished - 2024 Mar

Keywords

  • Cervical spinal cord injury
  • Elderly patients
  • Neurological outcomes
  • No bone injury
  • Relatively early surgery
  • Surgical timing

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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