• Tomoo Inoue, Shinsuke Suzuki, Toshiki Endo, Hiroshi Uenohara, and Teiji Tominaga.
• Department of Neurosurgery, Sendai Medical Center, Sendai, Japan. Electronic address: tomoo49@gmail.com.
• World Neurosurg. 2017 Sep 1; 105: 790-795.

BackgroundThe optimal timing for surgery for patients with spinal cord injury without radiographic evidence of trauma (SCIWORET) remains unclear. This is especially true in the elderly, given that most studies are done with younger patients to avoid age-related comorbidities. We aimed to compare the efficacy of early (<24 hours postinjury) and late (>24 hours postinjury) surgery in patients with SCIWORET aged ≥65 years.MethodsWe identified patients aged ≥65 years who underwent surgery for SCIWORET between January 1995 and February 2016. The primary outcome was a change in the Japanese Orthopaedic Association (JOA) score at discharge, with a recovery of >50% defined as a favorable neurologic outcome. Logistic regression analysis was performed, and model fit was assessed using the Hosmer-Lemeshow test.ResultsEighty patients aged ≥65 years with SCIWORET underwent surgery were enrolled. Favorable neurologic outcomes were seen in 43.3% of those who underwent early surgery, but only in 18.0% of those who underwent late surgery. Logistic regression analysis, adjusted for age, sex, comorbidities (Charlson Comorbidity Index), and JOA score, revealed that early surgery independently predicted favorable outcomes (odds ratio, 4.06; 95% confidence interval, 1.25-13.20), with excellent calibration (Hosmer-Lemeshow, P = 0.857).ConclusionsThe present study indicated that early surgery within 24 hours of injury for elderly patients with SCIWORET could lead to more favorable neurologic improvements. We believe that chronological age alone should not be considered sufficient justification to deny patients early surgical decompression for SCIWORET.Copyright © 2017 Elsevier Inc. All rights reserved.

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