• World Neurosurg · Feb 2020

    Comparative Study

    Early decompression (< 8 hours) improves the functional bladder outcome and mobility after traumatic thoracic spinal cord injury.

    • Christof Wutte, Johannes Becker, Barbara Klein, Orpheus Mach, Stephanie Panzer, Fabian Maria Stuby, Martin Strowitzki, Doris Maier, Claudius Thomé, and Lukas Grassner.
    • Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau, Germany; Department of Neurosurgery, Trauma Center Murnau, Murnau, Germany.
    • World Neurosurg. 2020 Feb 1; 134: e847-e854.

    BackgroundThere is accumulating evidence of a potential beneficial effect of early surgical intervention after acute cervical spinal cord injury (SCI). However, around one third of all SCIs affect the thoracic spine. This cohort has not been extensively investigated, mainly because of less sensitive clinical readout measures. Apart from regaining full sensorimotor function, improvements in bladder and bowel management remain of the highest priority for patients with chronic paraplegia. Therefore, this study investigates the effect of early decompression (here defined as <8 hours) versus delayed management on neurologic and functional outcome.MethodsWe retrospectively analyzed data from the institutional database, in which follow-up data were collected prospectively according to the European Multicenter Study about Spinal Cord Injury standards. Within a 13-year period, we identified 43 patients who met inclusion and exclusion criteria. Of these, 32 (74%) were managed surgically within the first 8 hours. There was a trend toward a higher rate of patients with clinically complete SCI in the early group at baseline.ResultsAfter 1 year, we did not observe a benefit on the neurologic outcome as assessed via the American Spinal Injury Association Impairment Scale grade. Functional outcome was evaluated using the Spinal Cord Independence Measure (SCIM). The early decompressed group demonstrated significantly improved SCIM 6 (i.e., bladder management) (P < 0.045) and SCIM 9-11 subitems (i.e., mobility, transfer) (P < 0.019).ConclusionsEarly decompression was an independent predictor for improved functional bladder outcome and mobility after 1 year. This effect needs to be studied in future prospective, multicenter studies.Copyright © 2019 Elsevier Inc. All rights reserved.

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