Outcomes of Delayed Surgical Interventions (> 72 h After Injury) in Patients with Incomplete Spinal Cord Injury: Observations from a Tertiary Rehabilitation Centre in India

Abstract

There is no consensus on the timing for early surgery in spinal cord injury (SCI). On Pubmed, we found no primary research article from India evaluating the effects of timing of surgery on outcomes in SCI patients. This single-centre prospective observational study was done to evaluate the outcome of surgical decompression done > 72 h after traumatic incomplete SCI and assess prognosis over 6 and 12 months. Patients, with history of traumatic incomplete SCI of < 6-month duration and below C5 vertebra level, who had had late surgery (> 72 h after the injury) elsewhere were enrolled. A complete and standard neurological examination was done at presentation. Neurological and functional recovery was assessed at 6 and 12 months. Forty-two patients fulfilling the inclusion criteria were followed up of at least 12 months. At baseline, 31 had ASIA B and 11 had ASIA C grade. By 6 months, 4 patients improved by 1 ASIA grade. By 12 months, 14 patients improved by 1 grade and two by 2 grades. Mean motor recovery and overall functional recovery were significant (p = 0.03 and p < 0.001 respectively). Patients with lumbar injuries had significantly better overall functional recovery at both 6 (p = 0.006) and 12 months (p < 0.001). ASIA C group recovered significantly better than ASIA B group in terms of mean motor recovery percentage (14.33 vs 8.12, p = 0.014 at 6 months; 23.96 vs 16.56, p = 0.016 at 12 months) and mean spinal cord independent measures (SCIM) recovery percentage (43.01 vs 32.03, p = 0.039 at 6 months; 62.25 vs 38.4, p < 0.001 at 12 months). Surgery > 72 h after incomplete traumatic SCI, assessed at 2-4 months post injury, may still have encouraging outcomes. Our study may be the first from India to assess the outcome of delayed surgery in incomplete SCI patients but larger prospective studies involving multiple centres are needed for stronger evidence. Inclusion of non-operative cohort would have differentiated the result from spontaneous recovery.