The impact of urgent intervention on the neurologic recovery in patients with thoracolumbar fractures

Ramírez-Villaescusa, José; Hidalgo, Jesús López-Torres; Ruiz-Picazo, David; Martin-Benlloch, Antonio; Torres-Lozano, Pedro; Portero-Martinez, Eloy

doi:10.21037/jss.2018.06.07

Cited by 14 publications

(13 citation statements)

References 26 publications

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“…Not only could the disruption of the segmental vessels be a tool for clinicians for their initial neurological assessment, but it also may be a prognosis factor for potential recovery post-injury. There still needs to be precise data about the benefits of emergent surgical decompression, compared to delayed surgery, for patients with complete SCI [28]. However, our study suggests the segmental arteries could be wedged into or compressed by the fracture, so the acute distraction of the fracture, to remove the extrinsic compression is a theory that deserves further investigation.…”

Section: Discussionmentioning

confidence: 80%

The Associative Pattern Between Segmental Arterial Damage and Complete Neurological Disorder After Spinal Cord Injury: A Case-Control Study

Boukebous¹,

Serfaty²,

Hodges-Tai³

et al. 2023

Cureus

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Introduction: The prevalence of vascular trauma surrounding the thoracic spine following Spinal Cord Injury (SCI) is unknown. The potential for neurologic recovery is uncertain in many cases; in some cases, neurologic assessment is not possible, for example, in severe head injury or early intubation, and detection of segmental artery injury may help as a predictive factor.Objective: To assess the prevalence of segmental vessel disruption in two groups, with and without neurologic deficit.Material and methods: This is a retrospective cohort study, with a group SCI American Spinal Injury Association (ASIA) E and a group SCI ASIA A. All patients had a high-energy thoracic or thoracolumbar fracture from T1 to L1. Patients were matched 1:1 (one ASIA A matched with one ASIA E) according to the fracture type, age, and level. The primary variable was the assessment of the presence/disruption of the segmental arteries, bilaterally, around the fracture. Analysis was performed twice by two independent surgeons in a blinded fashion.Results: Both groups had 2 type A, 8 type B, and 4 type C fractures. The right segmental artery was detected in 14/14 (100%) of the patients with ASIA E and in 3/14 (21%) or 2/14 (14%) of the patients with ASIA A, according to the observers, p=0.001. The left segmental artery was detectable in 13/14 (93%) or 14/14 (100%) of the patients ASIA E and in 3/14 (21%) of the patients ASIA A for both observers. All in all, 13/14 of the patients with ASIA A had at least one segmental artery undetectable. The sensibility varied between 78%to 92%, and the specificity from 82% to 100%. The Kappa Score varied between 0.55 and 0.78. Conclusion: Segmental arteries disruption was common in the group ASIA A. This may help to predict the neurological status of patients with no complete neurological assessment or potential for recovery postinjury.

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Section: Discussionmentioning

confidence: 80%

The Associative Pattern Between Segmental Arterial Damage and Complete Neurological Disorder After Spinal Cord Injury: A Case-Control Study

Boukebous¹,

Serfaty²,

Hodges-Tai³

et al. 2023

Cureus

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“…Finally, we observed that early surgery did not decrease the rate of complications but did significantly decrease the duration of hospitalization. The findings on complications should be interpreted cautiously, as the rate of operative complications is closely associated with the injured segment, the skilfulness of the surgeon, and the technologies at the time of surgery, especially in studies from more than 5 years ago 15–20…”

Section: Discussionmentioning

confidence: 99%

“…The findings on complications should be interpreted cautiously, as the rate of operative complications is closely associated with the injured segment, the skilfulness of the surgeon, and the technologies at the time of surgery, especially in studies from more than 5 years ago. [15][16][17][18][19][20]…”

Section: Summary Of Findingsmentioning

confidence: 99%

Early Surgery (Within 24 Hours) Benefits Patients Suffering from Acute Thoracolumbar Spinal Cord Injury

Wang

et al. 2022

Clinical Spine Surgery: A Spine Publication

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A meta-analysis of early surgery for acute thoracolumbar spinal cord injury.Objective: To evaluate whether early surgery increases the American Spinal Injury Association (ASIA) grade of patients confronted with acute thoracolumbar spinal cord injury. Summary of Background Data:The idea that early surgery aids the recovery of spinal cord function in patients confronted with acute thoracolumbar spinal cord injury is controversial.Methods: All articles were retrieved from the PubMed, Embase, Web of Science and Scopus databases, which were searched from onset until 1 May 2021. All data are presented as odds ratios (ORs) and mean deviations (MDs) with 95% confidential intervals (CIs).Results: Ten studies, including 6 prospective studies, 3 retrospective studies, and 1 randomized controlled trial, containing 952 patients, were included in the analysis. The results showed that early surgery significantly reduced the number of patients with ASIA grade A (OR 0.27, 95% CI: 0.13-0.58, P < 0.01) and B (OR 0.56, 95% CI: 0.39-0.82, P < 0.01) status but greatly increased the number of patients with grade E status (OR 1.44, 95% CI: 1.06-1.96, P < 0.01). Generally, the patients receiving early surgery achieved > 1 ASIA grade improvement (OR 1.70, 95% CI: 1.31-2.21, P < 0.01) or > 2 ASIA grade (OR 3.55, 95% CI: 2.20-5.70, P < 0.01) improvements. Although early surgery did not reduce the incidence of operative complications (OR 0.72, 95% CI: 0.45-1.16, P < 0.01), the duration of hospitalization was greatly shortened (MD−3.48, 95% CI: −0.45 to −2.91, P < 0.01). Conclusions:The spinal cord function of acute thoracolumbar spinal cord injury patients can benefit from early decompression. This conclusion should be further verified with randomized controlled trials.

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“…41,[45][46][47][48][49][50] Most studies on neurological outcome include patients with both complete and incomplete thoracic and thoracolumbar tSCI (Table 3). 13,16,41,51,52 Two studies evaluated the effect of surgical timing in thoracic tSCI specifically. 52,53 One study in 12 complete thoracic tSCI patients evaluated the efficacy of surgery.…”

Section: Impact Of Timing Of Surgical Interventionmentioning

confidence: 99%

Complete Traumatic Spinal Cord Injury: Current Insights Regarding Timing of Surgery and Level of Injury

Wengel

Haan

Feller

et al. 2019

Global Spine Journal

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Study Design: A narrative literature review. Objectives: To review the neurological recovery patterns in traumatic spinal cord injury (tSCI) patients with a complete lack of motor and sensory function below the level of injury (ie, ASIA A [American Spinal Injury Association scale]), as well as the impact of level of injury and timing of surgical intervention. Results: Spontaneous neurological recovery in patients with complete tSCI differs per level of injury: patients with cervical and thoracolumbar tSCI recover ≥1 ASIA grade in 17.3% to 34.0% 1 year after injury, compared with 10.7% to 18.6% in thoracic tSCI. Surgical decompression within 24 hours has a beneficial effect on neurological recovery in patients with complete cervical tSCI, whereas this effect is less clear for thoracic and thoracolumbar tSCI. A 1- or 2-grade improvement in the ASIA scale does not necessarily result in functional recovery. Conclusion: In complete tSCI, the level of injury as well as surgical timing affect neurological recovery. There appears to be a beneficial effect of early surgical decompression in patients with complete cervical tSCI, more so than for thoracic and thoracolumbar tSCI. Frequently, the effect of surgical intervention is evaluated by an improvement in ASIA grade, but it is unclear whether this scale is sensitive enough to evaluate meaningful effectiveness of the intervention and desired outcome for patients with tSCI.

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The impact of urgent intervention on the neurologic recovery in patients with thoracolumbar fractures

Abstract: Urgent surgery was associated with neurologic improvement in patients with spinal cord injury (SCI). This improvement was mainly observed in patients with an incomplete lesion.

Cited by 14 publications

References 26 publications

The Associative Pattern Between Segmental Arterial Damage and Complete Neurological Disorder After Spinal Cord Injury: A Case-Control Study

The Associative Pattern Between Segmental Arterial Damage and Complete Neurological Disorder After Spinal Cord Injury: A Case-Control Study

Early Surgery (Within 24 Hours) Benefits Patients Suffering from Acute Thoracolumbar Spinal Cord Injury

Complete Traumatic Spinal Cord Injury: Current Insights Regarding Timing of Surgery and Level of Injury

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