"This practice-changing study is the first to show that the timing of surgery after traumatic spinal cord injury (SCI) matters," says Alexander Vaccaro, MD, PhD, professor of Orthopaedics and Neurosurgery at Jefferson Medical College of Thomas Jefferson University and attending surgeon at Thomas Jefferson University Hospital, the largest spinal cord injury center in the country.
The multicenter study recruited 313 patients; 182 of whom underwent surgery less than 24 hours after traumatic cervical SCI and 131 of whom underwent surgery at or after 24 hours post-SCI.
For both groups, the degree of neurologic improvement was measured by change in American Spinal Injury Association's (ASIA's) ASIA Impairment Scale (AIS). A two-grade improvement in AIS scores post-surgery was associated with improved neurologic outcomes. Baseline neurological assessments were performed within 24 hours of injury on all subjects.
A total of 222 patients were followed to six months post-surgery.
In the early surgery group (surgery performed less than 24 hours post-injury), 42.7 percent showed no improvement, 36.6 percent had a one grade improvement, 16.8 percent had a two-grade improvement and 3.1 percent had a three grade improvement. Comparatively, in the late surgery group (surgery performed at 24 hours or more post-injury), 50 percent showed no improvement, 40.7 percent had a one grade improvement and 8.8 percent had a two grade improvement.
"What this tells us is that the odds of a significant (at least two grade) improvement in neurologic status is 2.8 times higher when surgery is performed within 24 hours post-injury. This can be the difference between walking and not for the rest of one's life," says Vaccaro.
Complications occurred in 24.2 percent of early surgery patients versus 30.5 percent of late surgery patients.
"Previous research has been inconclusive on the issue, with the common thought among most surgeons that you can wait up to five days post-injury and have the same outcomes. We should not practice that way anymore armed with this new information," says Vaccaro.
Research was performed in collaboration with the University of Toronto; University of Virginia; University of Maryland, Baltimore; University of British Columbia; and the University of Kansas.
Thomas Jefferson University Hospitals
Thomas Jefferson University Hospitals (TJUH) are dedicated to excellence in patient care and education. It is consistently ranked by U.S. News & World Report among the nation's top hospitals. It has over 950 licensed acute care beds with major programs in a wide range of clinical specialties. TJUH is one of the few hospitals in the U.S. that is both a Level 1 Trauma Center and a federally-designated regional spinal cord injury center. TJUH patient care facilities include: Jefferson Hospital, Jefferson Hospital for Neuroscience, and Methodist Hospital in South Philadelphia. Additional out-patient sites are located throughout Pennsylvania and New Jersey. TJUH is a part of Jefferson Health System and a partner of Thomas Jefferson University.
Lee-Ann Landis | EurekAlert!
Live probiotics can re-balance the gut microbiome and modify immune system response
20.11.2018 | Symprove
Purdue cancer identity technology makes it easier to find a tumor's 'address'
16.11.2018 | Purdue University
Max Planck researchers revel the nano-structure of molecular trains and the reason for smooth transport in cellular antennas.
Moving around, sensing the extracellular environment, and signaling to other cells are important for a cell to function properly. Responsible for those tasks...
Researchers at the University of New Hampshire have captured a difficult-to-view singular event involving "magnetic reconnection"--the process by which sparse particles and energy around Earth collide producing a quick but mighty explosion--in the Earth's magnetotail, the magnetic environment that trails behind the planet.
Magnetic reconnection has remained a bit of a mystery to scientists. They know it exists and have documented the effects that the energy explosions can...
Biochips have been developed at TU Wien (Vienna), on which tissue can be produced and examined. This allows supplying the tissue with different substances in a very controlled way.
Cultivating human cells in the Petri dish is not a big challenge today. Producing artificial tissue, however, permeated by fine blood vessels, is a much more...
Faster and secure data communication: This is the goal of a new joint project involving physicists from the University of Würzburg. The German Federal Ministry of Education and Research funds the project with 14.8 million euro.
In our digital world data security and secure communication are becoming more and more important. Quantum communication is a promising approach to achieve...
On Saturday, 10 November 2018, the research icebreaker Polarstern will leave its homeport of Bremerhaven, bound for Cape Town, South Africa.
19.11.2018 | Event News
09.11.2018 | Event News
06.11.2018 | Event News
20.11.2018 | Life Sciences
20.11.2018 | Life Sciences
20.11.2018 | Physics and Astronomy