The Effect of Timing of Surgery in Spinal Cord Injury on Non-neurologic Outcome

Introduction:

The appropriate timing for surgical intervention following SCI has been a subject of intense debate. Most studies have evaluated the effects of surgery on neurologic outcome with little attention to other outcome parameters.

Method:

We reviewed our prospective SCI database for patients who underwent surgical treatment for their injuries. All patients were treated between August 1996 and October 1998 at the University of Louisville Hospital, Louisville, KY and were managed in conjunction with our SCI clinical pathway. Patients were separated into two groups based on the timing of their surigcal intervention (treatment prior to or after PID 5).

Results:

Twenty–one of the 33 patients treated with our SCI clinical pathway were treated surgically; 12 early (avg. PID 2.3), 9 late (avg. PID 8.4). Patients treated in the early group had significantly shorter overall hospital lengths of stay, ICU length of stay and number of ventilator days (early: 17.4, 10.6, 5.7 days; late: 30.3, 26.9, 15.7 days respectively; p less than 0.005); as well as fewer episodes of pneumonia (early 0.6; late 1.6 episodes/patient; p=0.03). There was no mortality in either group and only one complication directly related to the surgical intervention, 4.5% (strut graft collapse).

Conclusion:

We believe that surgical intervention, when necessary, in the form of spinal column stabilization should be performed as soon as the patient is medically stable. We have shown that such early intervention not only expedites patient discharge with shorter lengths of stay; but also decreases the rate of infectious complications.