The influence of timing of surgery in the outcome of spinal
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Spinal cord injury without radiographic abnormality (SCIWORA) is a rare traumatic myelopathy. Although surgery is one of the most important treatments, the surgery for SCIWORA is controversial, especially the time of surgery is a topic of controversy. Here, investigation was done on the effects of difference in duration from injury to surgery on the outcome of SCIWORA.

Fifty-seven patients who met the study requirements were divided into 3 groups according to the duration from injury to surgery. Group A (surgery within 3days of injury) had 18 patients, group B (surgery within 3–7days) had 18 patients, and group C (surgery later than 7days) had 21 patients. All the groups were compared; the functional improvement of the spinal cord was compared and analyzed. There was a significant improvement in the long-term AIS (final follow-up) in all the 3 groups compared to before surgery. The final follow-up recovery rate of group C was worse than group A and group B. The curative effect of operation within 7days was significantly better than the surgery done 7days later. The recovery rate of group C was worse than group A and B. The ASIA sports score showed that recovery was quicker in the early stage and slow in the later stage.

Treatment of patients with SCIWORA should be determined individually. Patients with clear MRI evidence of epidural lesions, including compression of the spinal cord, ligament damage and instability, and worsening or no improvement of neurological lesions, should be preferred for surgery. The timing of dynamic X-ray and MRI is very important, and their corresponding results directly affect the treatment options. Although the prognosis of all patients improved significantly within 7days of surgery, the incidence of complications in premature surgery increased, and the surgical decompression range was affected. Early MRI examinations in a SCI within 3days are difficult to fully find the signal, which may lead to misdiagnosis or missed diagnosis. The optimal timing of surgical treatment is 3–7days after injury, which can significantly improve the short-term and long-term follow-up effects. Meanwhile, spinal cord concussion is excluded, which can lead to spinal cord decompression errors. Surgery performed after longer duration from the time injury worsens the prognosis of SCIWORA surgery.

Source: https://josr-online.biomedcentral.com/articles/10.1186/s13018-020-01743-1


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