Effect of Prehospital Pause on the Outcomes of Emergency Decompression and Stabilization Procedures in Patients with Tumor and Infectious Spine Diseases

Abstract

Purpose to assess the relationship between duration of pathological symptoms developed due to tumor or infectious destruction of the spine, and the medium-term outcomes of urgent surgeries. Materials and Methods. 84 patients with tumor (group 1, n = 43) and infectious (group 2, n = 41) lesions of the spine underwent decompression and stabilization procedures according to urgent indications in the period from 2016 to 2018. Neurological status (Frankel scale), pain intensity (VAS) and functional independence of patients (Karnofsky scale) were assessed before surgery, 3 months and 1 year after. Statistical relationship between outcomes and duration of the prehospital and hospital delay has been studied. Results. 23 patients in each group had neurological deficit (53.5% and 56.1%), while the average duration of the prehospital period in those patients in both groups (Me) was 14.0 days. 11 out of 84 patients (13.1%), were hospitalized in the first 72 hours from the onset of vertebral syndrome; 6 (7.1%) of them had neurological disorders. An inverse correlation of high strength between the duration of neurological deterioration and the possibility of their improvement by 3 months after surgery was revealed in both groups (rs1 = -0.793 and rs2 = -0.828; p0.001) and there was no relationship between outcomes and the duration of the hospital period (surgery urgency) (rs1 = -0.257; p = 0.283 and rs2 = -0.218; p = 0.330). The possibility of neurological improvement after surgery ceases to be statistically significant after 14 days from the onset of pathological symptoms (p1 = 0.083, p2 = 0.157 for both groups, respectively), while the likelihood of a decrease in pain syndrome and functional dependence on others remains independent of the duration of the prehospital period. Conclusion. In case of tumor or infectious spine lesions, urgent decompression and stabilization procedures reduce pain and improve the functional independence regardless of the duration of the prehospital period, while extension of prehospital period of more than 2 weeks is crucial for a reliable prognosis of neurological status improvement.