Features of the course of complicated injury of the lower cervical spine depending on the timing of surgical decompression of the spinal cord

Abstract

Objective. To determine the influence of the urgency of performing surgical decompression of the spinal cord (SC) on the course of acute and early periods of complicated injury of the lower cervical spine.Material and Methods. The results of treatment of 75 patients with acute complicated injury of the lower cervical spine with ASIA A and ASIA B severity of spinal cord injuries were retrospectively analyzed. Two groups were formed, depending on the timing of surgical decompression of the spinal cord after injury. Group I included 33 patients in whom the SC decompression was performed within the first eight hours after the injury, and Group II included 42 patients in whom the SC decompression was performed in more than eight hoursafter the injury.Results. The mean age of patients in Group I was 29 [25; 39] years, in Group II – 35 [30; 42] years (p = 0.129). There were 31 (94.0 %) male patients in Group I and 38 (90.5 %; p > 0.999) in Group II. The time from the moment of injury to decompression of the spinal cordwas 6.1 [5.0; 7.5] hours in Group I and 16.9 [11.8; 39.6] hours in Group II (p < 0.001). Pneumonia developed in 55 % [38 %; 70 %] of patients in Group I and in 86 % [72 %; 93 %] of patients in Group II (p = 0.004). The duration of pneumonia in Group I was 18 [8; 20] days, and in Group II – 28 [20; 39] days (p < 0.001). It was shown that the risk ratio for developing pneumonia in patients with delayed decompression of the spinal cord was 2.08 [1.17; 3.67] times higher (p = 0.01). The duration of mechanical ventilation in Group I was 12 [7; 17] days versus 19 [11; 26] days in Group II (p = 0.001). Maintaining the target blood pressure levels ≥ 85 mm Hg was required in 73 (97.3 %) patients with a duration of hemodynamic support of 6 [3; 10] days in Group I versus 10 [5; 15] days in Group II (p = 0.019). It was shown that SC decompression within the first eight hours after injury reduced the proportion of patients with a SOFA score of 4 points or more by 20 % in the acute period and by 42 % by the fifth day of the early period of injury. Positive dynamic in neurologicalstatus was recorded in 30.0 % [17.0 %; 47.0 %] of patients in Group I and only in 2.0 % [0.0 %; 12.0 %] of patients in Group II (p < 0.001). The duration of treatment in the ICU was 20 [16; 25] days in Group I and 29 [23.5; 41.75] days in Group II (p = 0.001).The total length of hospital stay was 38 [27; 46] days in Group I versus 57 [45.75; 67.50] days in Group II (p < 0.001). Mortality was recordedonly in Group II and amounted to 5.3 %.Conclusion. Decompression and stabilization surgery within the first eight hours after the injury, together with a complex of intensive care measures for acute complicated injury of the lower cervical spine have a significant positive effect on the course of the acute and early periods of traumatic SC disease.