Perform spinal decompression surgery within first 72 hours

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Stefan Parent, associate professor, Faculty of Medicine, Department of Surgery, University of Montreal, Montreal, Canada, presented a study at IMAST that showed surgical decompression surgery performed within 72 hours of a spinal cord injury (providing the patient is stable) is associated with a lower rate of non-neurological complications than if surgery is postponed until 72 hours after an injury has occurred

Parent told IMAST delegates: “Optimal timing of surgery after traumatic spinal cord injury is one of the most controversial subjects in spinal surgery.” He added that the two main objectives of surgical intervention are to promote neurological recovery and to stabilise the spine to allow rapid mobilisation, but said: “Recent literature has suggested that early intervention may increase the risk of complications. The objective of this study was to assess the relationship between surgical timing and the rate of non-neurological complications during acute hospital stay in spinal cord injury patients.”

The investigators (led by Jean-Marc Mac-Thiong, Faculty of Medicine, Department of Surgery, University of Montreal, Montreal, Canada) retrospectively reviewed 431 patients with a traumatic spinal cord injury who had undergone spinal stabilisation surgery between April 2000 and March 2011.They divided patients into three groups: those who received surgery within 24 hours of incurring the injury (90); those who received surgery within 72 hours (231); and those who received surgery after 72 hours (110). Mac-Thiong et al found that the rate of pneumonia and pressure ulcers were significantly higher in patients who underwent surgery after 72 hours than the rate in patients who received surgery within 72 hours. Parent said: “The global rate of complication was further decreased when surgery was performed within 24 hours following spinal cord injury when compared to surgery performed within 72 hours.” He added that a higher rate of complications was also associated with more severe trauma, a greater amount of comorbidities, age, American Spine Injury Association (ASIA) classification, and tetraplegia.

Parent concluded: “We recommend performing surgery for spinal cord injury within 24 hours to reduce the complication rate, both neurological and non-neurological. When such timing is impossible, surgeons should aim to perform surgery within 72 hours to reduce to reduce risk of complications.”