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68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
7. Joint Meeting mit der Britischen Gesellschaft für Neurochirurgie (SBNS)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

14. - 17. Mai 2017, Magdeburg

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Early decompression (less than 8 h) versus delayed surgical management improves the functional outcome after traumatic cervical spinal cord injury

Meeting Abstract

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  • Lukas Grassner - Berufsgenossenschaftliche Unfallklinik Murnau, Neurozentrum, Center for Spinal Cord Injuries, Murnau, Deutschland
  • B. Klein - Paracelsus Medical University, Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria
  • C. Wutte - Berufsgenossenschaftliche Unfallklinik Murnau, Neurozentrum, Center for Spinal Cord Injuries, Murnau, Deutschland
  • Matthias Vogel - Berufsgenossenschaftliche Unfallklinik Murnau, Neurozentrum, Center for Spinal Cord Injuries, Murnau, Deutschland
  • V. Bühren - Berufsgenossenschaftliche Unfallklinik Murnau, Neurozentrum, Center for Spinal Cord Injuries, Murnau, Deutschland
  • Jan Vastmans - Berufsgenossenschaftliche Unfallklinik Murnau, Neurozentrum, Center for Spinal Cord Injuries, Murnau, Deutschland
  • Martin Strowitzki - Berufsgenossenschaftliche Unfallklinik Murnau, Neurozentrum, Neurochirurgische Klinik, Murnau, Deutschland
  • Doris Maier - Berufsgenossenschaftliche Unfallklinik Murnau, Neurozentrum, Center for Spinal Cord Injuries, Murnau, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDI.26.03

doi: 10.3205/17dgnc333, urn:nbn:de:0183-17dgnc3339

Veröffentlicht: 9. Juni 2017

© 2017 Grassner et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Introduction: Traumatic cervical spinal cord injury affects the individual in a multi-faceted way. Early decompression of the spinal canal is recommended. The optimal time point for this intervention has been under debate for decades. This study evaluates if the neurologic as well as functional outcome is influenced by early surgical decompression (< 8h).

Materials and Methods: We performed a retrospective analysis at the Center for Spinal Cord Injuries (Trauma Center Murnau, Germany), a cross-regional level-I trauma center. Follow-up data was collected prospectively for one year after injury, according to institutional and international consensus criteria (EMSCI database – European Multicenter Study about Spinal Cord Injury). We included data acquired over a 10-year period (2004 - 2014). We only analyzed patients over 18 years with traumatic cervical spinal cord injury without concomitant extremity injury, traumatic brain injury or central cord injuries.

Results: We identified 70 patients (11 females), who met in- and exclusion criteria. Out of this population, 35 patients were decompressed within the first 8 h (average: 4.36 h after the insult) (= early group). After one year, patients from the early group showed a significantly higher gain in total motor score (TMS) points (27,1 versus 14,6; p<0,007). Additionally, this patient cohort showed significantly better grades on the American Spinal Injury Association Impairment Scale (AIS) and a significantly higher AIS conversion rate (45,7% versus 20,0%; p<0,029). This was reflected by a statistical significant segmental gain of the motor and neurological level. Furthermore, early operated patients were more likely to experience a significant greater difference in the Spinal Cord Independence Measure (SCIM: 45,8 versus 27,1; p<0,005) within the follow-up period.

Conclusion: This study shows that an early surgical decompression not only leads to higher AIS conversion rates, but – most importantly – also to a better functional outcome (as indicated by the SCIM score).