Influence of surgical timings on the therapeutic effect of cervical spinal cord injury without fracture and dislocation

English Keywords:Cervical spinal cord injury without fracture and dislocation  Early surgery  Delayed surgery  Anterior cervical discectomy and fusion(ACDF)  Posterior cervical surgery

English Abstract:

  【Abstract】 Objectives: To compare the effects of early versus delayed surgical intervention on neurological recovery in patients with cervical spinal cord injury without fracture and dislocation(CSCIwoFD). Methods: 104 patients with CSCIwoFD who underwent surgery between August 2020 and January 2023 were analyzed retrospectively. Based on the time from injury to surgery, the patients were divided into an early surgery group(≤7d) and a delayed surgery group(＞7d). Early surgery group consisted of 54 patients, including 39 males and 15 females, aged 25-69(49.5±12.1) years old; Delayed surgery group consisted of 50 patients, including 34 males and 16 females, aged 24-72(54.6±9.3) years old. No significant differences were observed between the two groups in general data(P>0.05). The surgical indexes were compared, including operation approach, number of fused segment, operative time, intraoperative blood loss, postoperative drainage volume, and bone fusion rate on X-ray images 6 months after operation. The Japanese Orthopaedic Association(JOA) score, American Spinal Cord Injury Association(ASIA) Motor Score(AMS), and ASIA Sensory Score(ASS), were compared between the two groups before operation, at postoperative 3 and 6 months, and 1 and 2 years, along with their respective recovery rates(JOA score RR, AMS RR, and ASS RR). Radiological parameters, including maximum canal compromise(MCC), maximum spinal cord compression(MSCC), were analyzed for linear correlations with age, gender, operation approach and other indexes, as well as functional scores and their improvement rates using Pearson analysis. Additional comparisons between the two groups included length of hospital stay, time to return to work, treatment costs, and patient satisfaction at 2 years post-treatment. Results: No significant differences were observed between the two groups in surgical parameters(P>0.05). Radiologically, MSCC was higher in the early surgery group[(21.28±8.63)% vs (18.24±9.29)%] with statistical significance(P<0.05), while MCC wasn′t statistically different between groups(P>0.05). MSCC showed a significant positive correlation with postoperative neurological recovery parameters, including JOA scores and RR, AMS and AMS RR, while its correlation with ASS RR was weaker. MSCC did not correlate significantly with age, gender, or surgical approach but exhibited a mild positive correlation with surgical timing. Both groups showed postoperative improvement in JOA score, ASS, and AMS, with the early surgery group demonstrating superior scores. The between-group difference in JOA scores at 2 years was 2.71 points, meeting the minimal clinically important difference(MCID). Significant differences in JOA score RR, ASS RR, and AMS RR between groups were observed at 1 and 2 years postoperatively(P<0.05). In the early surgery group, MSCC positively correlated with JOA score RR (γ=0.527, P<0.05) and AMS RR (γ=0.277, P<0.05) at 3 months. Conclusions: Both early and delayed surgery can improve spinal cord function in CSCIwoFD patients, with greater improvement observed in the early surgery group. MSCC is positively correlated with favorable motor recovery in patients undergoing early intervention. Provided the patient′s traumatic stress state is stable, surgical intervention within 7d is recommended to maximize neurological outcomes.