Lancet Neurology: Early decompression surgery after acute traumatic spinal cord injury can improve the prognosmation of the nervous system

Acute traumatic spinal cord injury (SCI) is a catastrophic event that places a huge physical, emotional and financial burden on patients, families and society.
of acute spinal cord injury can include paralysis, numbness, loss of bladder or intestinal control.
despite studies of potential neuropymination and regenerative therapies, SCU patients still have few treatment options, such as blood pressure control, methyl perisherone, or spinal cord decompression.
surgery to reduce stress provides an early opportunity to restore spinal cord blood flow, improve isoemia semi-dark band perfusion, and reduce secondary injuries.
although early decompression treatment of spinal cord injury has a strong biological basis, the impact of surgical decompression timing on SCI is still controversial, and there are great differences in clinical practice.
objective of this paper is to objectively evaluate the effect of SCI decompression surgery on the prognosis of long-term nerve function.
study included all patients who underwent decompression surgery due to acute spinal cord injury.
patients were divided into the early (-lt;24h) and late (≥24h) decompression groups.
results were evaluated by the American Spinal Cord Injury Association (ASIA) or the International Classification of Spinal Cord Injury Neurology Standard (ISNCSCI).
end point is a change in overall exercise scores from baseline to 1 year after spinal cord injury.
end point was the ASIA Injury Scale (AIS) score and changes in upper limb movement, lower limb movement, tap and needle score after 1 year.
a total of 1,548 eligible patients, of whom 1,031 (66.6%) had results one year after spinal cord injury.
1 year after the spinal cord injury, the early decompression surgery group (n-528) recovered faster than the late decompression surgery group (n-1020).
23.7 points (95% CI 19.2-28.2) for the early surgical group and 19.7 points (15.3-24.0) for the late surgical group (M) D 4.0 points (1.7-6.3) ;p -0.0006); Tap score increased by 19.0 points (15.1-23.0) vs 14.8 Scores (11.2-18.4; MD 4.3 ( 1.6-7.0 ) ;p . . . 0.0021) and needle scores increased by 18.3 points (13.3) 7-22.9) vs 14.2 cents (9.8-18.6; MD 4.0 ;p 1.5-6.6) and 0.0020).
patients with early decompression also had better AIS scores in the first year after surgery than those with late decompression, indicating less damage (cOR 1.48 (95% CI 1.16-1.89) ;p=0.0019).
When surgical decompression time is modeled as a continuous variable, changes in the total exercise score decrease dramatically over time during the first 24-36 hours after injury (p.lt;0.0001);
, surgical decompression within 24 hours of an acute traumatic spinal cord injury was associated with a good recovery of sensory exercise.
24-36 hours after an injury is a critical time window, reducing the delay of decompression surgery can improve the nervous system's prognosmation.
36 hours later, as the decompression time increases, the chances of regulating recovery may be lost, possibly due to isoemia resulting in irreversible tissue damage.
Badhiwala, Jetan H et al. The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. The Lancet Neurology, Volume 20, Issue 2, 117 - 126MedSci Original Source: MedSci Original Copyright Notice: All text, images and audio and video materials on this website that indicate "Source: Met Medical" or "Source: MedSci Original" are owned by Mets Medical and are not authorized to reproduce by any media, website or individual.
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