Earlier Surgery Reduces Complications in Acute Traumatic Thoracolumbar Spinal Cord Injury: Analysis of a Multicenter Cohort of 4,108 Patients.

@article{Balas2021EarlierSR,
  title={Earlier Surgery Reduces Complications in Acute Traumatic Thoracolumbar Spinal Cord Injury: Analysis of a Multicenter Cohort of 4,108 Patients.},
  author={Michael Balas and Matthew P. Guttman and Jetan H. Badhiwala and Gerald Lebovic and Avery B. Nathens and Leodante da Costa and Zsolt Zador and J. Spears and Michael G. Fehlings and Jefferson R. Wilson and Christopher D. Witiw},
  journal={Journal of neurotrauma},
  year={2021}
}
Early surgical intervention to decompress the spinal cord and stabilize the spinal column in patients with acute traumatic thoracolumbar spinal cord injury (TLSCI) may lessen the risk of developing complications and improve outcomes. However, there has yet to be agreement on what constitutes 'early' surgery; reported thresholds range from 8 to 72 hours. To address this knowledge gap, we conducted an observational cohort study using data from the American College of Surgeons Trauma Quality… 
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Time is spine: What's over the horizon.

References

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Number of vertebral levels fractured and upper thoracic level of injury (T1–8) were found to be associated with surgical delay, suggesting earlier spinal surgery in TLSCI would be facilitated by direct surgical hospital admission and improved access to the operating theater and surgical teams.

Earlier Decompression (< 8 Hours) Results in Better Neurological and Functional Outcome after Traumatic Thoracolumbar Spinal Cord Injury.

The data suggests that prompt surgical management after thoracolumbar SCI might have a positive impact on the functional and neurological outcome and linear regression models showed that early surgery was an independent predictor for higher AIS shifts and improved total SCIM difference.

Retrospective, propensity score-matched cohort study examining timing of fracture fixation for traumatic thoracolumbar fractures.

The beneficial impact of early spinal surgery (prior to 72 h) in traumatic thoracic/thoracolumbar fractures to reduce in-hospital complications, hospital stay, and resource utilization is reinforced.

Impact of Early (<24 h) Surgical Decompression on Neurological Recovery in Thoracic Spinal Cord Injury: A Meta-Analysis.

This study did not observe a significant beneficial effect of surgical decompression within 24 h in patients with thoracic and thoracolumbar tSCI.

The influence of time from injury to surgery on motor recovery and length of hospital stay in acute traumatic spinal cord injury: an observational Canadian cohort study.

Evidence is provided that for an incomplete acute tSCI in the cervical, thoracic, or thoracolumbar spine, surgery performed within 24 h from injury improves motor neurological recovery and early surgery also reduces LOS.

Natural History, Predictors of Outcome, and Effects of Treatment in Thoracic Spinal Cord Injury: A Multi-Center Cohort Study from the North American Clinical Trials Network.

Although small sample size limited the extent of analyses possible, early surgical treatment was associated with significantly larger motor recovery and lower rates of pulmonary complications and methylprednisolone administration was not an independent predictor of neurological outcome or pulmonary complications.

Timing of thoracic spine stabilization in trauma patients: impact on clinical course and outcome.

There is further evidence that early stabilization of thoracic spine injuries in trauma patients reduces overall hospital and ICU stay and improves outcome and early stabilization within 3 days after trauma appears to be favorable.

Complete Traumatic Spinal Cord Injury: Current Insights Regarding Timing of Surgery and Level of Injury

In complete tSCI, the level of injury as well as surgical timing affect neurological recovery, and there appears to be a beneficial effect of early surgical decompression in patients with complete cervical t SCI, more so than for thoracic and thoracolumbar tSCi.

Best practice determination of timing of spinal fracture fixation as defined by analysis of the National Trauma Data Bank.

NTDB records indicate that the majority of patients with spinal fractures undergo operative fixation within 3 days, and that these patients had less complications and required less resources.