The Effects of Ultra-Early Cord Decompression on Results in an Emergency Situation
Keywords:
Cervical spine, Early decompression, Surgery, TraumaAbstract
Background
Traumatic cervical are injuries are very common due to high motility of cervical spine and its vulnerability to traumatic injuries. Optimal time for stabilizing the patients with traumatic spinal fractures remains controversial. It is almost due to different out comes in various studies and the lack of consensus about it. Here we explain an ultra–early cord decompression that led to complete recovery of a patient with severe cervical cord injury.
Case Presentation
The patient was a 27-year-old gymnast woman with a recent history of spinal cord injury caused by high jumping with head back and neck hyperextension presented within 2-hours of trauma. As a critical case and lack of advanced radiologic equipment, only cervical spinal radiographs were used for decision-making within the first 3 hours of injury to save the patient’s cord function by surgical decompression.
Conclusion
Many studies have proposed different intervention times for achieving the optimal result; however, we present an ultra-early surgery (within 3-hours of injury), conducted in a context of limited medical facilities. This case revealed an excellent result after 12-months follow-up.
References
Shakya B, Bista P, Shrestha D. Instrumentation in cervical spine injury: neurological outcome measurement using ASIA impair-ment scale. Nepal Med Coll J. 2014; 16: 156-160.
Yue JK, Upadhyayula PS, Chan AK, Winkler EA, Burke JF, Re-addy WJ, et al. A review and update on the current and emerging clinical trials for the acute management of cervical spine and spinal cord injuries - Part III. J Neurosurg Sci. 2016; 60: 529-542.
Badhiwala JH, Wilson JR, Witiw CD, Harrop JS, Vaccaro AR, Aarabi B, et al. The influence of timing of surgical decompression for acute spinal cord injury: A pooled analysis of individual pa-tient data. The Lancet Neurology. 2020; 20(2): 117-126. doi: 10.1016/ S1474-4422(20)30406-3
Sánchez JAS, Sharif S, Costa F, Rangel J, Anania CD, Zileli M. Early management of spinal cord injury: WFNS spine committee recommendations. Neurospine. 2020; 17: 759-784. doi: 10.14245/ ns.2040366.183
Maas AIR, Peul W, Thomé C. Surgical decompression in acute spinal cord injury: Earlier is better. The Lancet Neurology. 2020; 20(2): 84-86. doi: 10.1016/S1474-4422(20)30478-6
Jug M, Kejžar N, Cimerman M, Bajrović FF. Window of op-portunity for surgical decompression in patients with acute trau-matic cervical spinal cord injury. J Neurosurg Spine. 2019; 1-9. doi: 10.3171/2019.10.SPINE19888
Burns S, Biering-Sørensen F, Donovan W, et al. International standards for neurological classification of spinal cord injury, re-vised 2011. Topics in Spinal Cord Injury Rehabilitation. 2012; 18: 85-99.
Xu R, Ebraheim NA, Klausner T, Yeasting RA. Modified Magerl technique of lateral mass screw placement in the lower cervical spine: an anatomic study. J Spinal Disord. 1998; 11: 237-240.
Liu Z, Yang Y, He L, Pang M, Luo C, Liu B, et al. High-dose 12 Zarei MR et al methylprednisolone for acute traumatic spinal cord injury: A meta-analysis. Neurology. 2019; 93: e841-e850. doi: 10.1212/ WNL.0000000000007998
Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic spinal cord injury: An overview of pathophysiology, models and acute injury mechanisms. Front Neurol. 2019; 10: 282. doi: 10.3389/ fneur.2019.00282
Frangen TM, Ruppert S, Muhr G, Schinkel C. The beneficial effects of early stabilization of thoracic spine fractures depend on trauma severity. J Trauma. 2010; 68: 1208-1212. doi: 10.1097/ TA.0b013e3181a0e558
Kerwin AJ, Frykberg ER, Schinco MA, Griffen MM, Mur-phy T, Tepas JJ. The effect of early spine fixation on non-neu-rologic outcome. J Trauma. 2005; 58: 15-21. doi: 10.1097/01. ta.0000154182.35386.7e
Carreon LY, Dimar JR. Early versus late stabilization of spine injuries: A systematic review. Spine. 2011; 36: E727-E733. doi: 10.1097/BRS.0b013e3181fab02f
Dvorak MF, Noonan VK, Fallah N, Fisher CG, Finkelstein J, Kwon BK, et al. The influence of time from injury to surgery on motor recovery and length of hospital stay in acute traumatic spi-nal cord injury: An observational Canadian cohort study. J Neu-rotrauma. 2015; 32: 645-654. doi: 10.1089/neu.2014.3632
Dobran M, Iacoangeli M, Nocchi N, Di Rienzo A, di Somma LGM, Nasi D, et al. Surgical treatment of cervical spine trauma: Our experience and results. Asian J Neurosurg. 2015; 10: 207-211. doi: 10.4103/1793-5482.161192
McKinley W, Meade MA, Kirshblum S, Barnard B. Outcomes of early surgical management versus late or no surgical interven-tion after acute spinal cord injury. Arch Phys Med Rehabil. 2004; 85: 1818-1825. doi: 10.1016/j.apmr.2004.04.032
Furlan JC, Craven BC, Massicotte EM, Fehlings MG. Early ver-sus delayed surgical decompression of spinal cord after traumatic cervical spinal cord injury: A cost-utility analysis. World Neurosurg. 2016; 88: 166-174. doi: 10.1016/j.wneu.2015.12.072
Biglari B, Child C, Yildirim TM, Swing T, Reitzel T, Moghad-dam A. Does surgical treatment within 4 hours after trauma have an influence on neurological remission in patients with acute spi-nal cord injury? Ther Clin Risk Manag. 2016; 12: 1339-1346. doi: 10.2147/TCRM.S108856
Liu Y, Shi CG, Wang XW, Chen HJ, Wang C, Cao P, et al. Tim-ing of surgical decompression for traumatic cervical spinal cord injury. Int Orthop. 2015; 39: 2457-2463. doi: 10.1007/s00264-014- 2652-z
Konieczny MR, Strüwer J, Jettkant B, Schinkel C, Kälicke T, Muhr G, et al. Early versus late surgery of thoracic spine frac-tures in multiple injured patients: Is early stabilization always recommendable? Spine J. 2015; 15: 1713-1718. doi: 10.1016/j. spinee.2013.07.469
Bourassa-Moreau É, Mac-Thiong JM, Li A, Feldman DE, Ga-gnon DH, Thompson C, et al. Do patients with complete spinal cord injury benefit from early surgical decompression? Analysis of neurological improvement in a prospective cohort study. J Neu-Submit your article to this journal | https://openventio.org/submit-manuscript/ Zarei MR et al rotrauma. 2016; 33: 301-306. doi: 10.1089/neu.2015.3957
Jug M, Kejžar N, Vesel M, Al Mawed S, Dobravec M, Herman S, et al. Neurological recovery after traumatic cervical spinal cord injury is superior if surgical decompression and instrumented fu-sion are performed within 8 hours versus 8 to 24 hours after injury: A single center experience. J Neurotrauma. 2015; 32: 1385-1392. doi: 10.1089/neu.2014.3767
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