Introduction The influence of timing of surgery on functional outcomes following spinal cord injury remains controversial. Animal studies suggest that the rate, degree, and duration of cord compression are the principal determinants of spinal cord injury (SCI) severity and prognosis for recovery. Delamarter et al, (J Bone Joint Surg Am 1995) have shown that when experimental cord compression in dogs is relieved within 1 hour, full motor recovery can be achieved. It is suggested by some clinically based research that definitive surgical treatment for unstable injuries results in fewer sequelae than prolonged immobilization and allows more rapid entry into rehabilitation. It is however the timing of this surgery which remains controversial. It has been suggested that early surgical management promotes neurological recovery by limiting secondary damage caused by inflammation, oedema, ischemia and instability. To date few studies have found a link between neurological recovery and timing of surgery (Fehlings, et al; Spine 2001).

Methods Data was gathered retrospectively by chart review of patients referred to the Princess Alexandra hospital with spinal cord injury. Patients were age matched into high and low velocity groups. This data was studied to assess the effects of energy of injury and timing of surgical intervention on neurological outcome. Patients either had anterior, posterior, or combined surgery, external immobilization or traction depending on the preference of the treating surgeon.

Results A cohort of 43 patients all of whom had spinal cord injury was retrospectively studied. Of these, 21 had a high energy injury (eg. MVA) and 21 had a low energy injury (eg. rugby). 28 had anterior stabilization 7 had traction, 4 had external immobilization 2 had a combined anterior / posterior fixation and 1 had posterior stabilization. The data suggest that the prognosis for recovery following a spinal cord injury is unrelated to the energy involved. The low energy group improved on average 0.6 ASIA grades (SEM 0.16) while the high energy improved 0.7 ASIA grades (SEM 0.17). The timing of definitive intervention for patients with incomplete cord lesions was shown to significantly (p=0.029) effect ultimate functional outcomes. Those with early (within 8hrs) intervention improved an average of 1.4 ASIA grades (SEM 0.21) and those with late intervention improved 0.6 ASIA grades (SEM 0.19). This effect was present in both high and low energy injury groups.

Discussion The timing of definitive intervention for spinal cord injury is still controversial. However there is Class II evidence that early surgery can be done safely in a patient with spinal cord injury (Fehlings, et al; Spine 2001). The findings from this retrospective study suggest that early surgical intervention may improve neurological recovery.

Introduction:

Cervical spondylotic myelopathy (CSM) is a degenerative condition that results in a non-traumatic, progressive and chronic compression of the cervical spinal cord.

Surgery is indicated for patients with moderate to severe myelopathy or progressive myelopathy. Literature shows that decompressive surgery halts progression of the condition. We undertook this study to see if there is a worthwhile improvement in function in patients who had spine decompression for cervical spondylotic myelopathy.

Aims

The aim of the present study was to analyze the oncological and neurological outcome of patients undergoing interdisciplinary treatment for primary malignant bone and soft-tissue tumours of the spine within the last seven decades, and changes over time.

The revised Tokuhashi score has been widely used to evaluate indications for surgery and predict survival in patients with metastatic spinal disease. Our objective was to determine whether the score accurately predicted survival in those with MSCC. Retrospective analysis. All patients with MSCC presenting to our unit were included in this study from October 2003 to December 2009. Patients were divided into three groups – Tokuhashi score 0 – 8, 9 – 11 and 12 -15. Neurological outcome and survival. A total of 109 patients with MSCC were managed in our unit during this time. Mean age of patients was 61 years (range 7 - 86). Mean and median survival was 350 (5-2256) and 93 days in the 0-8 group, 439 (8-1902) and 229 days in the 9-11 group, and 922 (6-222) and 875 days in the 12-15 group; p = 0.01. All patients underwent decompression and stabilisation surgery. The rate of consistency between the prognostic score and actual survival was 64% (0-8), 64% (9-11) and 69% (12-15). Overall the consistency was 66%. There was no difference in neurological outcome between the 3 groups. There was a significant difference in the mean survival between groups. There was a moderate consistency between predicted and actual survival in this group of patients who all had cord compression. All patients had undergone some form of decompression and stabilisation surgery regardless of the overall revised Tokuhashi score

To assess whether the timing of surgery is an important factor in neurological outcome in patients with MSCC. Retrospective review. All patients with MSCC presenting to our unit were included in this study from October 2003 to December 2009. Patients were divided into three groups - those who underwent surgery within 24 hours (Group 1), those 24 hours to 48 hours (Group 2) and those greater than 48 hours (Group 3). Neurological outcome (improvement in Frankel score), complication rate and survival were assessed in all groups. A total of 109 patients with MSCC were operated on in our unit during this time. Mean age of patients was 61 years (range 7 - 86). The number that had at least one grade of Frankel improvement was 21 /37 (57%) in group 1; 11/17 (65%) in group 2 and 20/49 (41%) in group 3, p=0.03. When patients treated less than 24 hours were compared with those greater than 24 hours, the Frankel grade improvement approached significance (p=0.05). When we compared those who had surgery within 48 hours and those greater than 48 hours, the Frankel grade improvement was highly significant (p=0.009). There was no difference in survival or complications between the groups. Our results suggest that early surgical treatment in patients with MSCC gives a better neurological outcome but has no influence on survival or complication rates

Aims

The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI).