Timing Matters for Spinal Cord Injury, Surgery Sooner Improves Outcome: Study

By Sheryl Ubelacker
Getting people who suffer an upper spinal cord injury into the operating room for decompression surgery sooner rather than later can have a significant payoff, even reducing the likelihood of permanent paralysis for some patients, researchers say.
A Canadian-U.S. study of patients with trauma to the cervical spinal cord found that those who had surgery within 24 hours of the injury had twice the chance of a much improved neurological recovery compared to those who had to wait longer for their operation.
The cervical spinal cord is encased in seven bony vertebrae that begin at the nape of the neck. Immediately below are the thoracic vertebrae, followed by those in the lumbar region that end in the tail bone.

The study focused on trauma to the cervical spine, the area which accounts for 30 per cent of all spinal cord injuries and can lead to a person becoming a quadriplegic.

“These are patients who have a very severe injury of the spinal cord,” said Toronto neurosurgeon Michael Fehlings, who led the study.

Traumas that cause upper spinal cord injury often occur from falls, sports injuries or motor vehicle accidents, said Dr. Fehlings, medical director of the Krembil Neuroscience Centre at Toronto Western Hospital.

“In most cases, there is a fracture of the cervical spine that results in either a dislocation of the vertebrae or a crush of one of the vertebra,” he said. “Or in some cases, patients who have pre-existing narrowing of the spinal canal due to degenerative disk disease or arthritis can have blunt trauma injury to the cord without an actual fracture.”

In the study of 313 patients with cervical spinal cord injury, published online Thursday in the journal PLoS ONE, almost 20 per cent of those who had decompression surgery on their spines within 24 hours showed marked improvement in function compared to less than nine per cent of those who had surgery later.

The operation involves releasing the pressure on the injured spinal cord and then stabilizing it.

“The differences that we are seeing with early decompression surgery are very significant and the results have a major impact on a person's life,” said Dr. Fehlings. In rare cases, and depending on the severity of the injury, a patient who otherwise would likely have been paralyzed was able to walk.

“The timing for a spinal cord injury matters. In other words, it's like a stroke or a heart attack. Both stroke and heart attack (are) medical emergencies ... The same is true for spinal cord injury.”

Dr. Fehlings said regional centres that specialize in traumatic spinal cord injuries should be created across Canada with the aim of providing patients, who may need to be transported from remote areas, more timely access to surgery.