Early versus late surgical decompression for traumatic thoracic/thoracolumbar (T1-L1) spinal cord injured patients. Primary results of a randomized controlled trial at one year follow-up.

OBJECTIVE To assess the efficacy of surgical decompression <24 (early) versus 24-72 hours (late) in thoracic/thoracolumbar traumatic spinal cord injury (TSCI). METHODS A randomized controlled trial (RCT) of 35 T1-L1 TSCI patients including early (n=16) and late (n=19) surgical decompression was conducted in the neurosurgery department of Shahid Rajaee Hospital from September 2010. Pre- and postoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor/sensory scores, length of hospitalization, complications, postoperative vertebral height restoration/rebuilding and angle reduction, and 12-month loss of height restoration/rebuilding and angle reduction were evaluated. RESULTS Sixteen patients (46%) had complete TSCI. No AIS change was seen in 17 (52%) patients. Complete TSCI patients had no motor improvement. The AIS change in this group was solely due to increased sensory scores. For incomplete TSCI, the mean motor score improved from 77 (± 22) to 92 (± 12) in early, and from 68 (± 22) to 82 (± 16) in late surgery. One deep vein thrombosis was observed in each group. There were 2 wound infections, one CSF leak, one case of meningitis, and one decubitus ulcer in the late surgery group. Six screw revisions were required. CONCLUSION Our primary results show overall AIS and motor score improvement in both groups. Motor improvement was only observed in incomplete TSCI. Two-grade improvements in AIS were seen in 3 early, and one late surgery patient.