Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study

Satoshi Nori; Kota Watanabe; Kazuki Takeda; Junichi Yamane; Hitoshi Kono; Noriaki Yokogawa; Takeshi Sasagawa; Kei Ando; Hiroaki Nakashima; Naoki Segi; Toru Funayama; Fumihiko Eto; Akihiro Yamaji; Takeo Furuya; Atsushi Yunde; Hideaki Nakajima; Tomohiro Yamada; Tomohiko Hasegawa; Yoshinori Terashima; Ryosuke Hirota; Hidenori Suzuki; Yasuaki Imajo; Shota Ikegami; Masashi Uehara; Hitoshi Tonomura; Munehiro Sakata; Ko Hashimoto; Yoshito Onoda; Kenichi Kawaguchi; Yohei Haruta; Hiroshi Uei; Hirokatsu Sawada; Kazuo Nakanishi; Kosuke Misaki; Hidetomi Terai; Koji Tamai; Eiki Shirasawa; Gen Inoue; Katsuhito Kiyasu; Yoichi Iizuka; Eiji Takasawa; Haruki Funao; Takashi Kaito; Toshitaka Yoshii; Masayuki Ishihara; Seiji Okada; Shiro Imagama; Satoshi Kato

doi:10.1016/j.jos.2023.01.004

Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study

Satoshi Nori, Kota Watanabe, Kazuki Takeda, Junichi Yamane, Hitoshi Kono, Noriaki Yokogawa, Takeshi Sasagawa, Kei Ando, Hiroaki Nakashima, Naoki Segi, Toru Funayama, Fumihiko Eto, Akihiro Yamaji, Takeo Furuya, Atsushi Yunde, Hideaki Nakajima, Tomohiro Yamada, Tomohiko Hasegawa, Yoshinori Terashima, Ryosuke HirotaHidenori Suzuki, Yasuaki Imajo, Shota Ikegami, Masashi Uehara, Hitoshi Tonomura, Munehiro Sakata, Ko Hashimoto, Yoshito Onoda, Kenichi Kawaguchi, Yohei Haruta, Hiroshi Uei, Hirokatsu Sawada, Kazuo Nakanishi, Kosuke Misaki, Hidetomi Terai, Koji Tamai, Eiki Shirasawa, Gen Inoue, Katsuhito Kiyasu, Yoichi Iizuka, Eiji Takasawa, Haruki Funao, Takashi Kaito, Toshitaka Yoshii, Masayuki Ishihara, Seiji Okada, Shiro Imagama, Satoshi Kato

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. Methods: In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. Results: The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. Conclusions: Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.

Original language	English
Journal	Journal of Orthopaedic Science
DOIs	https://doi.org/10.1016/j.jos.2023.01.004
Publication status	Accepted/In press - 2023
Externally published	Yes

Keywords

Cervical spinal cord injury
Elderly patients
Neurological outcomes
No bone injury
Relatively early surgery
Surgical timing

ASJC Scopus subject areas

Surgery
Orthopedics and Sports Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jos.2023.01.004

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Nori, S., Watanabe, K., Takeda, K., Yamane, J., Kono, H., Yokogawa, N., Sasagawa, T., Ando, K., Nakashima, H., Segi, N., Funayama, T., Eto, F., Yamaji, A., Furuya, T., Yunde, A., Nakajima, H., Yamada, T., Hasegawa, T., Terashima, Y., ... Kato, S. (Accepted/In press). Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study. Journal of Orthopaedic Science. https://doi.org/10.1016/j.jos.2023.01.004

Nori, S, Watanabe, K, Takeda, K, Yamane, J, Kono, H, Yokogawa, N, Sasagawa, T, Ando, K, Nakashima, H, Segi, N, Funayama, T, Eto, F, Yamaji, A, Furuya, T, Yunde, A, Nakajima, H, Yamada, T, Hasegawa, T, Terashima, Y, Hirota, R, Suzuki, H, Imajo, Y, Ikegami, S, Uehara, M, Tonomura, H, Sakata, M, Hashimoto, K, Onoda, Y, Kawaguchi, K, Haruta, Y, Uei, H, Sawada, H, Nakanishi, K, Misaki, K, Terai, H, Tamai, K, Shirasawa, E, Inoue, G, Kiyasu, K, Iizuka, Y, Takasawa, E, Funao, H, Kaito, T, Yoshii, T, Ishihara, M, Okada, S, Imagama, S & Kato, S 2023, 'Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study', Journal of Orthopaedic Science. https://doi.org/10.1016/j.jos.2023.01.004

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title = "Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study",

abstract = "Background: Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. Methods: In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. Results: The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. Conclusions: Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.",

keywords = "Cervical spinal cord injury, Elderly patients, Neurological outcomes, No bone injury, Relatively early surgery, Surgical timing",

author = "Satoshi Nori and Kota Watanabe and Kazuki Takeda and Junichi Yamane and Hitoshi Kono and Noriaki Yokogawa and Takeshi Sasagawa and Kei Ando and Hiroaki Nakashima and Naoki Segi and Toru Funayama and Fumihiko Eto and Akihiro Yamaji and Takeo Furuya and Atsushi Yunde and Hideaki Nakajima and Tomohiro Yamada and Tomohiko Hasegawa and Yoshinori Terashima and Ryosuke Hirota and Hidenori Suzuki and Yasuaki Imajo and Shota Ikegami and Masashi Uehara and Hitoshi Tonomura and Munehiro Sakata and Ko Hashimoto and Yoshito Onoda and Kenichi Kawaguchi and Yohei Haruta and Hiroshi Uei and Hirokatsu Sawada and Kazuo Nakanishi and Kosuke Misaki and Hidetomi Terai and Koji Tamai and Eiki Shirasawa and Gen Inoue and Katsuhito Kiyasu and Yoichi Iizuka and Eiji Takasawa and Haruki Funao and Takashi Kaito and Toshitaka Yoshii and Masayuki Ishihara and Seiji Okada and Shiro Imagama and Satoshi Kato",

note = "Publisher Copyright: {\textcopyright} 2023 The Japanese Orthopaedic Association",

year = "2023",

doi = "10.1016/j.jos.2023.01.004",

language = "English",

journal = "Journal of Orthopaedic Science",

issn = "0949-2658",

publisher = "Springer Japan",

}

TY - JOUR

T1 - Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly

T2 - A retrospective multicenter study

AU - Nori, Satoshi

AU - Watanabe, Kota

AU - Takeda, Kazuki

AU - Yamane, Junichi

AU - Kono, Hitoshi

AU - Yokogawa, Noriaki

AU - Sasagawa, Takeshi

AU - Ando, Kei

AU - Nakashima, Hiroaki

AU - Segi, Naoki

AU - Funayama, Toru

AU - Eto, Fumihiko

AU - Yamaji, Akihiro

AU - Furuya, Takeo

AU - Yunde, Atsushi

AU - Nakajima, Hideaki

AU - Yamada, Tomohiro

AU - Hasegawa, Tomohiko

AU - Terashima, Yoshinori

AU - Hirota, Ryosuke

AU - Suzuki, Hidenori

AU - Imajo, Yasuaki

AU - Ikegami, Shota

AU - Uehara, Masashi

AU - Tonomura, Hitoshi

AU - Sakata, Munehiro

AU - Hashimoto, Ko

AU - Onoda, Yoshito

AU - Kawaguchi, Kenichi

AU - Haruta, Yohei

AU - Uei, Hiroshi

AU - Sawada, Hirokatsu

AU - Nakanishi, Kazuo

AU - Misaki, Kosuke

AU - Terai, Hidetomi

AU - Tamai, Koji

AU - Shirasawa, Eiki

AU - Inoue, Gen

AU - Kiyasu, Katsuhito

AU - Iizuka, Yoichi

AU - Takasawa, Eiji

AU - Funao, Haruki

AU - Kaito, Takashi

AU - Yoshii, Toshitaka

AU - Ishihara, Masayuki

AU - Okada, Seiji

AU - Imagama, Shiro

AU - Kato, Satoshi

PY - 2023

Y1 - 2023

N2 - Background: Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. Methods: In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. Results: The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. Conclusions: Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.

AB - Background: Although previous studies have demonstrated the advantages of early surgery for traumatic spinal cord injury (SCI), the appropriate surgical timing for cervical SCIs (CSCIs) without bone injury remains controversial. Here, we investigated the influence of relatively early surgery within 48 h of injury on the neurological recovery of elderly patients with CSCI and no bone injury. Methods: In this retrospective multicenter study, we reviewed data from 159 consecutive patients aged ≥65 years with CSCI without bone injury who underwent surgery in participating centers between 2010 and 2020. Patients were followed up for at least 6 months following CSCI. We divided patients into relatively early (≤48 h after CSCI, n = 24) and late surgery (>48 h after CSCI, n = 135) groups, and baseline characteristics and neurological outcomes were compared between them. Multivariate analysis was performed to identify factors associated with neurological recovery. Results: The relatively early surgery group demonstrated a lower prevalence of cardiac disease, poorer baseline American Spinal Injury Association (ASIA) impairment scale grade, and lower baseline ASIA motor score (AMS) than those of the late surgery group (P < 0.030, P < 0.001, and P < 0.001, respectively). Although the AMS was lower in the relatively early surgery group at 6 months following injury (P = 0.001), greater improvement in this score from baseline to 6-months post injury was observed (P = 0.010). Multiple linear regression analysis revealed that relatively early surgery did not affect postoperative improvement in AMS, rather, lower baseline AMS was associated with better AMS improvement (P < 0.001). Delirium (P = 0.006), pneumonia (P = 0.030), and diabetes mellitus (P = 0.039) negatively influenced postoperative improvement. Conclusions: Although further validation by future studies is required, relatively early surgery did not show a positive influence on neurological recovery after CSCI without bone injury in the elderly.

KW - Cervical spinal cord injury

KW - Elderly patients

KW - Neurological outcomes

KW - No bone injury

KW - Relatively early surgery

KW - Surgical timing

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DO - 10.1016/j.jos.2023.01.004

M3 - Article

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SN - 0949-2658

JO - Journal of Orthopaedic Science

JF - Journal of Orthopaedic Science

ER -

Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: A retrospective multicenter study

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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