TY - JOUR
T1 - Efficacy of Early Surgery for Neurological Improvement in Spinal Cord Injury without Radiographic Evidence of Trauma in the Elderly
AU - Inoue, Tomoo
AU - Suzuki, Shinsuke
AU - Endo, Toshiki
AU - Uenohara, Hiroshi
AU - Tominaga, Teiji
PY - 2017/9
Y1 - 2017/9
N2 - Background The optimal timing for surgery for patients with spinal cord injury without radiographic evidence of trauma (SCIWORET) remains unclear. This is especially true in the elderly, given that most studies are done with younger patients to avoid age-related comorbidities. We aimed to compare the efficacy of early (<24 hours postinjury) and late (>24 hours postinjury) surgery in patients with SCIWORET aged ≥65 years. Methods We identified patients aged ≥65 years who underwent surgery for SCIWORET between January 1995 and February 2016. The primary outcome was a change in the Japanese Orthopaedic Association (JOA) score at discharge, with a recovery of >50% defined as a favorable neurologic outcome. Logistic regression analysis was performed, and model fit was assessed using the Hosmer–Lemeshow test. Results Eighty patients aged ≥65 years with SCIWORET underwent surgery were enrolled. Favorable neurologic outcomes were seen in 43.3% of those who underwent early surgery, but only in 18.0% of those who underwent late surgery. Logistic regression analysis, adjusted for age, sex, comorbidities (Charlson Comorbidity Index), and JOA score, revealed that early surgery independently predicted favorable outcomes (odds ratio, 4.06; 95% confidence interval, 1.25–13.20), with excellent calibration (Hosmer–Lemeshow, P = 0.857). Conclusions The present study indicated that early surgery within 24 hours of injury for elderly patients with SCIWORET could lead to more favorable neurologic improvements. We believe that chronological age alone should not be considered sufficient justification to deny patients early surgical decompression for SCIWORET.
AB - Background The optimal timing for surgery for patients with spinal cord injury without radiographic evidence of trauma (SCIWORET) remains unclear. This is especially true in the elderly, given that most studies are done with younger patients to avoid age-related comorbidities. We aimed to compare the efficacy of early (<24 hours postinjury) and late (>24 hours postinjury) surgery in patients with SCIWORET aged ≥65 years. Methods We identified patients aged ≥65 years who underwent surgery for SCIWORET between January 1995 and February 2016. The primary outcome was a change in the Japanese Orthopaedic Association (JOA) score at discharge, with a recovery of >50% defined as a favorable neurologic outcome. Logistic regression analysis was performed, and model fit was assessed using the Hosmer–Lemeshow test. Results Eighty patients aged ≥65 years with SCIWORET underwent surgery were enrolled. Favorable neurologic outcomes were seen in 43.3% of those who underwent early surgery, but only in 18.0% of those who underwent late surgery. Logistic regression analysis, adjusted for age, sex, comorbidities (Charlson Comorbidity Index), and JOA score, revealed that early surgery independently predicted favorable outcomes (odds ratio, 4.06; 95% confidence interval, 1.25–13.20), with excellent calibration (Hosmer–Lemeshow, P = 0.857). Conclusions The present study indicated that early surgery within 24 hours of injury for elderly patients with SCIWORET could lead to more favorable neurologic improvements. We believe that chronological age alone should not be considered sufficient justification to deny patients early surgical decompression for SCIWORET.
KW - Degenerative cervical spine disorders
KW - Early surgery
KW - Elderly
KW - JOA score
KW - SCIWORET
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U2 - 10.1016/j.wneu.2017.06.070
DO - 10.1016/j.wneu.2017.06.070
M3 - Article
C2 - 28645598
AN - SCOPUS:85021956759
VL - 105
SP - 790
EP - 795
JO - World Neurosurgery
JF - World Neurosurgery
SN - 1878-8750
ER -