Timing operací páteře při akutním poškození míchy a jeho vliv na vývoj neurologického nálezu
Richard Lukáš, Pavel Barsa, Jan Pazour, Jaroslav Šrám
Klíčová slova: časové faktory, dekomprese chirurgická, lidé, mícha - poranění, obnova funkce, páteř
Anotace: PURPOSE OF THE STUDY The effect of an early surgical intervention in the traumatised spine on resolution of neurological deficit still remains a topic of professional discussions. The aim of this retrospective study was to find a correlation between the length of an injury-to-surgery interval and the development of a post-operative neurological deficit, and thus to answer the question of whether early surgical decompression and stabilization gives better chance of neurological recovery. MATERIAL AND METHODS Medical records of consecutive surgical patients admitted between 2007 and 2010 with traumatic spinal cord injury were reviewed and the injury-to-surgery interval and post-operative development of neurological deficit at a minimum follow-up of 6 months was evaluated. The initial neurological finding and the finding at 6 months of follow-up were classified on the Frankel scale and the outcome was assessed as improved or unimproved. The patients were allocated to four subgroups according to the time that elapsed between injury and surgery, i.e., time up to 24 h, 24 - 72 h, 72 h - 1 week, and longer than 1 week. The percentage of improved patients was calculated in each subgroup and the results were statistically evaluated using the Kruskal-Wallis test at a significance level of 0.1. RESULTS Out of the total number of 32 evaluated patients, 28 had at least partial neurological recovery. In the subgroup treated within first 24 h, improvement was found in 93 % of the patients, in the 24 - 72 h subgroup it was 80%, in the 72 h - 1 week subgroup it was 60% and surgery later than a week after injury resulted in improvement in 42% of the patients. Based on statistical evaluation, the time between injury and surgery appeared to be a significant prognostic factor. When a paired comparison of subgroups was made, the only significant difference was found between the subgroup treated within 24 hours of injury and that operated on later than a week after injury. The other paired comparisons failed to show a significant difference due to a small number of patients; however, a tendency to better functional results was observed in all earlier-treated subgroups. DISCUSSION The authors are aware of few limitations of the study. Its retrospective character, a relatively small number of patients and a single institution setup may limit the interpretation. Despite this fact, the message is clear. Similar studies carried out prospectively at several institutions may, however, provide results with a higher validity. CONCLUSIONS Patients with traumatic spinal cord injury who undergo early decompression and stabilisation have a higher chance of at least partial neurological recovery.
Citace: LUKÁŠ, Richard, Pavel BARSA, Jan PAZOUR a Jaroslav ŠRÁM. Timing operací páteře při akutním poškození míchy a jeho vliv na vývoj neurologického nálezu. Acta chirurgiae orthopaedicae et traumatologiae čechoslovaca. 2012, 79(3), 233-237. Dostupné také z: http://www.medvik.cz/link/bmc12021469