Earlier Decompression (< 8 Hours) Results in Better Neurological and Functional Outcome after Traumatic Thoracolumbar Spinal Cord Injury

The optimal timing of surgical intervention following spinal cord injury (SCI) remains under debate. Recent studies indicate a potential neurological and functional benefit of early surgery (< 8 h) after cervical SCI. For thoracolumbar SCI syndromes, fewer studies exist. Bladder and bowel dysfunction are highly relevant for these patients and impair their quality of life. Hence, we performed a retrospective study on patients with thoracolumbar SCI who were operated on at our institution and who met inclusion as well as exclusion criteria (n = 58 patients). Follow-up data were collected prospectively within a fixed time schedule over 1 year according to the European Multicenter Study about Spinal Cord Injury protocol. Early decompression was defined as within the first 8 h after injury and was performed in 35 patients. After the follow-up period, the early decompression group showed improved American Spinal Injury Association Impairment Scale (AIS) grades (p < 0.040) and a higher AIS conversion (p < 0.021). Further, these patients demonstrated a higher total Spinal Cord Independence Measure (SCIM) difference (p < 0.005). Special emphasis was placed on the functional bladder and bowel outcome. Here, we observed improved bladder outcome (i.e., SCIM-6 sub-item; p < 0.021) and a trend towards better functional bowel management (i.e., SCIM-7; p < 0.090). Linear regression models showed that early surgery was an independent predictor for higher AIS shifts and improved total SCIM difference. Our data suggests that prompt surgical management after thoracolumbar SCI might have a positive impact on the functional and neurological outcome.