Surgical and Nonsurgical Treatment of Penetrating Spinal Cord Injury: Analysis of Long-term Neurological and Functional Outcomes

Top Spinal Cord Inj Rehabil, 2019 · DOI: 10.1310/sci2502–186 · Published: June 1, 2019

Spinal Cord Injury Surgery Rehabilitation

Simple Explanation

This study examines the long-term effects of surgery versus no surgery on patients with penetrating spinal cord injuries (PSCIs). It looks at how these treatments affect neurological and functional recovery. The researchers used data from the Spinal Cord Injury Model Systems (SCIMS) database, analyzing patient outcomes based on whether they received surgery or not. The study found that surgery for complete PSCI is associated with increased hospital stay, but no improvement in neurological or functional outcomes compared to non-surgical treatment.

Study Duration

1994-2015

Participants

1,052 PSCI admissions (212 SX patients and 840 NSX patients)

Evidence Level

Not specified

Key Findings

1
Surgery for complete PSCI is associated with a longer acute hospital stay.
2
There was no significant difference in neurological or functional outcomes at 1-year follow-up between surgical and non-surgical groups for both complete and incomplete PSCI.
3
Surgery was identified as an independent predictor of increased acute hospital length of stay.

Research Summary

This study analyzed long-term outcomes of surgical (SX) and non-surgical (NSX) treatment for penetrating spinal cord injury (PSCI) patients using the Spinal Cord Injury Model Systems (SCIMS) database from 1994-2015. The results indicated that surgery for complete PSCI is associated with increased acute hospital length of stay (LOS) but does not lead to improvement in neurological or functional outcomes at 1-year follow-up for either complete or incomplete PSCI. Linear regression analysis confirmed that surgery is an independent predictor of increased acute hospital LOS, suggesting that surgical intervention may not provide additional benefits in terms of functional recovery for these patients.

Practical Implications

Clinical Practice

The study suggests that surgical intervention for PSCI may not improve neurological or functional outcomes, challenging the necessity of surgery in all cases.

Resource Allocation

Given the increased hospital length of stay associated with surgery, healthcare resources might be better allocated to rehabilitation and other supportive care.

Future Research

Further research is needed to identify specific subgroups of PSCI patients who may benefit from surgery and to explore alternative treatment options.

Study Limitations

1
Retrospective analysis introduces potential selection bias and unmeasured baseline differences between groups.
2
The spine surgery variable in the SCIMS database lacks detailed information about the type of surgery performed.
3
Standardized scales like the FIM score have known ceiling effects in SCI patients, particularly at long-term follow-up.

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