The impact of time from injury to surgery on the risk of neuropathic pain after traumatic spinal cord injury

Journal of Orthopaedic Surgery and Research, 2023 · DOI: https://doi.org/10.1186/s13018-023-04355-7 · Published: November 7, 2023

Spinal Cord Injury Pain Management Surgery

Simple Explanation

Traumatic spinal cord injury (SCI) is a serious condition often accompanied by neuropathic pain (NeP), impacting patients' lives. This study investigates how the timing of surgery after a spinal cord injury affects the likelihood of developing NeP. The study reviewed records of 320 patients with traumatic SCI who had surgery. It looked at factors like demographics, injury details, surgery specifics, and pain assessments to see what might be linked to NeP. The research found that in patients with incomplete SCI (AIS B, C, and D), earlier surgery was associated with a lower risk of developing NeP. This suggests that prompt surgical intervention could help prevent chronic pain after SCI.

Study Duration

Between 2017.01 and 2021.01, with a minimum follow-up of 12 months

Participants

320 patients with traumatic SCI who underwent surgical intervention

Evidence Level

Not specified

Key Findings

1
Age at injury, Injury Severity Score, and neurological level of injury are independent risk factors for the development of NeP in both AIS A and AIS B, C, and D subgroups.
2
A significant association between the time from injury to surgery and NeP was observed in AIS B, C, and D patients, while no such association was found in AIS A patients.
3
Patients with incomplete traumatic SCI (AIS B, C, and D) benefit from early and ultra-early surgical intervention in preventing NeP.

Research Summary

This retrospective study investigated the impact of time from injury to surgery on neuropathic pain (NeP) development after traumatic spinal cord injury (SCI). The study found that delayed surgical intervention in patients with incomplete SCI (AIS B, C, and D) was associated with an increased risk of NeP. Early surgical intervention, especially ultra-early surgery (within 8 hours), may help mitigate the incidence of NeP after traumatic SCI in AIS B, C, and D patients.

Practical Implications

Optimizing Surgical Timing

Early surgical intervention, particularly within 8-24 hours, should be considered for patients with incomplete SCI (AIS B, C, and D) to potentially reduce the risk of developing neuropathic pain.

Risk Factor Awareness

Clinicians should be aware of the identified risk factors (age at injury, Injury Severity Score, neurological level of injury) for NeP development in SCI patients to provide targeted preventative strategies.

Further Research

Prospective studies are needed to confirm these findings and establish evidence-based surgical guidelines for managing traumatic SCI and preventing NeP effectively.

Study Limitations

1
Retrospective study design introduces biases and constraints in data collection.
2
The study lacked objective indicators for evaluating neuropathic pain, including sophisticated neuro-physiological techniques.
3
Specific intraoperative intricacies, such as the surgical approach and decompression techniques, were omitted.

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