The influence of the energy of trauma, the timing of decompression, and the impact of grade of SCI on outcome

STUDY DESIGN  Retrospective cohort study. OBJECTIVES  To find out: (1) if the energy of trauma (high and low) influence the outcome after cervical spinal cord injury; (2) if time to decompression and degree of injury (complete and incomplete) influence the outcome after high- and low-energy cervical spinal cord injury. METHODS  Twenty-one consecutive patients with low-energy cervical spinal cord injury were identified from the spinal injuries unit database (eg, ball sports, diving, surfing, and falls). Twenty-one aged-matched patients with high-energy cervical spinal cord injury (eg, motor vehicle trauma) were then randomly selected and the groups were compared. All patients had formal American Spinal Injuries Association assessment on admission and at 6 months. RESULTS  At the 6-month follow-up, the energy of the initial trauma was not found to influence the neurological outcome (P = .76). Early definitive intervention (<8 hours) for patients with incomplete cord lesions was shown to significantly affect outcome (P = .049). As expected, patients with an incomplete spinal cord injury at presentation showed significantly greater neurological improvement at follow-up compared with those with complete injuries (P = .006). CONCLUSIONS  We were unable to find a correlation between the energy of the initial trauma causing a spinal cord injury and the neurological outcome. Early definitive decompression improved outcomes for patients with spinal cord injury, especially those with incomplete spinal cord injury. [Table: see text] The definiton of the different classes of evidence is available on page 55.