Traumatic Spinal Cord Injury
Conditions
Keywords
Traumatic Spinal Cord Injury
Brief summary
To compare the outcome of early versus delayed surgical decompression among patients presenting with traumatic spinal cord injury in a tertiary care hospital.
Detailed description
Despite the increasing advocacy for early surgery, significant variability persists in clinical practice. This inconsistency stems from conflicting evidence in the literature, with some studies reporting substantial neurological benefits from early intervention, while others find no significant difference compared to delayed surgery. Similarly, in our institute, both early and delayed decompressions are in practice, whichever considered suitable by the experts. But no study has done to date that compare the outcome of both techniques. Given these gaps, there is a pressing need for a comprehensive evaluation of the existing evidence to determine the optimal timing of surgical intervention for acute traumatic SCI especially among our local population where past evidence is scarce. So, this study seeks to contribute to this critical discourse by systematically evaluating the impact of early versus delayed surgical decompression on clinical outcomes in our local population. The study would not only add evidence to the global and local data but would also help the surgeons to choose the better technique in future as the technique with better outcome would be preferred in future among all the local patients who will present to our hospital with acute SCI. Adopting the treatment strategy with better outcome would also help to reduce the overall morbidity associated with a cute SCI in our local population. Finally objectives are , to compare the outcome of early versus delayed surgical decompression among patients presenting with traumatic spinal cord injury in a tertiary care hospital.
Interventions
PROCEDUREEarly Surgical Decompression
it will be defined as the surgical decompression performed within 24 hours of injury. It will be performed among all the patients who presented within 24 hours of injury.
PROCEDUREDelayed Surgical Decompression
It will be defined as the surgical decompression performed after 24 hours of spinal cord injury. It will be performed among all the patients who needed it due to medical optimization (such as hemodynamically unstable, shock, pulmonary contusions, cerebrovascular destabilization etc.) or those who will present after 24 hours of injury due to logistical delay.
Sponsors
Fauji Foundation Hospital
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Patients presenting with spinal cord injury (both cervical and thoracic) as per described in the operational definition * Age from 18-60 years * Both male and female patients
Exclusion criteria
* Patients with penetrating spinal injuries such as gunshot/stab wounds * Patients with pre-existing neurological conditions like myelopathy etc. * Patients with any kind of malignancy * Patients having CSF infection etc. * Patients who are not fit for general anesthesia (i.e. ASA Grade \>2 Annexure-B) * Diagnosis of subclinical or clinical polyneuropathy * Non-traumatic or pathological fractures or cord compression * Inability to cooperate with preoperative physical examination because of cognitive impairment * Patients with previous spinal column or SCI.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| improvement in neurological impairment using ASIA Impairment Scale (AIS) | 12 Weeks after surgery | Treatment outcomes will be measured 12 weeks after early or delayed surgical decompression among all the patients who underwent spinal cord injury in terms of improvement in neurological impairment using ASIA Impairment Scale (AIS) attached as annexure-C. Outcome will be labelled as good if shows improvement for at least two AIS grades. |
Countries
Pakistan
Contacts
CONTACTDr. Salman Tahir, MBBS
Outcome results
None listed