ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1619141
The Impact of Early Versus Delayed Surgery on Outcomes in Cervical Spinal Cord Injury Without Fracture or Dislocation
Provisionally accepted
- 1Beijing Tongren Hospital, Capital Medical University, Beijing, China
- 2Department of orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Objective:This study retrospectively analyzed 104 patients with cervical spinal cord injury without fracture or dislocation (CSCIwoFD) who underwent surgical treatment, comparing neurological recovery between early and delayed surgery.Methods:Patients treated between August 2020 and January 2023 were categorized into early (≤7 days) and delayed (>7 days) surgery groups. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, ASIA motor score (AMS), and sensory score (ASS), with recovery rates (RR, AMSRR, ASSRR) calculated. Imaging parameters, including maximum canal compromise (MCC) and maximum spinal cord compression (MSCC), were analyzed. Pearson correlation and intergroup comparisons evaluated outcomes and complications.Results:MSCC correlated positively with RR, JOA, AMS, and AMSRR, but only weakly with ASSRR. No significant association was found between MSCC and age, sex, or surgical approach, although a mild positive correlation with surgical timing was noted. The early surgery group had longer operative times and greater blood loss, but complication rates and hospital-related metrics were similar between groups (P > 0.05). Higher MCC and MSCC were observed in the early group, with MSCC showing significant difference (P < 0.05).Postoperatively, both groups showed improved JOA, AMS, and ASS scores, but improvements were significantly greater in the early surgery group. Significant differences were noted in JOA and AMS at 6 months, 1 year, and 2 years, and in ASS at 1 and 2 years (P < 0.05). The 2-year JOA score difference exceeded the minimal clinically important difference. Recovery rates (RR, AMSRR, ASSRR) were also significantly better in the early group. MSCC was positively correlated with 3-month RR (γ = 0.527) and AMSRR (γ = 0.277).Conclusion:Both early and delayed surgeries improved outcomes in CSCIwoFD, but early surgery led to superior recovery. MSCC is a valuable predictor of motor recovery, and surgery within 7 days is recommended when trauma stabilization allows.
Keywords: Cervical spinal cord injury without fracture or dislocation, Early surgery, Delayed surgery, Anterior cervical discectomy and fusion (ACDF), posterior cervical surgery, JOA scores, ASIA score
Received: 27 Apr 2025; Accepted: 01 Jul 2025.
Copyright: © 2025 Xiao, Yan, Bao, Wu, Cheng, Xu and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jiaguang Tang, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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