Outcomes of early vs delayed surgical intervention in geriatric patients with cervical spinal fractures and spinal cord injuries.

BACKGROUND

Older adults have high rates of morbidity and mortality following traumatic spinal cord injuries (SCI) but are also at increased risk of intraoperative and postoperative complications compared to younger counterparts. This study aims to identify the optimal time to surgical intervention in elderly patients presenting with traumatic SCI.

METHODS

A retrospective review was carried out at our centre from 2016 to 2020 to identify geriatric patients (≥65 years old) presenting with a traumatic SCI, managed surgically. Cohorts were categorised and compared for outcomes based on their time from injury to surgery. The different time intervals assessed include: 24 h and 72 h.

RESULTS

72 patients were identified. 13/72 (18.1 %) underwent surgery within 24 h of their injury and 32/72 (44.4 %) underwent surgery within 72 h of their injury. Overall, the results favoured delayed surgical intervention for both time intervals in terms of high dependency unit (HDU) requirement (p = 0.004 and p = 0.048), intensive care unit (ICU) requirement (p = 0.001 and p = 0.015) and intraoperative complications (p = 0.043 and p = 0.02). Of the patients with preoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS) A grade, those who underwent surgical decompression after 72 h had greater neurological improvement (p = 0.019) and a smaller proportion of HDU (p = 0.006) and ICU (p = 0.047) requirement.

CONCLUSION

To the authors' knowledge, this is the first study to compare surgical outcomes in geriatric patients with traumatic spinal cord injury (SCI) based on injury-to-surgery time intervals. The findings are hypothesis-generating and suggest a potential benefit to delayed surgical intervention in a subset of these patients. Further prospective research is needed to better define optimal timing and management strategies in this complex and vulnerable population.