The Study Of The Timing Of Surgery For Acute Central Cervical Spinal Cord Injury

Object: To investigate the effect of different operative timing on acute central cervical spinal cord injury.Method: The clinical data of 46 patients with acute central cervical spinal cord injury treated in The Second Hospital Affiliated to Suzhou University and the Department of neurosurgery in the 101 Hospital of Wuxi from March 2015 to March 2017 were analyzed retrospectively.According to the operation time,the patients were divided into 3 groups: group A(operation group within 48 hours after injury),group B(48 hours to 7 days after injury)and group C(operation group 7 days after injury),analysis of the age of three groups of patients.In the median sagittal plane,the sagittal diameter of the spinal canal,the maximum spinal canal stenosis(MCC),the maximum spinal cord compression(MSCC)and the T2 like high signal length of the spinal cord were not different.The choice of surgical methods was to use microscopically under the microscope to excise the intervertebral foramen,spinal canal decompression,or cervical posterior laminectomy with spinal canal decompression plus side block fixation.Recorded the postoperative complications of the three groups.The methods of telephone follow-up and outpatient follow-up were used to assess the neurological function of the patients.According to the standard method of evaluating the function of the cervical spinal cord(JOA17),the Department of orthopedics Association of Japan was used to evaluate the function of the patients.Results: There was no statistical difference between three groups of patients in age,MCC,MSCC,T2 high signal length and preoperative JOA score(P > 0.05).Among the 46 patients in this group,2 cases of A group had sore throat pain,2 cases of hoarseness in group B,1 cases of pulmonary infection,2 cases of sore throat pain in group C,1 cases of internal fixation loosening,3 cases of pulmonary infection,all cured after treatment.After operation,the scores of JOA were improved in all three groups.Compared with JOA score before operation,the JOA score was statistically significant(P < 0.05).The improvement of nerve function in the three groups was 1,6 and 12 months after operation.The effect of nerve function improvement in 1 months after the operation was better than that of the B operation group(P = 0.032)and C operation group(P = 0.027).The difference was statistically significant,there was no statistically significant difference between the B operation group and the C operation group(P = 0.895).The operative effect of the A operation group was better than the B operation group(P = 0.037)and the C operation group(P = 0.011)in 6 months after the operation,and the difference was statistically significant.There was no difference between the B operation group and the C operation group.Statistical significance(P = 0.493).12 months after operation,the effect of A operation group was better than that of B operation group(P = 0.011)and C operation group(P = 0.004),the difference was statistically significant,and there was no statistical difference between the B operation group and the C operation group.Conclusion: Early surgical treatment can effectively improve the spinal cord blood circulation,reduce the spinal cord edema,ischemia and a series of secondary damage,and the microscope operation is more safe,can reduce the occurrence of intraoperative complications,more conducive to the recovery of spinal nerve function.The results of this study suggest that the 48 hours of decompression surgery can improve the prognosis of the patient significantly.If the condition is allowed,it should be operated within 24 hours or even in the first 8 hours.