Evaluation of the relationship between time of early decompression and disability and quality of life in patients with acute traumatic spinal cord injury

Abstract

0. 0Introduction: Individuals with spinal cord injury (SCI) experience a noticeable reduction in qualityOf life (QOL) due to physical limitations and immobility after injury. Considering that secondary spinal cord injury can be prevented through decompression surgery.This study was conducted with the aim of investigating the relationship between time of early decompression and disability and quality of life in patients with acute trumatic spinal cord injury in the spinal cord injury patients of Tabriz city as well as the spinal cord injury patients registered in the spinal cord injury registry system of Iran. Method This study has 2 separate objectives with two different statistical populations and as a historical cohort on patients with spinal cord injury admitted to Imam Reza Hospital in Tabriz from 2022/09/22 to 2024/05/21 and patients with spinal cord injury registered in the registry system of spinal cord injury from 2016/04/03 to 2022/11/21 was done. To compare the quality of life between different levels of spinal cord injury, the mean and standard error were used and to investigate the relationship between the time of decompression surgery and the improvement of neurological outcomes, binary logistic regression was used. Results The average age of Tabriz patients was 39.8± 1.45, the majority were male (77.4%) and had paraplegic spinal cord injury (39.8%). Traffic accidents followed by falls were the cause of more than 90% of injuries. Quadriplegic patients had a significantly lower total mean (38.38±8.59) and paraparetic patients had a significantly higher total mean (91,26±3.51) than the other groups Also, among all areas of quality of life, regardless of the type of spinal cord injury, the highest average was related to breathing (97,39 ± 1,9) and the lowest average was related to usual life activities (58,73 ± 4,06). people who were decompressed less than 48 hours after surgery had a higher chance of ASIA level A and B compared to people who were operated more than 48 hours later, and this difference was not statistically significant (OR=2,49 ; 95% CI:0,73- 8,53), Also, the chance of ASIA recovery in people who underwent surgery less than 48 hours after the injury was reduced by 50%, which is not significant (OR=0,49; 95% CI: 0,2- 1,91). The chance of recovery increased 10.7 times in people who received methylprednisolone (P<0.001). The percentage of spinal cord decompression surgeries in less than 48 hours after injury was 34.3% in Iran and 5% in East Azerbaijan. Conclusion Identifying and eliminating the causes involved in the increase in surgery time should be prioritized by policymakers, the administration of methylprednisolone in spinal cord injury patients leads to better neurological outcomes. The level of damage is an important factor that determines the quality of life, and quadriplegic and paraplegic patients have a very low quality of life, and governments should consider support programs for these people in addition to injury prevention. By controlling the damage caused by traffic accidents and falls, more than 90% of spinal cord injuries can be reduced with an average age of less than 40 years. Also, in order to determine the best time for surgery, more studies by researchers with consecutive follow-ups of patients after discharge are needed Keywords: QOL (quality of life), spinal cord injury, paraplegia, paraparesis, quadriplegia, quadriparesis.