McMaster University

McMaster University

Surgical Treatment for Traumatic Spinal Cord Injury in Canada

We are pleased to share with you a recent publication in the Journal of Neurosurgery: Spine. This publication is entitled "Surgical treatment for traumatic spinal cord injury in Canada: a national registry-based study."

Find the abstract below.

Drew B, Tsai E, Finkelstein J, Ahn H, Kwon B, Fehlings M, Attabib N, Bailey C, Christie S, Fourney D, Hurlbert RJ, Johnson M, Paquet J, Parent S, Rivers C, Shen T, Noonan V. Surgical treatment for traumatic spinal cord injury in Canada: a national registry-based study. J Neurosurg Spine.


There is an increasing trend towards surgical intervention for traumatic spinal cord injury (tSCI), however the benefits of surgical intervention over non-surgical treatment remain a topic of debate. There is a lack of published data on surgical rates for tSCI, making it difficult to use global data to establish whether surgical management is advantageous. We describe current surgical practice in Canada for tSCI patients, including patient characteristics in those treated surgically and non-surgically, including trends over time.
We analyzed participants included in the Rick Hansen Spinal Cord Injury Registry (RHSCIR), a Canadian multicenter prospective registry of newly injured Canadians with tSCI to identify the patient and injury characteristics of those who did and did not receive acute surgical treatment for tSCI. We also identified annual rates of surgery across all RHSCIR sites from 2006-2012.
Of the 3074 participants in RHSCIR, 1603 (52.1%) had complete data including information on acute surgical or non-surgical treatment, and 1471 (47.9%) had minimal data recorded and analyzed to identify any biases. Of the 1603 with complete data, 1357 (84.7%) had acute surgical treatment for tSCI. Those treated surgically were younger (44.7 vs 52.8y, p<0.0001), more likely to have had a more severe injury (ASIA Impairment Scale (AIS) A/B; 54.3 vs 20.7%, p<0.0001), and more likely to have a thoracolumbar level of injury (37.1 vs 20.0%, p<0.0001). Those treated non-surgically were more likely injured by a fall (53.4 vs 40.9%, p=0.0003), have central cord syndrome (57.4 vs 24.3%, p<0.0001), and have more comorbidities (27.5 vs 38.0%, p=0.0045). Surgery rate across Canada varied from 81.4-94.8% from 2006-2012. Compared to those with complete data, participants with minimal data were older (49.1 vs 46.0y, p=0.0001), more likely to have a less severe injury (AIS C/D; 59.8 vs 50.3%, p<0.0001), and more likely to have a cervical level of injury (72.4 vs 65.2%, p=0.0004).
The rates of surgery for individuals with tSCI in Canada are high and have remained consistent over time. Specific anatomic locations and patterns of injury such as central cord syndrome may be preferentially treated without surgery. Future work on the comparative outcomes and value of surgical and non-surgical treatment will determine optimal care for acute tSCI.


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