Early Versus Delayed Surgery for Elderly Traumatic Cervical Spinal Injury: A Nationwide Multicenter Study in Japan

Area of Science:

• Neurosurgery
• Geriatric Medicine
• Trauma Surgery

Background:

• Early surgical intervention for cervical spinal injury (CSI) is established as effective.
• The benefit of early surgery in elderly patients (≥65 years) with CSI remains unclear.
• This study addresses the impact of early versus delayed surgery on outcomes in this demographic.

Purpose of the Study:

• To investigate whether early surgery for CSI in elderly patients affects complication rates.
• To determine if early surgery impacts neurological outcomes in elderly CSI patients.
• To compare outcomes between early and delayed surgical treatment groups.

Main Methods:

• Retrospective multicenter study of 462 patients with traumatic acute CSI, aged ≥65 years.
• Patients undergoing surgery within 24 hours (early group, n=65) were compared to those undergoing delayed surgery (n=397).
• Propensity score-matched cohorts (n=63) were analyzed with a minimum 6-month follow-up.

Main Results:

• No significant differences in complication rates or ASIA Impairment Scale scores at 6 months post-injury between matched early and delayed surgery groups.
• Ambulatory abilities at 6 months were similar, with 61% in the early group and 53% in the delayed group achieving ambulation.
• While the early group had younger patients with more severe injuries (tetraplegia, lower motor scores), outcomes were comparable.

Conclusions:

• Early surgery for CSI in elderly patients is feasible.
• No significant differences in complication rates, neurological recovery, or ambulatory status were observed between early and delayed surgery groups in matched cohorts.
• These findings support considering early surgical intervention for elderly patients with CSI.