The impact of the timing of spinal decompression on urinary and sexual function after acute spinal cord injury

While earlier decompression after spinal cord injury (SCI) is linked to better motor recovery, its impact on bladder and sexual function remains unexplored. Our objective was to determine if time to surgical decompression is associated with bladder and sexual function.

We conducted a retrospective cohort study using the prospectively collected Canadian Rick Hansen SCI Registry. Primary exposure was time to surgical decompression. Primary outcome was abnormal bladder function defined by use of catheters or any incontinence at 1-year. Secondary outcomes were sexual function and motor score. Adjusted logarithmic regression models were used.

One thousand thirty-eight participants met inclusion criteria. Median time to surgical decompression was 25 (IQR17-50) hours, and 46% (475/1038) had early decompression (<24 h). There were 63% (650/1038) who had evidence of abnormal bladder function at 1-year. On multivariate regression, time to decompression was not significantly related to abnormal bladder function (OR 1.00, 95% CI 1.00-1.01, p = 0.38); older age (OR 1.13, 95% CI 1.03-1.23, p = 0.01) and worse ASIA score (ASIA A OR 16.35, p < 0.01, ASIA B OR 5.12, p < 0.01 and ASIA C OR 2.23, p < 0.01 all relative to ASIA D) were significantly associated with abnormal bladder function. These results were similar in several sensitivity analyses. Time to decompression was also not significantly associated with sexual function or motor score at 1-year.

A shorter time to surgical decompression after SCI was not associated with improved bladder or sexual function outcomes; however, older age and a more complete injury were significant predictors.