DIFFERENCES IN OUTCOME OF SURGICAL MANAGEMENT OF ACUTE SPINAL INJURY IN SPECIALIST VERSUS NON-SPECIALISED UNITS

Abstract

Introduction and Aims: To determine the increased complications of spinal surgery done in non-specialised units for acute spinal injury patients.

Method: Retrospective analysis of all admissions to NSIC from February 1999 to August 2000.

Results: To hundred and forty-three patients admitted to NSIC over 18 months. Fifty-five patients underwent surgical interventions. Majority of patients were male, average age 36 years. Commonest cause of injury is RTA (45%). A complete injury (ASIA A) occurred in (54.5%) of patients.

Primary interventions were done in NSIC, with no major complication, for 36 patients. Nineteen patients operated on in the referring hospital (non-specialised units) before transfer to our centre. Early corrective surgery required for 10 of the total 19 patients due to spinal instability in five patients, non-union in two patients, CSF leak, infection in two patients and wrong level in one patient.

A comparison between primary and corrective surgery performed in NSIC by the same surgical team showed that the average length of corrective surgery was 240 minutes, with 150 minutes for primary procedure. Blood loss: 1750 mls on average for corrective surgery, compared to 600 mls for primary intervention. Post-op mobilisation started on average five days after primary surgery and 20 days after corrective surgery. Period of rehabilitation – 16 weeks on average after primary surgery in NSIC, compared to 40 weeks after corrective surgery.

Conclusion: Our results showed that early transfer to spinal injury unit and early spinal decompression and stabilisation performed by an experienced spinal surgeon, in a spinal injury centre would prevent complications and delays in rehabilitation.