In order to define the optimum timing of surgery for a hip fracture, we undertook a systematic review of all previously published studies on this topic. Data from the retrieved studies was extracted by two independent reviews and the methodology of each study assessed. In total, 43 studies involving 265137 patients were identified. Outcomes considered were mortality, post-operative complications, length of hospital stay and return of patients back home. There were no randomised trials on this topic. Six studies of 8535 patients have the most appropriate methodology, which was prospective collection of data with adjustment for confounding variables. These studies found no effect on mortality for any delays in surgery. One of these studies found fewer complications for those operated on early but this was not found in the other study to report on these outcomes. Two of these studies reported on hospital stay, which was reduced for those operated on early. Six studies of 229418 patients were retrospective reviews of patient administration databases with an attempt at adjusting for confounding factors. They reported a reduce mortality, hospital stay and complications for those operated on early. Thirty-one other studies of variable methodology reported similar findings of reduced complications with early surgery apart from one study of 399 patients, which reported an increased mortality and morbidity for those operated on within 24 hours of admission. In conclusion those studies with more careful methodology were less likely to report a beneficial effect of early surgery, particularly in relation to mortality. But early surgery (within 48 hours of admission) does seem to reduce complications such as pressure sores and reduces hospital stay

To assess whether the timing of surgery is an important factor in neurological outcome in patients with MSCC. Retrospective review. All patients with MSCC presenting to our unit were included in this study from October 2003 to December 2009. Patients were divided into three groups - those who underwent surgery within 24 hours (Group 1), those 24 hours to 48 hours (Group 2) and those greater than 48 hours (Group 3). Neurological outcome (improvement in Frankel score), complication rate and survival were assessed in all groups. A total of 109 patients with MSCC were operated on in our unit during this time. Mean age of patients was 61 years (range 7 - 86). The number that had at least one grade of Frankel improvement was 21 /37 (57%) in group 1; 11/17 (65%) in group 2 and 20/49 (41%) in group 3, p=0.03. When patients treated less than 24 hours were compared with those greater than 24 hours, the Frankel grade improvement approached significance (p=0.05). When we compared those who had surgery within 48 hours and those greater than 48 hours, the Frankel grade improvement was highly significant (p=0.009). There was no difference in survival or complications between the groups. Our results suggest that early surgical treatment in patients with MSCC gives a better neurological outcome but has no influence on survival or complication rates

Introduction: Ankle fractures are one of the most common injuries treated by the orthopaedic surgeon. The general recommendation is if surgical treatment is not carried out within the first 24 hours from the injury, then it should be delayed for about 5-7 days to reduce the risk of wound complications associated with limb swelling. The aim of our study was to see whether timing of surgery significantly affects the outcome or wound complications following internal fixation of displaced ankle fractures. METHOD: We retrospectively analysed the medical records of 37 patients with ankle fractures, who were admitted to the orthopaedic department at our Hospital between May 2003 and May 2004. The fractures were classified according to Dennis-Weber classification. Open reduction and rigid internal fixation was performed according to the techniques of the Association for the Study of Internal Fixation (AO Group). RESULTS: The mean age of the patients was 41.6 years (range 19-70). According to Denis-Weber classification 2 (6%) were type A, 26 (70%) were type B and 9 (24%) were type C fractures. The mean delay before surgery was 2.4 (0-9) days. The mean length of hospital stay was 4.6 (1-13) days. 35% of the fractures were operated between the second and fourth days after the injury without any increase in wound or fracture related complications. There were no cases of wound infection or dehiscence. Although there was one case of delayed union of medial malleolus, the overall union rate was 100%. CONCLUSION: We conclude that for ankle fractures that are not operated on within the initial 24 hours from the injury, delayed treatment could be instituted as soon as patient and limb factors permit and rigid adherence to waiting times of 5-8 days is not necessary

Introduction: Ankle fractures are one of the most common injuries treated by the orthopaedic surgeon. The general recommendation is if surgical treatment is not carried out within the first 24 hours from injury, then it should be delayed for about 5–7 days to reduce the risk of wound complications associated with limb swelling. The aim of our study was to see whether timing of surgery affects the relative risk of skin complications following internal fixation of ankle fractures. Method: We analysed medical records of 102 patients with closed ankle fractures admitted to the orthopaedic department at our hospital between May 2003 and May 2005. The fractures were classified according to the Weber-AO classification. Open reduction and internal fixation was performed according to the techniques of the AO Group. Results: The mean age of patients was 43 years(range 13–87). According to the AO classification, 3 were type A(A1–3), 77 were type B(B1-16, B2-42, B3-16), 17 were type C(C1-2, C2-11, C3-4), 4 were isolated medial malleolus and 1 was Salter-Harris type 2 fractures. The mean delay before surgery was 3(0–18) days. The mean length of hospital stay was 6(1–44) days. Out of 102 patients, 53 of the patients were operated within 24 hours, 22 were operated from 24–72 hours, 15 within 4 to 7 days and the rest were operated within 7–18 days. The main reasons for delay were either failed initial conservative management or late presentation. There was one case of superficial wound infection, deep vein thrombosis, neuroma and delayed union of medial malleolus each. Conclusion: We conclude that for ankle fractures that are not operated on within the initial 24 hours from the injury, delayed treatment could be instituted as soon as patient and limb factors permit and rigid adherence to waiting times of 5–7 days is not necessary

Background: The timing of surgery for closed ankle fracture is controversial. Conventional teaching recommends either immediate surgery or a delay of 5–7 days in order to minimise soft tissue complications. However, there have been no large studies to produce clear guidelines and the literature is conflicting. Some authors suggest that delayed surgery results in increased risk of wound complications, less satisfactory rate of anatomical reduction, increased hospital stay and health service cost. Objective: We aimed to determine whether surgery can be safely performed in an intermediate time frame with respect to soft tissues complications. Method: We performed retrospective analysis of case notes and plain radiographs of 85 patients undergoing open reduction and internal fixation for closed ankle fractures at our unit in 2004. Data was analysed using the StatView statistical analysis program. Continuous variables were assessed for association with wound complication by means of an unpaired t-test. Nominal variables were assessed using Fisher’s exact test. Results: The overall rate of infection in our population of 85 patients was 9.4%. This comprised 7 superficial wound infections and one deep infection. Patients were classified into early (within 1 day), intermediate (between 2–6 days) and delayed (after 6 days) groups according to the time delay prior to surgery. Only 1 patient in the intermediate surgery group developed infection compared to 6 in the delayed group and this was statistically significant (p = 0.046). Conclusion: We suggest that with experience, meticulous soft tissue handling and good operative technique, delaying surgery until swelling has subsided is unnecessary in the majority of patients and is associated with a higher risk of wound complication

The purpose of this study was to investigate the importance of the timing of surgery for disease-free survival (DFS). The increasing efficacy of neo-adjuvant chemotherapy in Ewing’s sarcoma modifies the prognostic factors. In a recent monocentric study the classical prognostic value of size and location of the primary disappeared (. Delepine G, Alkallaf S. . J. Chem. 1997. ;. 9. :. 352. –63. ). This study confirmed the value of histologic response and pointed out the importance of dose intensity of VCR and ACTD. However, the role of local treatment could not be significantly demonstrated because the number of patients was too small. Seventy-five patients with an average age of 19 years (range 4 to 40) years with Ewing’s sarcoma of bone fulfilled the inclusion criteria for this study: localised tumour at first screening (CT of lungs + bone scan) and location of the tumour in resectional bones (limb, scapula, innominate, rib, maxilla, skull). Metastatic patients and vertebral locations were excluded. The patients received multi-drug chemotherapy and were treated by surgery and radiotherapy in cases of bad responders and/or marginal surgery. The histologic response was evaluated according to Picci’s criteria (. Picci, A. . J Clin Oncol. 1993. ;. 11. :. 1793. –99. ). The duration of local treatment was calculated from biopsy to surgery in weeks. After a mean follow-up of 54 months, 41 patients were in first complete remission. Patients operated before the tenth week had a higher chance (68%) of first complete remission than patients operated later (DFS: 43%). The difference is significant (p< 0.03). Further analysis shows that the difference is due to late local control, which causes a dismal prognosis for bad responders. Local treatment must be performed early, especially when histologic response is incomplete or uncertain. Preoperative chemotherapy that is too long increases the risk of metastases in bad responders. These factors must be taken into account when analysing multicentre protocols

The purpose of this study was to investigate the importance of the timing of surgery for disease-free survival (DFS). The increasing efficacy of neo-adjuvant chemotherapy in Ewing’s sarcoma modifies the prognostic factors. In a recent monocentric study the classical prognostic value of size and location of the primary disappeared (. Delepine G, Alkallaf S. . J. Chem. 1997. ;. 9. :. 352. –63. ). This study confirmed the value of histologic response and pointed out the importance of dose intensity of VCR and ACTD. However, the role of local treatment could not be significantly demonstrated because the number of patients was too small. Seventy-five patients with an average age of 19 years (range 4 to 40) years with Ewing’s sarcoma of bone fulfilled the inclusion criteria for this study: localised tumour at first screening (CT of lungs + bone scan) and location of the tumour in resectional bones (limb, scapula, innominate, rib, maxilla, skull). Metastatic patients and vertebral locations were excluded. The patients received multi-drug chemotherapy and were treated by surgery and radiotherapy in cases of bad responders and/or marginal surgery. The histologic response was evaluated according to Picci’s criteria (. Picci, A. . J Clin Oncol. 1993. ;. 11. :. 1793. –99. ). The duration of local treatment was calculated from biopsy to surgery in weeks. After a mean follow-up of 54 months, 41 patients were in first complete remission. Patients operated before the tenth week had a higher chance (68%) of first complete remission than patients operated later (DFS: 43%). The difference is significant (p< 0.03). Further analysis shows that the difference is due to late local control, which causes a dismal prognosis for bad responders. Local treatment must be performed early, especially when histologic response is incomplete or uncertain. Preoperative chemotherapy that is too long increases the risk of metastases in bad responders. These factors must be taken into account when analysing multicentre protocols

37 patients (38 hips) underwent sub-capital osteotomy for slipped upper femoral epiphysis (SUFE) between 1980 and 1999. All slips were severe, and 28 (74%) were unstable. Patients were followed-up at a mean 6. 9 years (range 2. 2–20 years) to identify the relationship between the timing of surgery and complications. Stable slips underwent urgent elective operations. Unstable slips, admitted as emergencies, were operated upon following two different protocols. 17 cases underwent the Dunn procedure on the next available list at a mean 1. 7 days after admission. 21 cases underwent the Fish procedure after a mean 22. 2 days of bedrest on “slings and springs”. Of 23 patients (24 hips) who suffered no complications and for whom on Iowa Flip Score was available, the means score was 96. 5 (range 91–100). There were 6 cases of Avascular Nervosis (AVN) (16%), all occurring after unstable slips, and 4 cases of chondrolysis (10%). Amongst unstable slips, shorter periods of pre-operative bedrest were associated with a higher incidence of avascular necrosis (AVN) (p< 0. 025). Direct comparison of the two surgical procedures showed no statistically significance difference in the incidence of AVN. Sub-capital osteotomy is valid treatment for severe SUFE. More than 20 days of pre-operative bedrest decreased the incidence of AVN in unstable SUFE

Aims. Despite the increase in the surgical repair of proximal hamstring tears, there exists a lack of consensus in the optimal timing for surgery. There is also disagreement on how partial tears managed surgically compare with complete tears repaired surgically. This study aims to compare the mid-term functional outcomes in, and operating time required for, complete and partial proximal hamstring avulsions, that are repaired both acutely and chronically. Methods. This is a prospective series of 156 proximal hamstring surgical repairs, with a mean age of 48.9 years (21.5 to 78). Functional outcomes were assessed preinjury, preoperatively, and postoperatively (six months and minimum three years) using the Sydney Hamstring Origin Rupture Evaluation (SHORE) score. Operating time was recorded for every patient. Results. Overall, significant improvements in SHORE scores were seen at both six months and mid-term follow-up. Preoperatively, acute patients (median score 27.1 (interquartile range (IQR) 22.9)) reported significantly poorer SHORE scores than chronic patients (median score 42.9 (IQR 22.1); p < 0.001). However, this difference was not maintained postoperatively. For partial tears, acutely repaired patients reported significantly lower preoperative SHORE scores compared to chronically reapired partial tears (median score 24.3 (IQR 15.7) vs median score 40.0 (IQR 25.0); p < 0.001) but also significantly higher SHORE scores at six-month follow-up compared to chronically repaired partial tears (median score 92.9 (IQR 10.7) vs. median score 82.9 (IQR 14.3); p < 0.001). For complete tears, there was only a difference in preoperative SHORE scores between acute and chronic groups. Overall, acute repairs had a significantly shorter operating time (mean 64.67 minutes (standard deviation (SD) 12.99)) compared to chronic repairs (mean 74.71 minutes (SD = 12.0); t = 5.12, p < 0.001). Conclusion. Surgical repair of proximal hamstring avulsions successfully improves patient reported functional outcomes in the majority of patients, irrespective of the timing of their surgery or injury classification. However, reducing the time from injury to surgery is associated with greater improvement in patient outcomes and an increased likelihood of returning to preinjury functional status. Acute repair appears to be a technically less complex procedure, as indicated by reduced operating times, postoperative neurological symptoms and number of patients requiring bracing. Acute repair is therefore a preference among many surgeons. Cite this article: Bone Joint J 2020;102-B(10):1419–1427

We studied prospectively a consecutive series of 765 patients with proximal femoral fractures to determine if the time interval between injury and surgery influenced the outcome. Patients in whom surgery had been delayed for medical reasons were excluded. We divided the patients into four groups depending on the delay to surgery. Analysis of pre- and postoperative characteristics showed the groups to be similar. Mortality in the four groups was not significantly different but morbidity was increased by delay, particularly with regard to the incidence of pressure sores.

We reviewed 87 patients who underwent revision anterior cruciate ligament (ACL) reconstruction. The incidence of meniscal tears and degenerative change was assessed and related to the timing from primary ACL graft failure to revision ACL reconstruction. Patients were divided into either an early group (revision surgery within 6 months of graft failure) or a delayed group. Degenerative change was scored using the French Society of Arthroscopy system. There was a significantly higher incidence of articular cartilage degeneration in the delayed group compared to the early group (53.2% vs 24%, p < 0.01, Mann- Whitney U test). No patients in the early group had advanced degenerative change (SFA grades 3 or 4), compared with 12.9% of patients in the delayed group. There was no significant difference in the incidence of meniscal tears between the two groups. In conclusion, the findings of the study support the view that patients with a failed ACL reconstruction and symptomatic instability should have an early revision reconstruction procedure carried out to minimise the risk of articular degenerative change.

Introduction: Ankle fractures are among the commonest orthopaedic injuries. A delay in operating is often due to the swelling associated with such fractures. On the other hand, the delay in operative fixation beyond 24 h from injury is associated with a lengthening of hospital stay which costs approximately £225 per patient per day for an acute trauma bed.

Objectives: The aim of this study was to analyse the relationship between the delay in surgical intervention of open reduction and internal fixation of ankle fractures from presentation due to ankle swelling, and the length of hospital stay and postoperative complications.

Patients and Methods: A retrospective study of 145 consecutive patients treated for ankle fractures over a period of 12 months between January and December 2008. results were collated excluding talar and pilon fractures. Emergency department presentation times were noted and time of anaesthetic to determine surgical delay. Notes were reviewed for inpatient stay and postoperative complications.

Results: There were 62 male and 83 female patients with a mean age of 49 years. In total, 117 (80%) patients were operated on within 24 hours of presentation (early group). 28 patients’ surgery was delayed beyond 24 hours (delayed group). Of the 117 patients the mean inpatient stay was 3.79 days (± 2.39) whereas in the delayed group the mean stay was 8.57 days (± 6.54). Of the delayed group, 57% of the cases had swelling as the cause of a postponed operation, whereas other causes included lack of theatre time and lack of fitness for surgery. In the early group, 5 patients (4.27%) had wound infections and one patient had a chest infection (0.85%). Four patients (14.28%) from the delayed group developed wound infections all of whom were from patients with ankle swelling.

Conclusion: We recommend that policies be put in place to provide early operative intervention for patients with fractured ankles prior to the development of swelling as this would result in improved patient outcome and significant financial savings. If an operation is not feasible within 24 hours of admission and the ankle is swollen resulting in a high operative risk, we recommend sending the patient home for a period of 5–7 days with advice on RICE and anticoagulation which would both permit surgery and cut down costs.

Aims: The purpose of the study was to determine the relationship of preoperative health status and surgery delay on postoperative complications and mortality in patients with hip fracture Methods: 195 patients with hip fracture were admitted to the Institute between 1997 and 2001. Information on the demographics, pre-existing medical conditions, type of fracture, operation and anesthesia, and postoperative complications during hospitalization was obtained from the medical records. Preoperative health status was assessed by the ASA classification. Medical records and the telephone interviews were used for follow-up on the patient’s vital status. Results: Analysis include patients who were 65 and older, cognitively intact, living at home and able to walk before surgery. 64% were female with femoral neck fracture. More than half had two or more pre-existing medical conditions and ASA grade III or IV. Follow-up period averaged 24 months (6 to 60). The overall mortality was 15% at one year, 23% at two years and 30% at three years. The three year mortality was less for ASA I and II patients than for ASA III, IV and V group. We found difference in mortality between patients having surgery within 24 hours of admission (25%) and those with operative delay beyond 24 hours of admission (45%). Conclusions: Operative treatment within 24 hours of admission showed lower mortality rate than in patients having surgery beyond 24 hours of admission in conjunction with preoperative ASA classification

Aims

To determine whether a delay of greater than 6 hrs from injury to initial surgical debridement and the timing of antibiotic administration affect infection rates in open long-bone fractures in a typical district general hospital in the UK.

Introduction:. Early stabilization has the potential to expedite early return to function and reduce hospital stay thus reducing cost to health care. A clinical audit was performed to test the hypothesis that early surgical stabilization lowers the rate of soft tissue complications and is not influenced by choice of distal fibular implants used for stabilization of ankle fractures. Methods:. All surgically treated adult patients with isolated unstable ankle fracture were included from April 2012 to April 2013 at a MTC in UK. Patients with poly-trauma were excluded. All patients underwent a standard surgical protocol: aim for early definitive surgical fixation (ORIF) within 24 hours however if significantly swollen than temporary stabilization with an external fixation followed by a staged definitive fixation. Results:. In total 172 consecutive unstable ankle fractures were included in one-year study period. Definitive fixation (ORIF) was achieved in 91% patients with only 9% patients required temporary stabilization with external fixation. Fibular locking plates were used in 59(38%) patients compared to conventional one-third tubular plates in 91(60%) patients. In ORIF group 42% (73) patients were operated within 24 hours of admission whilst 58% (83) under went early fixation after 24–72 hours. At one year follow up complications were recorded in 18(11%) patients including metal irritation requiring removal of implant in 6(4%) patients. Wound complications and deep infection leading to a further surgical procedure in 8(5%) patients. There was no statistical difference between complication rates (p=0.016) in early versus delayed fixation groups. Fibular locking plates were associated with higher soft tissue complications (13%) as compared with conventional plates (2%) (p=0.004). Conclusion:. Our study showed that the timing of the surgery has less influence on the complications of the ankle fracture fixation. However choice of implants requires careful consideration and we suggest caution against use of current fibular locking plates

Reviewing our experience of scoliosis in children with a Cavopulmonary Shunt or Fontan circulation and the cardiovascular challenges that this presents.

A notes and x ray review was performed. Special attention was paid to the changes in cardiovascular status whilst prone. The review was from first presentation to latest follow up.

There were 6 patients who underwent 7 major procedures between 2001 and 2009. All had cardiac procedures in early life. Both definitive fusion and growing instrumentation was used. All procedures were successful. Growing instrumentation allowed earlier primary surgery before completion of the Fontan circulation. All have been subsequently lengthened in a lateral position. The mean follow up is 56 months. There was one death 40 months following last surgery, cause unrelated to spinal surgery.

In the older patients with a completed Fontan significant blood loss was seen, due to the raised venous pressure required to run the Fontan, and occult hypotension seen as a climbing difference between Pulmonary Artery Wedge Pressure and Central Venous Pressure were common when prone.

We recommend early intervention, using instrumentation without fusion to correct the deformity over time and allow intervention prior to completing the Fontan circulation. As haemodynamic instability increases with increasing time in the prone position, surgery should be expedited rapidly.

The August 2024 Spine Roundup. 360. looks at: Laminectomy adjacent to instrumented fusion increases adjacent segment disease; Influence of the timing of surgery for cervical spinal cord injury without bone injury in the elderly: a retrospective multicentre study; Lumbar vertebral body tethering: single-centre outcomes and reoperations in a consecutive series of 106 patients; Machine-learning algorithms for predicting Cobb angle beyond 25° in female adolescent idiopathic scoliosis patients; Pain in adolescent idiopathic scoliosis; Teriparatide prevents surgery for osteoporotic vertebral compression fracture

Aims. Ankle fractures are common injuries and the third most common fragility fracture. In all, 40% of ankle fractures in the frail are open and represent a complex clinical scenario, with morbidity and mortality rates similar to hip fracture patients. They have a higher risk of complications, such as wound infections, malunion, hospital-acquired infections, pressure sores, veno-thromboembolic events, and significant sarcopaenia from prolonged bed rest. Methods. A modified Delphi method was used and a group of experts with a vested interest in best practice were invited from the British Foot and Ankle Society (BOFAS), British Orthopaedic Association (BOA), Orthopaedic Trauma Society (OTS), British Association of Plastic & Reconstructive Surgeons (BAPRAS), British Geriatric Society (BGS), and the British Limb Reconstruction Society (BLRS). Results. In the first stage, there were 36 respondents to the survey, with over 70% stating their unit treats more than 20 such cases per year. There was a 50:50 split regarding if the timing of surgery should be within 36 hours, as per the hip fracture guidelines, or 72 hours, as per the open fracture guidelines. Overall, 75% would attempt primary wound closure and 25% would utilize a local flap. There was no orthopaedic agreement on fixation, and 75% would permit weightbearing immediately. In the second stage, performed at the BLRS meeting, experts discussed the survey results and agreed upon a consensus for the management of open elderly ankle fractures. Conclusion. A mutually agreed consensus from the expert panel was reached to enable the best practice for the management of patients with frailty with an open ankle fracture: 1) all units managing lower limb fragility fractures should do so through a cohorted multidisciplinary pathway. This pathway should follow the standards laid down in the "care of the older or frail orthopaedic trauma patient" British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) guideline. These patients have low bone density, and we should recommend full falls and bone health assessment; 2) all open lower limb fragility fractures should be treated in a single stage within 24 hours of injury if possible; 3) all patients with fragility fractures of the lower limb should be considered for mobilisation on the day following surgery; 4) all patients with lower limb open fragility fractures should be considered for tissue sparing, with judicious debridement as a default; 5) all patients with open lower limb fragility fractures should be managed by a consultant plastic surgeon with primary closure wherever possible; and 6) the method of fixation must allow for immediate unrestricted weightbearing. Cite this article: Bone Jt Open 2024;5(3):236–242

Aims. Extensive literature exists relating to the management of shoulder instability, with a more recent focus on glenoid and humeral bone loss. However, the optimal timing for surgery following a dislocation remains unclear. There is concern that recurrent dislocations may worsen subsequent surgical outcomes, with some advocating stabilization after the first dislocation. The aim of this study was to determine if the recurrence of instability following arthroscopic stabilization in patients without significant glenoid bone loss was influenced by the number of dislocations prior to surgery. Methods. A systematic review and meta-analysis was performed using the PubMed, EMBASE, Orthosearch, and Cochrane databases with the following search terms: ((shoulder or glenohumeral) and (dislocation or subluxation) and arthroscopic and (Bankart or stabilisation or stabilization) and (redislocation or re-dislocation or recurrence or instability)). Methodology followed the PRISMA guidelines. Data and outcomes were synthesized by two independent reviewers, and papers were assessed for bias and quality. Results. Overall, 35 studies including 7,995 shoulders were eligible for analysis, with a mean follow-up of 32.7 months (12 to 159.5). The rate of post-stabilization instability was 9.8% in first-time dislocators, 9.1% in recurrent dislocators, and 8.5% in a mixed cohort. A descriptive analysis investigated the influence of recurrent instability or age in the risk of instability post-stabilization, with an association seen with increasing age and a reduced risk of recurrence post-stabilization. Conclusion. Using modern arthroscopic techniques, patients sustaining an anterior shoulder dislocation without glenoid bone loss can expect a low risk of recurrence postoperatively, and no significant difference was found between first-time and recurrent dislocators. Furthermore, high-risk cohorts can expect a low, albeit slightly higher, rate of redislocation. With the findings of this study, patients and clinicians can be more informed as to the likely outcomes of arthroscopic stabilization within this patient subset. Cite this article: Bone Joint J 2024;106-B(10):1141–1149

Aims. The aim of this study was to explore the prognostic factors for postoperative neurological recovery and survival in patients with complete paralysis due to neoplastic epidural spinal cord compression. Patients and Methods. The medical records of 135 patients with complete paralysis due to neoplastic cord compression were retrospectively reviewed. Potential factors including the timing of surgery, muscular tone, and tumour characteristics were analyzed in relation to neurological recovery using logistical regression analysis. The association between neurological recovery and survival was analyzed using a Cox model. A nomogram was formulated to predict recovery. Results. A total of 52 patients (38.5%) achieved American Spinal Injury Association Impairment Scale (AIS) D or E recovery postoperatively. The timing of surgery (p = 0.003) was found to be significant in univariate analysis. In multivariate analysis, surgery within one week was associated with better neurological recovery than surgery within three weeks (p = 0.002), with a trend towards being associated with a better neurological recovery than surgery within one to two weeks (p = 0.597) and two to three weeks (p = 0.055). Age (p = 0.039) and muscle tone (p = 0.018) were also significant predictors. In Cox regression analysis, good neurological recovery (p = 0.004), benign tumours (p = 0.039), and primary tumours (p = 0.005) were associated with longer survival. Calibration graphs showed that the nomogram did well with an ideal model. The bootstrap-corrected C-index for neurological recovery was 0.72. Conclusion. In patients with complete paralysis due to neoplastic spinal cord compression, whose treatment is delayed for more than 48 hours from the onset of symptoms, surgery within one week is still beneficial. Surgery undertaken at this time may still offer neurological recovery and longer survival. The identification of the association between these factors and neurological recovery may help guide treatment for these patients. Cite this article: Bone Joint J 2019;101-B:872–879