Ultra-Early (<5 Hours) Decompression forThoracolumbar Spinal Cord Injury: A Case Series

Early surgical decompression within 24 hours for traumatic spinal cord injury (SCI) is associated withimproved neurological recovery. However, the ideal timing of decompression is still up for debate. Theobjective of this study was to utilize our retrospective single-institution series of ultra-early (<5 hours)decompression to determine if ultra-early decompression led to improved neurological outcomes and was afeasible target over previously defined early decompression targets. Retrospective data on patients with SCI who underwent ultra-early (<5 hours) decompression at a level onemetropolitan trauma center were extracted and collected from 2015-2018. American Spinal InjuryAssociation (ASIA) Impairment Scale (AIS) grade improvement was the primary outcome, with ASIA Motorscore improvement and complication rate as secondary outcomes. Four individuals met the criteria for inclusion in this case series. All four suffered thoracolumbar SCI. Allpatients improved neurologically by AIS grade, and there were no complications directly related to ultra-early surgery. Given the small sample size, there was no statistically significant difference in outcomescompared to a control group who underwent early (5-24 hour) decompression in the same period. Ultra-early decompression is a feasible and safe target for thoracolumbar SCI and may lead to improvedneurological outcomes without increased risk of complications. This case series can help create thefoundation for future, larger studies that may definitively show the benefit of ultra-early decompression.