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The use of classification and regression tree analysis to identify the optimal surgical timing for improving neurological outcomes following motor-complete thoracolumbar traumatic spinal cord injury

Abstract

Study design

Observational cohort study.

Objectives

To identify the optimal surgical timing for improving neurological outcomes in patients that sustained a motor-complete traumatic spinal cord injury (TSCI) secondary to a thoracolumbar injury.

Setting

Level 1 trauma center specialized in TSCI care.

Methods

We prospectively analyzed clinical data of 35 patients admitted for motor-complete TSCI secondary to a thoracolumbar injury. We quantified neurological recovery with three different outcomes: the improvement of at least one grade on the American Spinal Injury Association Impairment Scale (AIS), of at least one neurological level of injury (NLI), and of at least 10-points on the motor score (MS). Classification and regression tree analysis was used to identify outcome predictors and to provide cutoff values of surgical timing associated with recovery.

Results

The proportion of the patients improving by at least one AIS grade was higher in the group undergoing early surgery within 25.7 h of the TSCI (46% vs 0%). The proportion of patients that improved by at least one NLI was also higher in the group undergoing early surgery within 21.5 h of the TSCI (71% vs 18%). Lastly, 25% of the AIS grade A patients undergoing early surgery within 25.6 h of the TSCI improved 10 MS points or more as compared with 0% in the other group.

Conclusions

Earlier surgery was effective in improving neurological outcome in motor-complete TSCI at the thoracolumbar levels. Performing surgery within 21.5 h from the traumatic event in these patients increases the likelihood of improving the neurological recovery.

Sponsorship

This study was supported by the Fonds de Recherche du Québec—Santé (FRQS), Department of the Army—United States Army Medical Research Acquisition Activity, Rick Hansen Spinal Cord Injury Registry and Medtronic research chair in spinal trauma at Université de Montréal.

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Fig. 1
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Fig. 3: Classification tree obtained when considering a neurological improvement of at least one AIS grade as the dependent variable, with corresponding p value.
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Fig. 5

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We acknowledge the contribution of the whole team at the research unit of the Department of Orthopedics of the Hôpital du Sacré-Coeur de Montréal. We thank the patients and their families for their essential contribution in the research effort for the improvement of care.

Funding

This study was supported by the Fonds de Recherche du Québec—Santé (FRQS), Department of the Army—United States Army Medical Research Acquisition Activity, Rick Hansen Spinal Cord Injury Registry and Medtronic research chair in spinal trauma at Université de Montréal.

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Affiliations

Authors

Contributions

JG was responsible for designing the protocol, conducting the search, screening potentially eligible patients, extracting and analysing data, interpreting results, creating ‘Summary of findings’ tables, and writing the article. ARD was responsible for designing the protocol. She contributed to writing the manuscript, extracting and analysing data, interpreting results. JMMT is the senior researcher who was responsible for designing the protocol, he revised the manuscript critically, he also contributed in extracting and analysing data and interpreting results. He also obtained funding for this research project.

Corresponding author

Correspondence to Jean-Marc Mac-Thiong.

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The authors declare that they have no conflict of interest.

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We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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Goulet, J., Richard-Denis, A. & Mac-Thiong, JM. The use of classification and regression tree analysis to identify the optimal surgical timing for improving neurological outcomes following motor-complete thoracolumbar traumatic spinal cord injury. Spinal Cord 58, 682–688 (2020). https://doi.org/10.1038/s41393-020-0412-z

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