Traumatic cervical spinal cord injury (TCSCI) is a disabling condition with uncertain neurologic recovery. Clinical and preclinical studies have suggested early surgical decompression and other measures of neuroprotection improve neurologic outcome. We investigated the role of intramedullary lesion length (IMLL) on preoperative magnetic resonance imaging (MRI) and the effect of early cervical decompressive surgery on ASIA impairment scale (AIS) grade improvement following TCSCI.

In this retrospective study, we analyzed 34 TCSCI patients admitted over a 12-year period from January 1, 2008, to January 31, 2020. We evaluated patient demographics, mode of injury, IMLL, and timing of surgical decompression. IMLL, defined as the total length of edema and contusion/hemorrhage within the cord, was assessed using short tau inversion recovery (STIR) sequences or T2-weighted MRI with fat saturation. All patients had confirmed adequate spinal cord decompression with cervical fixation and a minimum follow-up of 6 months.

Among the 34 patients, 16 underwent surgery within 24 hours (early surgery group), while 18 had surgery 24 hours after trauma (delayed surgery group). In the early surgery group, 13 (81.3%) patients showed an improvement of at least one AIS grade, compared to 8 (44.5%) patients in the delayed surgery group (odds ratio [OR] = 1.828; CI: 1.036–3.225). Multivariate regression analysis indicated that the timing of surgery and IMLL were significant factors for AIS grade improvement (p < 0.001). The mean IMLL was 41.47 mm. Patients with an IMLL of less than 30 mm had better probability of grade conversion, irrespective of the timing of surgery, while those with an IMLL greater than 61 mm had a higher probability of non-conversion, even with early surgery.

Surgical decompression within 24 hours and shorter preoperative IMLL significantly correlate with improved neurologic outcomes after a TCSCI, as indicated by better AIS grade improvement at 6 months.