Fehlings (2012) — Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS).

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (stascis).

·PloS one·2012·1,200 citations·Spine

STASCIS is a multicenter prospective cohort study across 6 North American centers enrolling 313 adults with traumatic cervical SCI (AIS A–D) between 2002–2009. It compares neurological outcomes at 6 months in patients who underwent surgical decompression before versus at or after 24 hours from injury, using ordinal AIS grade change as the primary endpoint.

Study Snapshot

Design

Multicenter prospective cohort

Setting: 6 North American centers

Objective

Determine whether early spinal cord decompression improves neurologic outcomes after cervical SCI

Outcome(s)

≥2 grade AIS improvement at 6 months post-injury

Subjects

313 adults with acute cervical SCI

182Early decompression <24h post-injury
131Late decompression ≥24h post-injury

Inclusion

Age 16–80
Acute traumatic cervical SCI

Follow-up

6 months

Statistics

Ordinal logistic regressionMultivariate analysis

Key Findings

19.8% of early-surgery patients achieved ≥2 AIS grade improvement at 6 months vs. 8.8% in the late group (unadjusted OR 2.57, 95% CI 1.11–5.97)
On multivariate analysis controlling for baseline neurological status and steroids, early surgery conferred 2.83× higher odds of ≥2-grade AIS improvement (OR 2.83, 95% CI 1.10–7.28, p=0.03)
Complication rates did not differ significantly: 24.2% early vs. 30.5% late (p=0.21), confirming safety of the early approach
Mean time to surgery was 14.2 hours in the early group vs. 48.3 hours in the late group
40% of complete (AIS A) injury patients gained ≥1 AIS grade — more than double historical recovery rates of 15–25%

Clinical Relevance

When a patient presents with acute traumatic cervical SCI and imaging confirms cord compression, target decompression within 24 hours: STASCIS shows this nearly triples the odds of meaningful neurological recovery (≥2 AIS grades) without increasing complication risk.

The benefit held even after adjusting for injury severity, so don't let a worse initial AIS grade be a reason to delay.

Core

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (stascis).

Fehlings, Rampersaud, et al.·PloS one·2012·1,200 citations·Spine

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (stascis).

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (stascis).

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (stascis).

Study Snapshot

Key Findings

Clinical Relevance

Related Articles

Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (stascis).

Study Snapshot

Key Findings

Clinical Relevance

Related Articles