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Purpose To investigate the association of age with delay in spine surgery and the effects on neurological outcome after traumatic spinal cord injury (SCI). Methods Ambispective cohort study (2011–2017) in  n  = 213 patients consecutively enrolled in a Level I trauma center with SCI care in a metropolitan region in Germany. Age-related differences in the injury to surgery interval and conditions associated with its delay (&gt; 12 h after SCI) were explored using age categories or continuous variables and natural cubic splines. Effects of delayed surgery or age with outcome were analyzed using multiple logistic regression. Results The median age of the study population was 58.8 years (42.0–74.6 IQR). Older age (≥ 75y) was associated with a prolonged injury to surgery interval of 22.8 h (7.2–121.3) compared to 6.6 h (4.4–47.9) in younger patients (≤ 44y). Main reasons for delayed surgery in older individuals were secondary referrals and multimorbidity. Shorter time span to surgery (≤ 12 h) was associated with higher rates of ASIA impairment scale (AIS) conversion (OR 4.22, 95%CI 1.85–9.65), as mirrored by adjusted spline curves (  60 h &lt; 10% probability of AIS conversion). In incomplete SCI, the probability of AIS conversion was lower in older patients [e.g., OR 0.09 (0.02–0.44) for’45-59y’ vs.’ ≤ 44y’], as confirmed by spline curves (&lt; 40y 20–80%, ≥ 40y 5–20% probability). Conclusion Older patient age complexifies surgical SCI care and research. Tackling secondary referral to Level I trauma centers and delayed spine surgery imposes as tangible opportunity to improve the outcome of older SCI patients.

Association of age with the timing of acute spine surgery–effects on neurological outcome after traumatic spinal cord injury