scholarly journals Early Surgery for Traumatic Spinal Cord Injury: Where Are We Now?

2020 ◽  
Vol 10 (1_suppl) ◽  
pp. 84S-91S ◽  
Author(s):  
Jefferson R. Wilson ◽  
Christopher D. Witiw ◽  
Jetan Badhiwala ◽  
Brian K. Kwon ◽  
Michael G. Fehlings ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Injury Severity ◽  
Significant Proportion ◽  
Evidence Base ◽  
Narrative Review ◽  
Early Surgery ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury ◽  
Central Cord Syndrome

Study Design: Narrative review. Objective: There is a strong biological rationale to perform early decompression after traumatic spinal cord injury (SCI). With an enlarging clinical evidence base, most spine surgeons internationally now favor early decompression for the majority of SCI patients; however, a number of pertinent questions remain surrounding this therapy. Methods: A narrative review evaluating the status of early surgery for SCI. In particular, we addressed the following questions: (1) Which patients stand to benefit most from early surgery? 2) What is the most appropriate time threshold defining early surgery? Results: Although heterogeneity exists, the evidence generally seems to support early surgery. While the best evidence exists for cervical SCI, there is insufficient data to support a differential effect for early surgery depending on neurological level or injury severity. When comparing thresholds to define early versus late surgery—including a later threshold (48-72 hours), an earlier threshold (24 hours), and an ultra-early threshold (8-12 hours)—the 2 earlier time points seem to be associated with the greatest potential for improved outcomes. However, existing prehospital and hospital logistics pose barriers to early surgery in a significant proportion of patients. An overview of recommendations from the recent AOSpine guidelines is provided. Conclusion: In spite of increasing acceptance of early surgery post SCI, further research is needed to (1) identify subgroups of patients who stand to derive particular benefit—in particular to develop more evidence-based approaches for central cord syndrome and (2) investigate the efficacy and feasibility of ultra-early surgery targeting more aggressive timelines.

MR Imaging for Assessing Injury Severity and Prognosis in Acute Traumatic Spinal Cord Injury

2019 ◽  
Vol 57 (2) ◽  
pp. 319-339 ◽  
Author(s):  
Jason F. Talbott ◽  
John Russell Huie ◽  
Adam R. Ferguson ◽  
Jacqueline C. Bresnahan ◽  
Michael S. Beattie ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Mr Imaging ◽  
Injury Severity ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury

Acute traumatic quadriplegia: Predictors of in-hospital and six-month mortality

Trauma ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. 300-306
Author(s):  
Ehsan Alimohammadi ◽  
Paniz Ahadi ◽  
Cyrous Rezaee ◽  
Roya Safari-Faramani ◽  
Seyed Reza Bagheri ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Logistic Regression ◽  
Respiratory Failure ◽  
Hospital Mortality ◽  
Logistic Regression Model ◽  
Injury Severity ◽  
Traumatic Spinal Cord Injury ◽  
Multiple Logistic Regression ◽  
Cord Injury

Background Traumatic spinal cord injury is one of the most disastrous and devastating health burdens all over the world with a high mortality rate. The present study aimed to evaluate the predictors of in-hospital and six-month mortality in these patients. Methods The electronic medical records of 87 consecutive patients with acute complete traumatic quadriplegia were reviewed to extract clinical, radiological, and laboratory data. Simple and multiple logistic regression models were used to estimate crude and adjusted odds with 95% confidence interval (CI) ratios for the predictors of in-hospital mortality and six-month mortality. Results There were 48 males and the mean age was 38.67 ± 12.81; in-hospital and six-month mortality were 21.84% and 11.76%, respectively. Traffic road accidents (67.8%) and falls (12.6%) were the most common causes of injury. The univariate analysis demonstrated advanced age, level of injury, late surgery or no surgical intervention, the lack of methylprednisolone therapy, a higher Charlson comorbidity index, the Injury Severity Score, and the presence of respiratory failure or bradycardia on admission were predictors of in-hospital mortality ( p < 0.05). In the final multiple logistic regression model, the level of injury (OR = 0.02 (0.001,0.35), p = 0.008) and the presence of respiratory failure (OR = 2.37 (0.03,13.88), p = 0.024) were the only predictors of in-hospital mortality. The univariate model showed that the level of injury, respiratory failure on admission, and the Injury Severity Score were the predictors of six-month mortality; however, the level of injury was the only predictor of the six-month mortality (OR = 1.12 (0.99, 1.27), p = 0.028) according to the multiple logistic regression model. Conclusions Several factors could affect in-hospital and six-month mortality in patients with traumatic spinal cord injury. Our findings demonstrated the level of injury and respiratory failure on admission as independent predictors of in-hospital mortality in these patients. Furthermore, the level of injury was the only independent predictor of six-month mortality in the present study.

scholarly journals Traumatic Spinal Cord Injury: the Impact of Timing. A Prospective Cohort Study to Evaluate Outcomes after Early Surgery (and Reasons for Delays)

2016 ◽  
Vol 6 (1_suppl) ◽  
pp. s-0036-1582942-s-0036-1582942
Author(s):  
Giuseppe Barbagallo ◽  
Joost J. van Middendorp ◽  
Denise Hess ◽  
Anahi Hurtado-Chong ◽  
Allard J. Hosman
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Early Surgery ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury ◽  
The Impact

Cerebrospinal Fluid Biomarkers To Stratify Injury Severity and Predict Outcome in Human Traumatic Spinal Cord Injury

2017 ◽  
Vol 34 (3) ◽  
pp. 567-580 ◽  
Author(s):  
Brian K. Kwon ◽  
Femke Streijger ◽  
Nader Fallah ◽  
Vanessa K. Noonan ◽  
Lise M. Bélanger ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cerebrospinal Fluid ◽  
Injury Severity ◽  
Traumatic Spinal Cord Injury ◽  
Cerebrospinal Fluid Biomarkers ◽  
Cord Injury

scholarly journals P.220 Mechanism of injury is associated with neurological outcomes in cervical sensorimotor complete traumatic spinal cord injury

2021 ◽  
Vol 48 (s3) ◽  
pp. S83-S83
Author(s):  
AB Bak ◽  
A Moghaddamjou ◽  
M Fehlings
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Significant Proportion ◽  
Sports Injury ◽  
Neurological Recovery ◽  
Traumatic Spinal Cord Injury ◽  
Significant Heterogeneity ◽  
Mechanism Of Injury ◽  
Cord Injury

Background: There is significant heterogeneity in neurological recovery after complete (ASIA A) traumatic spinal cord injury (tSCI). Neurological recovery is often associated with a conversion to a higher letter grade of the American Spinal Injury Association’s impairment scale (ASIA). The mechanism of injury (MOI) may play a significant role in the primary injury and should be considered for greater precision in care. Methods: We isolated ASIA A cervical tSCI patients from three multicenter prospective randomized controlled trials (NACTN, STASCIS, Sygen). Chi-square test with pairwise comparisons with Bonferroni corrections was performed to compare the proportion of ASIA A patients that converted to a higher ASIA grade between different MOI. Results: We identified 486 complete cervical tSCI patients. For patients who developed tSCI as a result of a fall, a significant proportion converted to a higher ASIA grade by 52 weeks (p = 0.009). For patients who developed tSCI as a result of a sports injury, a significantly smaller proportion did not convert to a higher ASIA grade compared to those that converted (p = 0.034). Conclusions: Due to the difference in outcomes, tSCI patients should be treated differently depending on their mechanism of injury.

scholarly journals A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 195S-202S ◽  
Author(s):  
Michael G. Fehlings ◽  
Lindsay A. Tetreault ◽  
Jefferson R. Wilson ◽  
Bizhan Aarabi ◽  
Paul Anderson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Practice ◽  
Guideline Development ◽  
Surgical Decompression ◽  
Early Surgery ◽  
Clinical Expertise ◽  
Cord Injury ◽  
Central Cord Syndrome

Objective: To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as “we recommend,” whereas a weak recommendation is presented as “we suggest.” Results: Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: “We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome” and “We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level.” Quality of evidence for both recommendations was considered low. Conclusions: These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions.

scholarly journals Nitrous oxide myelopathy posing as spinal cord injury

2012 ◽  
Vol 16 (5) ◽  
pp. 489-491 ◽  
Author(s):  
George M. Ghobrial ◽  
Richard Dalyai ◽  
Adam E. Flanders ◽  
James Harrop
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Nitrous Oxide ◽  
Side Effects ◽  
Dorsal Column ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury ◽  
Central Cord Syndrome ◽  
Patient’S History ◽  
Radiographic Presentation

The authors describe a patient who presented with acute tetraparesis and a proposed acute traumatic spinal cord injury that was the result of nitrous oxide myelopathy. This 19-year-old man sustained a traumatic fall off a 6-ft high wall. His examination was consistent with a central cord syndrome with the addition of dorsal column impairment. Cervical MRI demonstrated an isolated dorsal column signal that was suggestive of a nontraumatic etiology. The patient's symptoms resolved entirely over the course of 48 hours. Nitrous oxide abuse is increasing in prevalence. Its toxic side effects can mask vitamin B12 and folate deficiency and central cord syndrome. The patient's history and radiographic presentation are key to establishing a diagnosis.

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