Michael G. Fehlings, Toronto Western Hospital; University of Toronto
Lindsay A. Tetreault, Toronto Western Hospital; University College Cork
Jefferson R. Wilson, University of Toronto; St. Michael’s Hospital
Bizhan Aarabi, University of Maryland
Paul Anderson, University of Wisconsin, Madison
Paul M. Arnold, The University of Kansas
Darrel S. Brodke, University of Utah
Anthony S. Burns, Toronto Rehabilitation Institute
Kazuhiro Chiba, National Defense Medical College
Joseph R. Dettori, Spectrum Research, Inc
Julio C. Furlan, University of Toronto
Gregory Hawryluk, University of Utah
Langston T. Holly, University of California at Los Angeles
Susan Howley, Christopher & Dana Reeve Foundation
Tara Jeji, Ontario Neurotrauma Foundation
Sukhvinder Kalsi-Ryan, Toronto Western Hospital
Mark Kotter, University of Cambridge
Shekar Kurpad, Medical College of Wisconsin
Ralph J. Marino, Thomas Jefferson UniversityFollow
Allan R. Martin, Toronto Western Hospital
Eric Massicotte, Toronto Western Hospital
Geno J. Merli, Thomas Jefferson UniversityFollow
James W. Middleton, University of Sydney
Hiroaki Nakashima, Nagoya University
Narihito Nagoshi, Toronto Western Hospital; Keio University
Katherine Palmieri, The University of Kansas
Anoushka Singh, Toronto Western Hospital
Andrea C. Skelly, Spectrum Research, Inc
Eve C. Tsai, University of Ottawa
Alexander R. Vaccaro, Thomas Jefferson UniversityFollow
Albert Yee, Sunnybrook Health Sciences Centre
James S. Harrop, Thomas Jefferson UniversityFollow

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Publication Date



This article has been peer reviewed. It is the author’s final published version in Global Spine Journal

Volume 7, Issue 3 Supplement, September 2017, Pages 195S-202S

The published version is available at DOI: 10.1177/2192568217706367. Copyright © Fehlings et al.


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. © 2017, © The Author(s) 2017.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.