Document Type
Article
Publication Date
9-1-2017
Abstract
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.
Recommended Citation
Fehlings, Michael G.; Tetreault, Lindsay A.; Wilson, Jefferson R.; Aarabi, Bizhan; Anderson, Paul; Arnold, Paul M.; Brodke, Darrel S.; Burns, Anthony S.; Chiba, Kazuhiro; Dettori, Joseph R.; Furlan, Julio C.; Hawryluk, Gregory; Holly, Langston T.; Howley, Susan; Jeji, Tara; Kalsi-Ryan, Sukhvinder; Kotter, Mark; Kurpad, Shekar; Marino, Ralph J.; Martin, Allan R.; Massicotte, Eric; Merli, Geno J.; Middleton, James W.; Nakashima, Hiroaki; Nagoshi, Narihito; Palmieri, Katherine; Singh, Anoushka; Skelly, Andrea C.; Tsai, Eve C.; Vaccaro, Alexander R.; Yee, Albert; and Harrop, James S., "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). Department of Rehabilitation Medicine Faculty Papers. Paper 30.
https://jdc.jefferson.edu/rmfp/30
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Comments
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.