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

Document Type


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.