Early versus Late Surgical Decompression for Traumatic Spinal Cord Injury on Neurological Recovery: A Systematic Review and Meta-Analysis

Hsieh, Yu-Lin; Tay, Joyce; Hsu, Shun-Chin; Chen, Wei‐Ting; Fang, Yao-De; Liew, Chiat-Qiao; Chou, Eric; Wolfshohl, Jon; d'Etienne, James P; Wang, Chih‐Hung

doi:10.1089/neu.2021.0102

Cited by 18 publications

(6 citation statements)

References 43 publications

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“…Recent studies suggest as early decompressive surgery (performed within 24 h from trauma) is associated with better neurological outcomes, thus highlighting the concept of “time is spine” [ 21 , 22 ]. A more rapid approach (within 12 h or less) was also proposed in case of the incomplete spinal lesion (ASIA B–D) [ 23 – 25 ].…”

Section: Discussionmentioning

confidence: 99%

The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study

et al. 2022

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Background Few data on the management of acute phase of traumatic spinal cord injury (tSCI) in patients suffering polytrauma are available. As the therapeutic choices in the first hours may have a deep impact on outcome of tSCI patients, we conducted an international survey investigating this topic. Methods The survey was composed of 29 items. The main endpoints of the survey were to examine: (1) the hemodynamic and respiratory management, (2) the coagulation management, (3) the timing of magnetic resonance imaging (MRI) and spinal surgery, (4) the use of corticosteroid therapy, (5) the role of intraspinal pressure (ISP)/spinal cord perfusion pressure (SCPP) monitoring and (6) the utilization of therapeutic hypothermia. Results There were 171 respondents from 139 centers worldwide. A target mean arterial pressure (MAP) target of 80–90 mmHg was chosen in almost half of the cases [n = 84 (49.1%)]. A temporary reduction in the target MAP, for the time strictly necessary to achieve bleeding control in polytrauma, was accepted by most respondents [n = 100 (58.5%)]. Sixty-one respondents (35.7%) considered acceptable a hemoglobin (Hb) level of 7 g/dl in tSCI polytraumatized patients. An arterial partial pressure of oxygen (PaO2) of 80–100 mmHg [n = 94 (55%)] and an arterial partial pressure of carbon dioxide (PaCO2) of 35–40 mmHg [n = 130 (76%)] were chosen in most cases. A little more than half of respondents considered safe a platelet (PLT) count > 100.000/mm3 [n = 99 (57.9%)] and prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 85 (49.7%)] in patients needing spinal surgery. MRI [n = 160 (93.6%)] and spinal surgery [n = 158 (92.4%)] should be performed after intracranial, hemodynamic, and respiratory stabilization by most respondents. Corticosteroids [n = 103 (60.2%)], ISP/SCPP monitoring [n = 148 (86.5%)], and therapeutic hypothermia [n = 137 (80%)] were not utilized by most respondents. Conclusions Our survey has shown a great worldwide variability in clinical practices for acute phase management of tSCI patients with polytrauma. These findings can be helpful to define future research in order to optimize the care of patients suffering tSCI.

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Section: Discussionmentioning

confidence: 99%

The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study

et al. 2022

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“…Immobilisation of the spinal column for resuscitation is recommended where possible to avoid additional damage through the mechanical effects of instability [ 61 ]. More definitive management of bony instability is typically achieved via fixation, accompanied (where indicated) by bony decompression of the spinal cord [ 39 , 62 , 63 , 64 , 65 ]. Along with the supportive management of blood pressure dysregulation (through neurogenic shock, orthostatic hypotension and autonomic dysreflexia), targeted blood pressure regulation and augmentation to optimise spinal cord perfusion is also a common feature of contemporary management [ 66 , 67 ].…”

Section: Spinal Cord Injurymentioning

confidence: 99%

Neurotrauma—From Injury to Repair: Clinical Perspectives, Cellular Mechanisms and Promoting Regeneration of the Injured Brain and Spinal Cord

Stevens,

Belli,

Ahmed

2024

Biomedicines

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Traumatic injury to the brain and spinal cord (neurotrauma) is a common event across populations and often causes profound and irreversible disability. Pathophysiological responses to trauma exacerbate the damage of an index injury, propagating the loss of function that the central nervous system (CNS) cannot repair after the initial event is resolved. The way in which function is lost after injury is the consequence of a complex array of mechanisms that continue in the chronic phase post-injury to prevent effective neural repair. This review summarises the events after traumatic brain injury (TBI) and spinal cord injury (SCI), comprising a description of current clinical management strategies, a summary of known cellular and molecular mechanisms of secondary damage and their role in the prevention of repair. A discussion of current and emerging approaches to promote neuroregeneration after CNS injury is presented. The barriers to promoting repair after neurotrauma are across pathways and cell types and occur on a molecular and system level. This presents a challenge to traditional molecular pharmacological approaches to targeting single molecular pathways. It is suggested that novel approaches targeting multiple mechanisms or using combinatorial therapies may yield the sought-after recovery for future patients.

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“… 9 Surgical decompression within 24 h of a SCI does, however, facilitate sensorimotor recovery. 10 , 11 Studies have shown that surgical decompression within 6 h of injury results in ⩾1 American Spinal Injury Association grade improvement in approximately 70% of patients. 12 Moreover, surgical decompression prevents the spinal cord from being compressed, improves its surrounding environment, and helps nerve recovery in the damaged area, but it cannot regenerate necrotic nerve cells.…”

Section: Introductionmentioning

confidence: 99%

Biomaterials delivery strategies to repair spinal cord injury by modulating macrophage phenotypes

et al. 2022

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Spinal cord injury (SCI) causes tremendous harm to a patient’s physical, mental, and financial health. Moreover, recovery of SCI is affected by many factors, inflammation is one of the most important as it engulfs necrotic tissue and cells during the early stages of injury. However, excessive inflammation is not conducive to damage repair. Macrophages are classified into either blood-derived macrophages or resident microglia based on their origin, their effects on SCI being two-sided. Microglia first activate and recruit blood-derived macrophages at the site of injury—blood-borne macrophages being divided into pro-inflammatory M1 phenotypes and anti-inflammatory M2 phenotypes. Among them, M1 macrophages secrete inflammatory factors such as interleukin-β (IL-β), tumor necrosis factor-α (TNF-α), IL-6, and interferon-γ (IFN-γ) at the injury site, which aggravates SCIs. M2 macrophages secrete IL-4, IL-10, IL-13, and neurotrophic factors to inhibit the inflammatory response and inhibit neuronal apoptosis. Consequently, modulating phenotypic differentiation of macrophages appears to be a meaningful therapeutic target for the treatment of SCI. Biomaterials are widely used in regenerative medicine and tissue engineering due to their targeting and bio-histocompatibility. In this review, we describe the effects of biomaterials applied to modulate macrophage phenotypes on SCI recovery and provide an outlook.

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Early versus Late Surgical Decompression for Traumatic Spinal Cord Injury on Neurological Recovery: A Systematic Review and Meta-Analysis

Cited by 18 publications

References 43 publications

The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study

The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study

Neurotrauma—From Injury to Repair: Clinical Perspectives, Cellular Mechanisms and Promoting Regeneration of the Injured Brain and Spinal Cord

Biomaterials delivery strategies to repair spinal cord injury by modulating macrophage phenotypes

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