Neurologic Outcome of Early Versus Late Surgery for Cervical Spinal Cord Injury

Vaccaro, Alexander R.; Daugherty, Reza; Sheehan, Terrence P.; Dante, Stephen J.; Cotler, Jerome M.; Balderston, Richard A.; Herbison, Gerald J.; Northrup, Bruce E.

doi:10.1097/00007632-199711150-00006

Cited by 301 publications

(187 citation statements)

References 19 publications

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“…Further studies (prospective and multi-centric) are overdue. The only prospective randomized trial to determine whether functional outcome is improved in traumatic cervical spinal cord injured patients is Vaccaro et al 17 The results of this study revealed no significant benefit if decompression and fixation is performed less than 72 h after injury (mean 1.8 days), as opposed to waiting longer than 5 days (mean 16.8 days). 8 We found that Frankel grading in combination with ASIA motor scoring is a powerful tool for measuring neurological outcome.…”

Section: Discussionmentioning

confidence: 76%

Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury

et al. 2008

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Study design: Retrospective study based on a reference paper. Neurological outcome in patients who were managed surgically with closed traumatic cervical spine injury was evaluated using the ASIA motor scoring system and Frankel grading. Objectives: To assess the accuracy of motor charting and Frankel grading as tools to evaluate neurological outcome in closed traumatic cervical spine injury, and also to evaluate how the surgically treated patients fared in their neurological recovery by measurement tools as in the reference paper. Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Method: Fifty-seven patients were admitted within 2 days of the injury with closed traumatic cervical spine injuries (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Thirty-seven (65%) met the inclusion criteria as per the referenced paper, that is, were treated surgically, were Frankel grade B and above and had at least 12 months follow up. The remaining 20 patients were not included as they did not meet the inclusion criteria. The breakdown of the 20 patients is given in Table 1. The mean recovery percentage (MRP) and mean deficit percentage (MDP) were calculated as per the referenced paper. Results: An evaluation of 37 patients surgically treated, who had follow up of at least 12 months, showed that preservation of pin prick below the level of lesion, and preservation of anal tone and perianal sensation were good prognostic indicators. There was no correlation between degree of encroachment of canal or the degree of kyphosis to MDP or MRP. The mean time from injury to mobilization was 7.6 days in 25 out of 37 patients. Twelve of the 37 patients had prolonged immobilization because of ITU stay or because they were initially treated conservatively. Three out of the 37 patients developed DVT/PE. Mean hospital stay was 6.4 months. Conclusion: The neurological outcome in surgically treated patients is comparable to the conservatively treated patients. The Frankel grading and ASIA motor charting combined is a powerful tool in assessing the neurological outcome in closed traumatic cervical spinal injured patients. Until now there has been no evidence to suggest that the obvious advantages of surgical management of closed cervical spine injuries (better alignment, easier manual handling and early mobilization) is traded for poorer neurological outcome.

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Section: Discussionmentioning

confidence: 76%

Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury

et al. 2008

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“…In a prospective analysis, Papadopoulos et al 11 concluded that immediate spinal surgery after acute SCI may significantly improve neurological outcome. In contrast, another prospective study 12 found no statistical difference in neurological recovery between early (o72 h post trauma) and late (45 days after trauma) spinal surgery groups. McKinley et al 13 agreed with the findings of the latter study, but also highlighted the increased length of stay, the increased costs and the higher incidence of pulmonary complications in late surgical interventions.…”

Section: Discussionmentioning

confidence: 83%

Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study

2009

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Study design: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS). Objectives: To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI). Settings: The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden. Methods: Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry. Results: There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki. Conclusions: Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not.

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“…The mean period from injury to operation was 8.2 days (range [3][4][5][6][7][8][9][10][11][12][13][14]. Sixteen cases were treated by laminoplasty, and only one case by anterior decompression and spinal fusion.…”

Section: Methodsmentioning

confidence: 99%

“…The terminology regarding this type of injury remains confusing whereas, in addition, treatment with either surgery or conservative measures remains controversial. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Such cervical cord injury has previously been called 'Adult SCIWORA (Spinal cord injury without radiographic abnormality in adults, 10 or Spinal cord injury without radiological abnormality in adults 19 )'. However, this term is incorrect because the terminology 'SCIWORA (Spinal cord injury without radiographic abnormality)' was created before the development of computed tomography and magnetic resonance imaging (MRI), and only for children.…”

Section: Introductionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] This injury does not usually require surgery for the reconstruction of the spinal column but instead may require decompression for the narrowed spinal canal with laminoplasty, to achieve an improvement in the paralysis. Some surgeons have reported an improvement of paralysis, following decompression of the spinal cord, whereas others have concluded that the fate of an injured spinal cord cannot change by decompression surgery, as such spinal cord compression may have existed before the injury even though such patients had been asymptomatic.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression: a multicenter prospective study

et al. 2010

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Study design: A multicenter prospective study comparing the neurological outcome of patients treated by surgical intervention versus conservative treatment for cervical spinal cord injury (CSCI) without bone and disc injury. Objective: To evaluate the neurological outcome of decompression surgery for CSCI without bone and disc injury in patients with spinal cord compression with incomplete paralysis (AIS B, C). Setting: The Japan LHWO Spinal Injuries Center and the other 10 labor accident hospitals in Japan. Methods: Thirty-four patients with AIS B, C and cervical spinal cord compression were classified into either a surgical treatment group or a conservative treatment group. The 34 patients enrolled were equally divided between the groups. Patients with AIS B, C and mild spinal compression were enrolled into another group. Results: The neurological outcome of surgical treatment and conservative treatment for AIS B, C with spinal cord compression was found to be closely similar. In addition, the neurological outcome was also similar to that observed after conservative treatment for AIS B, C in patients presenting with mild spinal cord compression. Conclusions: Surgical treatment was not found to be superior to conservative treatment for CSCI patients without bone and disc injury suffering from spinal cord compression in the acute phase.

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Neurologic Outcome of Early Versus Late Surgery for Cervical Spinal Cord Injury

Abstract: The results of this study reveal no significant neurologic benefit when cervical spinal cord decompression after trauma is performed less than 72 hours after injury (mean, 1.8 days) as opposed to waiting longer than 5 days (mean, 16.8 days).

Cited by 301 publications

References 19 publications

Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury

Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury

Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study

Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression: a multicenter prospective study

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