Neurologic Recovery in Quadriplegia Following Operative Treatment

Weinshel, Steven S.; Maiman, Dennis J.; Baek, Paul N.; Scales, Lisa

doi:10.1097/00002517-199009000-00008

Cited by 18 publications

(7 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are few published studies in literature, which are prospective, controlled studies of surgical decompression in acute SCI[ 23 24 25 26 27 28 ] Papadopoulos. [ 20 ] evaluated 91 patients with acute cervical SCI.…”

Section: Discussionmentioning

confidence: 99%

Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India

et al. 2015

View full text Add to dashboard Cite

Aims:This study was done with the aim to compare the clinical outcome and patients’ quality of life between early versus delayed surgically treated patients of acute subaxial cervical spinal cord injury. The current study was based on the hypothesis that early surgical decompression and fixations in acute subaxial cervical spinal cord trauma is safe and is associated with improved outcome as compared to delayed surgical decompression.Materials and Methods:A total of 69 patients were recruited and divided into early decompression surgery Group A (operated within 48 h of trauma; n = 23) and late/delayed decompression surgery Group B (operated between 48 h and 7 days of trauma; n = 46). The patients in both groups were followed up, and comparative differences noted in the neurological outcome, quality of life, and bony fusion.Results:The early surgery group spent lesser days in the intensive care unit and hospital (Group A 28.6 vs. Group B 35 days) had lesser postoperative complications (Group A 43% vs. Group B 61%) and a reduced mortality (Group A 30% vs. Group B 45%). In Group A, 38% patients had 1 American Spinal Injury Association (ASIA) grade improvement while 31% experienced >2 ASIA grade improvement. In Group B, the neurological improvement was 27% and 32%, respectively (P = 0.7). There was a significant improvement in the postoperative quality of life scores in both groups.Conclusion:Early surgery in patients with acute subaxial cervical spine injury should be considered strongly in view of the lesser complications, early discharge, and reduced mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India

et al. 2015

View full text Add to dashboard Cite

show abstract

“…), removal at 2 hours of an extradural clip that compressed the spinal cord produced better neurological recovery than removal at 4 hours. [30] In some clinical studies in patients who have undergone decompressive surgery, promising results have been demonstrated, [6,53,54] although results of other studies have failed to show a benefit from early decompressive compared with later decompressive surgery. [5,26,34,35,38,[49][50][51] Findings from several studies have failed to show improved recovery in those patients who underwent surgery compared with those receiving nonoperative treatment.…”

Section: Discussionmentioning

confidence: 99%

Current use and timing of spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study

Tator

Fehlings²,

Thorpe³

et al. 1999

Journal of Neurosurgery: Spine

View full text Add to dashboard Cite

Object. A multicenter retrospective study was performed in 36 North American centers to examine the use and timing of surgery in patients who have sustained acute spinal cord injury (SCI). The study was performed to obtain information required for the planning of a randomized controlled trial in which early and late decompressive surgery are compared. Methods. The records of all patients aged 16 to 75 years with acute SCI admitted to 36 centers within 24 hours of injury over a 9-month period in 1994 and 1995 were examined to obtain data on admission variables, methods of diagnosis, use of traction, and surgical variables including type and timing of surgery. A total of 585 patients with acute SCI or cauda equina injury were admitted to participating centers, although approximately half were ultimately excluded because they did not meet inclusion criteria. Common causes for exclusion were late admission, age, gunshot wound, and absence of signs of compression on imaging studies. Thus, only approximately 50% of patients with acute SCI would be eligible for inclusion in a study of acute decompressive surgery. Although all patients underwent computerized tomography (CT) scanning, only 54% underwent magnetic resonance imaging, and CT myelography was performed in only 6%. Complete neurological injuries (American Spinal Injury Association Grade A) were present in 57.8%. Traction was applied in only 47% of patients who sustained cervical injury, in whom decompressive traction was successful in only 42% of cases. Neurological deterioration occurred in 8.1% of cases after traction. Surgery was performed in 65.4% of patients. The timing of surgery varied widely: less than 24 hours postinjury in 23.5%, between 25 and 48 hours postinjury in 15.8%, between 48 and 96 hours in 19%, and more than 5 days postinjury in 41.7% of patients. Conclusions. These data indicate that although surgery is commonly performed in patients with acute SCI, one third of cases are managed nonoperatively, and there is very little agreement on the optimum timing of surgical treatment. The results of this study confirm the need for a randomized controlled trial to assess the optimum timing of decompressive surgery in SCI.

show abstract

“…21,22 Furthermore, definitive and unequivocal evidence to support the practice of early or late surgery are still lacking in clinical studies. 21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] Recently, in an evidence-based review of the literature, Fehlings and Tator 10 concluded, on the bases of the current knowledge, that early decompression can be considered a practice option. 37 Clinically, the neurological examination within 24 h of injury is fraught with difficulty.…”

Section: Introductionmentioning

confidence: 99%

Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach

et al. 2004

View full text Add to dashboard Cite

Study design: Definitive and unequivocal evidence to support the practice of early or late surgery is still lacking in clinical studies. Accordingly, meta-analysis is one of the few methods that offer a rational, statistical approach to management decision. A review of the clinical literature on spinal cord injury with emphasis on the role of early surgical decompression and a meta-analysis of results was performed. Objectives: To determine whether neurological outcome is improved in traumatic spinal cordinjured patients who had surgery within 24 h as compared with those who had late surgery or conservative treatment. Methods: A Medline search covering the period 1966-2000, supplemented with manual search, was used to locate studies containing information on indication, rationale and timing of surgical decompression after spinal cord injuries. The analysis included a total of 1687 eligible patients. Results: Statistically, early decompression resulted in better outcome compared with both conservative (Po0.001) and late management (Po0.001). Nevertheless, analysis of homogeneity showed that only data regarding patients with incomplete neurological deficits who had early surgery were reliable. Conclusions: Although statistically the percentage of patients with incomplete neurological deficits improving after early decompression appear 89.7% (95% confidence interval: 83.9, 95.5%), to be better than with the other modes of treatment when taking into consideration the material available for analysis and the various other factors including clinical limitations; early surgical decompression can only be considered as practice option for all groups of patients.

show abstract

Neurologic Recovery in Quadriplegia Following Operative Treatment

Cited by 18 publications

References 0 publications

Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India

Early versus delayed decompression in acute subaxial cervical spinal cord injury: A prospective outcome study at a Level I trauma center from India

Current use and timing of spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study

Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach

Contact Info

Product

Resources

About