Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression.

Delamarter, Rick B.; Sherman, John E.; Carr, James B.

doi:10.2106/00004623-199507000-00010

Cited by 261 publications

(133 citation statements)

References 32 publications

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“…[1][2][3][4][5][6][7][8][9][14][15][16][17][18][19][20] Some of these events, together constituting the 'secondary injury', evolve very early after the trauma.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Experimental data have demonstrated that neurological recovery is enhanced by early decompressive procedures. [14][15][16][17][18][19][20] On the other hand, early surgery can cause deterioration of respiratory, haemodynamic and neurological functions. In acute systemic trauma, there is a greater probability of failure of alignment and fusion, and surgical treatment may be precluded by the lack of specific equipment and experienced personnel.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2004

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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.

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“…[1][2][3][4][5][6][7][8][9][14][15][16][17][18][19][20] Some of these events, together constituting the 'secondary injury', evolve very early after the trauma.…”

Section: Literature Reviewmentioning

confidence: 99%

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

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“…It has been shown experimentally that the persistence of spinal cord compression is correlated with neurological worsening. 27,28 Furthermore, an unstable vertebral lesion presents a risk of secondary displacement. Although there is relative consensus concerning the need for surgery of patients who have spinal injury with incomplete neurological de®cit, in complete lesions the type and timing of surgical intervention are unsettled issues.…”

Section: Spinal Cordmentioning

confidence: 99%

Pharmacological therapy of spinal cord injury during the acute phase

et al. 2000

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Study design: Prospective, randomized clinical trial. Setting: France. Objectives: To evaluate the safety and e ect on neurological outcome of nimodipine, methylprednisolone, or both versus no medical treatment in spinal-cord injury during the acute phase. Method: One hundred and six patients who had spinal trauma (including 48 with paraplegia and 58 with tetraplegia) were randomly separated into four groups: M=methylprednisolone (30 mg×kg 71 over 1 h, followed by 5.4 mg×kg 71 ×h 71 for 23 h), N=nimodipine (0.015 mg×kg 71 ×h 71 for 2 h followed by 0.03 mg×kg 71 ×h 71 for 7 days), MN (both agents) or P (neither medication). Neurological assessment (ASIA score) was performed by a blinded senior neurologist before treatment and at 1-year follow-up. Early spinal decompression and stabilization was performed as soon as possible after injury. Results: One hundred patients were reassessed at 1 year. Neurological improvement was seen in each group (P50.0001), however no additional neurological bene®t from treatment was observed. Infectious complications occurred more often in patients treated with M. Early surgery (49 patients underwent surgery within 8 h of their accident) did not in¯uence the neurological outcome. The only predictor of the latter was the extent of the spinal injury (complete or incomplete lesion). Conclusion: The present study con®rms the absence of bene®t of pharmacological therapy in this indication. Because of the paucity of clinical studies that demonstrate the e cacy of pharmacological treatment in spinal injury during the acute phase, systematic use of pharmaceutical agents should be reconsidered. Spinal Cord (2000) 38, 71 ± 76

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“…Hematoma is thought to result from tearing of the epidural veins lying within this premembranous space. It seems to be more likely that the appearance of chronic hematomas occurs in the conus medullaris because at this level there are higher pressures in the spinal cord and their arteries [7,14]. Apparently, tearing of the epidural veins occurs during an exertion, which increases the thoracic or abdominal pressure; the epidural blood plexus volume and pressure depend on the integration of the blood output between intracranial, intrathoracic and intrabdominal blood flow changes [6,15].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous chronic epidural hematoma of the lumbar spine mimicking an extradural spine tumour

et al. 2012

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Purpose Spontaneous chronic epidural hematomas are extremely rare and can be extremely challenging to diagnose and differentiate. The clinical findings, computed tomographic scan and magnetic resonance imaging does not always enough to complete differentiate this condition. Our purpose is to report a case of a spontaneous chronic epidural hematoma presenting as an extradural mass leading to compressive radicular symptoms with images of bony scalloping which are sparsely reported in the literature. Methods We describe a 61-year-old woman who was evaluated after 18-month history of pain, disestesias and mild weakness in both lower extremities with significant radicular symptoms on the right side associated to neurogenic claudication. Results CT scans revealed a nodular image of soft tissue density located in the right anterolateral epidural space at the L4-L5 level demonstrating resorption of the bony margins. MRI studies revealed a round mass in the vertebral canal displacing the dural sac and scalloping the posterior wall of the L4 vertebral body. Diagnosis was established between a degenerative cyst versus an atypical neurinoma. Surgical findings demonstrated an isolated well-formed chronic hematoma. Conclusion Spontaneous chronic epidural hematomas are rare, even more when they produce scalloping of bony structures becoming a diagnostic challenge. Therefore they should be always considered as a differential diagnosis in patients with extradural chronic compressions taking into account that also chronic epidural hematomas can cause bone involvement.

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Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression.

Cited by 261 publications

References 32 publications

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

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

Pharmacological therapy of spinal cord injury during the acute phase

Spontaneous chronic epidural hematoma of the lumbar spine mimicking an extradural spine tumour

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