The value of decompression for acute experimental spinal cord compression injury

Dolan, Eugen J.; Tator, Charles H.; Endrényi, László

doi:10.3171/jns.1980.53.6.0749

Cited by 210 publications

(101 citation statements)

References 8 publications

(1 reference statement)

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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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“…Based on existing preclinical studies, it is clear that ongoing compression of the spinal cord represents a form of secondary injury that can be attenuated by decompressive surgery [21][22][23][24][25][26][27][28][29][30][31]. It is also evident that the degree of neural injury is directly related to the duration of spinal cord compression and inversely related to the time elapsed from injury to surgical decompression.…”

Section: Preclinical Evidence For Surgical Decompressionmentioning

confidence: 99%

Emerging Approaches to the Surgical Management of Acute Traumatic Spinal Cord Injury

Wilson

Fehlings

2011

Neurotherapeutics

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Summary: Traumatic, spinal cord injury (SCI) is a potentially catastrophic event causing major impact at both a personal and societal level. To date, virtually all therapies that have shown promise at the preclinical stage of study have failed to translate into clinically effective treatments. Surgery is performed in the setting of SCI, with the goals of decompressing the spinal cord and restoring spinal stability. Although a consensus regarding the optimal timing of surgical decompression for SCI has not been reached, much of the preclinical and clinical evidence, as well as a recent international survey of spine surgeons, support performing early surgery (<24 hours). Results of the multicenter, Surgical Trial in Acute Spinal Cord Injury Study (STASCIS), expected later this year, should further clarify this important management issue. The overall goal of this review is to provide an update regarding the current status of surgical therapy for traumatic SCI by reviewing relevant pathophysiology, laboratory, and clinical evidence, as well as to introduce radiologic and clinical tools that aid in the surgical decision-making process.

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“…The role of decompression combined with stabilisation is still con troversial (Dolan et at., 1980;Karulas and Bedbrook, 1927;Ducker and Byrnes, 1979;Freeman, 1958;Meyer, 1977). In many cases Harrington instrumentation can produce an anatomical restoration of the vertebral column, (Flesch et at., 1977;Roy-Camille et at., 1976;Yosipovitch et at., 1977) but does it adequately decompress the spinal canal?…”

Section: Introductionmentioning

confidence: 99%

“…If so, should Harrington instrumenta tion be combined with decompression, whether from the anterior, the anterolateral, the posterolateral or the posterior approach? (Schmidek et at., 1977;Larson et at., 1976;Riska and Myllynen, 1981;Bohlman and Eismont, 1981;Dolan et at., 1980;Paul et at., 1977;Wang et at., 1979;Young et at., 1981). The purpose of this paper is to report the gradual evolution of a philosophy as it applies to spinal injuries at the thoracolumbar junction.…”

Section: Introductionmentioning

confidence: 99%

Fractures of the thoraco-lumbar spine

1985

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SummaryA personal prospective study of 98 consecutive patients presenting with neurological impairment and fractures or dislocations between the 9th thoracic and 2nd lumbar vertebrae bodies. Fifty-three patients underwent Harrington instrumentation, and 45 patients were treated recumbently. Neurological improvement was much better fo llowing Harrington rods in the complete paraplegia group but there was no dif ference in neurological recovery between the two groups in those with incomplete paraplegia. Forty-two patients who had been stabilised with Harrington rods underwent post-operative myelography or tomography to assess the adequacy of sp inal decompression. The best results were in patients with adequate neural canal decompression. In 21 cases decompression had not been adequate, usually due to a stereotyped pattern in which the postero-superior aspect of the fractured body remained in the neural canal. All 21 underwent anterior decompression at an average of five months post injury. All the incomplete paraplegics (nine patients) regained the ability to walk, three of the 12 complete paraplegics improved and regained the ability to walk with bilateral ankle-foot orthoses. Neurological improvement was dependent upon the adequacy of spinal cord decompression and not upon Harrington rods. per se. Harrington rods alone were not adequate to decompress the spinal canal in 50 per cent of cases. The best results after anterior decompression occurred where neural compression was caused by a minimally displaced wedge fr acture distal to T12.

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The value of decompression for acute experimental spinal cord compression injury

Cited by 210 publications

References 8 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

Emerging Approaches to the Surgical Management of Acute Traumatic Spinal Cord Injury

Fractures of the thoraco-lumbar spine

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