Early surgical intervention among patients with acute central cord syndrome is not associated with higher mortality and morbidity

Godzik, Jakub; Dalton, Jonathan; Hemphill, Courtney; Walker, Corey T.; Chapple, Kristina; Cook, Alan; Uribe, Juan S.; Turner, Jay D.

doi:10.21037/jss.2019.09.26

Cited by 10 publications

(13 citation statements)

References 18 publications

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“…33 Despite the limitations of current literature, increasing evidence indicates that early surgery may lessen the rate of medical complications and improve neurological recovery. [20][21][22][23][24] Our study was undertaken to define "early" surgical intervention, which might portend a lower rate of complications and shorter length of stay as well as to identify if a trend existed with respect to the timing of treatment. Results from this study indicate that the admission-daysurgery cohort receiving surgery on the day of admission had a clinically and statistically significant 50% decrease in 30-day postoperative complication rates compared with the next-day-surgery group or late-surgery group as well as a shorter length of stay.…”

Section: Discussionmentioning

confidence: 99%

“…Data varies on the optimal time for surgical treatment of CCS with some studies favoring early intervention20–24 and others advocating that surgery can or should be delayed for up to 2–6 weeks 13,25. Data also exists that indicates no difference in outcomes with either early or delayed surgery6,11,26–28 and some suggest that the timing of surgery should be individualized to patient-specific factors 29–31…”

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confidence: 99%

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Surgery on the Day of Admission Decreases Postoperative Complication Rates for Patients With Central Cord Syndrome

Smith¹,

Somogyi²,

Wright³

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Objective: This study was undertaken to determine what constitutes "early optimal timing" of surgical management of central cord syndrome (CCS) with respect to a reduction of medical complications.Summary of Background Data: Data varies on the optimal time for surgical treatment of CCS with some studies favoring early intervention and others advocating that surgery can or should be delayed for 2-6 weeks.Methods: This IRB-approved study was a retrospective crosssectional review of surgical management outcomes for patients diagnosed with CCS using the National Surgical Quality Improvement Program database, which consists of anonymized medical record data from the year 2010 to 2020. Patient data included age, sex, American Society of Anesthesiologists score, current procedural terminology codes, length of stay, and postoperative complications. Patients were grouped into admissionday surgery, next-day surgery, and late-surgery groups.Results: A total of 738 patients who underwent surgery to treat CCS were identified in the National Surgical Quality Improvement Program database from 2010 to 2020 and included in this study. Admission-day surgery compared with next-day surgery was associated with a decreased postoperative complication rate after multivariate analysis (odds ratio: 0.52; 95% CI: 0.28-0.97; P = 0.0387) as well as shorter length of stay (P <0.0001). Complication rates between the next-day-surgery cohort and latesurgery cohort did not differ after multivariate analysis (odds ratio: 1.02; 95% CI: 0.63-1.65; P = 0.9451), but the length of stay was shorter for next-day surgery (P <0.0001). Two-year rolling averages for the admission-day-surgery rate and next-day-surgery rate show a compound annual growth rate of 2.52% and 4.10%, respectively. Conclusions:In patients admitted for surgical treatment of CCS, those who receive admission-day surgery have significantly reduced 30-day complication rates as well as shorter length of stays. Therefore, we advocate that "early surgery" should be defined as surgery on the day of admission and should occur in as timely a manner as possible. Prior studies, which define "early surgery" as within 24 hours might, unfortunately, fall short of reaching the optimal threshold for the reduction of 30-day medical complications associated with the treatment of patients with CCS.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Surgery on the Day of Admission Decreases Postoperative Complication Rates for Patients With Central Cord Syndrome

Smith¹,

Somogyi²,

Wright³

et al. 2023

Clinical Spine Surgery: A Spine Publication

View full text Add to dashboard Cite

show abstract

“…Often, decompression of pressure from cerebrospinal fluid that presses on the spinal cord (decompression laminoplasty) is performed within at least 24 h post-trauma to preserve surviving neurons from blood brain barrier breach processes and reduce the risk of secondary injury ( 11 ). Several studies suggest that early surgical management in the acute phase is intrinsically connected to an earlier initiation of rehabilitation protocols and an improvement in neurological outcomes ( 12 , 13 ). In the scope of recommended guidelines for SCI management, timely surgical intervention essentially serves as a neuroprotective strategy and not a predictor of full functional recovery.…”

Section: Current Clinical Management Strategies Are Not Truly Regener...mentioning

confidence: 99%

Electroactive Scaffolds to Improve Neural Stem Cell Therapy for Spinal Cord Injury

Mutepfa

Hardy

Adams

2022

Front. Med. Technol.

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Spinal cord injury (SCI) is a serious condition caused by damage to the spinal cord through trauma or disease, often with permanent debilitating effects. Globally, the prevalence of SCI is estimated between 40 to 80 cases per million people per year. Patients with SCI can experience devastating health and socioeconomic consequences from paralysis, which is a loss of motor, sensory and autonomic nerve function below the level of the injury that often accompanies SCI. SCI carries a high mortality and increased risk of premature death due to secondary complications. The health, social and economic consequences of SCI are significant, and therefore elucidation of the complex molecular processes that occur in SCI and development of novel effective treatments is critical. Despite advances in medicine for the SCI patient such as surgery and anaesthesiology, imaging, rehabilitation and drug discovery, there have been no definitive findings toward complete functional neurologic recovery. However, the advent of neural stem cell therapy and the engineering of functionalized biomaterials to facilitate cell transplantation and promote regeneration of damaged spinal cord tissue presents a potential avenue to advance SCI research. This review will explore this emerging field and identify new lines of research.

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“…Godzik et al 62 identified 2,379 ATCCS patients inflicted with multisystem trauma from a U.S. National Trauma Data Bank, of whom 30.7% underwent surgery within 24 hours. Early surgery did not appear to be associated with increased mortality.…”

Section: Literature Reviewmentioning

confidence: 99%

Pros and Cons of Early and Very Early Surgery for Traumatic Central Cord Syndrome with Spinal Stenosis: Literature Review and Case Report

Hildebrandt

Joswig

Stienen

et al. 2021

J Neurol Surg A Cent Eur Neurosurg

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Background The case of a 69-year-old patient with an acute traumatic central cord syndrome (ATCCS) with preexisting spinal stenosis raised a discussion over the question of conservative versus surgical treatment in the acute setting. We provide a literature overview on the management (conservative vs. surgical treatment) of ATCCS with preexisting spinal stenosis. Methods We reviewed the literature concerning essential concepts for the management of ATCCS with spinal stenosis and cervical spinal cord injury. The data retrieved from these studies were applied to the potential management of an illustrative case report. Results Not rarely has ATCCS an unpredictable neurologic course because of its dynamic character with secondary injury mechanisms within the cervical spinal cord in the early phase, the possibility of functional deterioration, and the appearance of a neuropathic pain syndrome during late follow-up. The result of the literature review favors early surgical treatment in ATCCS patients with preexisting cervical stenosis. Conclusion Reluctance toward aggressive and timely surgical treatment of ATCCS should at least be questioned in patients with preexisting spinal stenosis.

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Early surgical intervention among patients with acute central cord syndrome is not associated with higher mortality and morbidity

Cited by 10 publications

References 18 publications

Surgery on the Day of Admission Decreases Postoperative Complication Rates for Patients With Central Cord Syndrome

Surgery on the Day of Admission Decreases Postoperative Complication Rates for Patients With Central Cord Syndrome

Electroactive Scaffolds to Improve Neural Stem Cell Therapy for Spinal Cord Injury

Pros and Cons of Early and Very Early Surgery for Traumatic Central Cord Syndrome with Spinal Stenosis: Literature Review and Case Report

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