Neurological Recovery after Early Versus Delayed Surgical Decompression for Acute, Traumatic Spinal Cord Injury: A Prospective, Observational, European Multicentre (SCI-POEM) Study

Hosman, Allard J. F.; Barbagallo, Giuseppe; Popescu, Eugen Cezar; Meent, Henk van de; Öner, F. Cumhur; Iure, Federico De; Bonavita, Jacopo; Kreinest, Michael; Lindtner, Richard A.; Quraish, Nasir A.; Thumbikat, Pradeep; Bilić, Vitomir; Reynolds, Jeremy; Belci, Maurizio; Börcek, Alp Özgün; Morris, Seamus; Hoffmann, Christoph; Signorelli, Francesco; Uzunov, K; Middendorp, Joost J. van

doi:10.2139/ssrn.4066501

Cited by 6 publications

(7 citation statements)

References 26 publications

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“…Nonetheless, the outcomes are not as straight forward as they may initially appear. Recently, a prospective, multicenter study was published, which aimed to investigate the impact of ultra-early intervention (<12 h) on neurological outcome, particularly focusing on lower extremity motor score (LEMS) [17 ▪ ]. Surprisingly, this study did not reveal significant differences between the early and late cohort.…”

Section: Surgical Timingmentioning

confidence: 88%

Traumatic spinal cord injury: acute phase treatment in critical care

Adegeest,

ter Wengel,

Peul

2023

Current Opinion in Critical Care

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Purpose of review Surgical timing in traumatic spinal cord injury (t-SCI) remains a point of debate. Current guidelines recommend surgery within 24 h after trauma; however, earlier timeframes are currently intensively being investigated. The aim of this review is to provide an insight on the acute care of patients with t-SCI. Recent findings Multiple studies show that there appears to be a beneficial effect on neurological recovery of early surgical decompression within 24 h after trauma. Currently, the impact of ultra-early surgery is less clear as well as lacking evidence for the most optimal surgical technique. Nevertheless, early surgery to decompress the spinal cord by whatever method can impact the occurrence for perioperative complications and potentially expedite rehabilitation. There are clinical and socioeconomic barriers in achieving timely and adequate surgical interventions for t-SCI. Summary In this review, we provide an overview of the recent insights of surgical timing in t-SCI and the current barriers in acute t-SCI treatment.

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Section: Surgical Timingmentioning

confidence: 88%

Traumatic spinal cord injury: acute phase treatment in critical care

Adegeest,

ter Wengel,

Peul

2023

Current Opinion in Critical Care

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“…Mattiassich et al, in contrast, failed to show an improved outcome with surgery performed within 5 h post-injury ( Mattiassich et al, 2017 ). In addition, the recent SCI-POEM study comparing surgery ≤12 h after injury to surgery beyond 12 h in 294 patients, failed to show improvement at 12 months with early surgery ( Hosman et al, 2023 ). It is speculated that the dynamic and unstable initial hemodynamic and neurological situation, in addition to logistical challenges, may outweigh the benefits of ultra-early surgical decompression since the patient may be exposed to a greater risk with surgery during the initial phase ( Mattiassich et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study

Rask,

Uvelius,

Marklund

2024

Brain and Spine

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“…That lack is now being addressed by multiple groups, including the authors of the SCI-POEM study report. 8 Resolving the issue of which treatments are most effective for each sub-group of patients with acute SCI will be the most important task for researchers in the years to come.…”

Section: Discussionmentioning

confidence: 99%

“…Although the inclusion of patients with injuries of the cervical and thoracolumbar spine is likely to weaken the conclusions, this paper is the first comprehensive report on the results of the SCI-POEM study. 8 We look forward to future subgroup analyses and comparisons with the results of recent tSCI studies at the thoracolumbar spine level. 81,82…”

Section: Statistical Analysis Used To Improve the Evidence Basementioning

confidence: 99%

Which treatment provides the best neurological outcomes in acute spinal cord injury?

Birch¹,

Cheung

Takenaka

et al. 2023

Bone Joint J

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Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial. However, there has never been a properly conducted trial of surgery versus active conservative care. As a result, it is still not known whether early surgery or active physiological management of the unstable injured spinal cord offers the better chance for recovery. Surgeons who care for patients with traumatic spinal cord injuries in the acute setting should be aware of the arguments on all sides of the debate, a summary of which this annotation presents.Cite this article: Bone Joint J 2023;105-B(4):347–355.

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Neurological Recovery after Early Versus Delayed Surgical Decompression for Acute, Traumatic Spinal Cord Injury: A Prospective, Observational, European Multicentre (SCI-POEM) Study

Cited by 6 publications

References 26 publications

Traumatic spinal cord injury: acute phase treatment in critical care

Traumatic spinal cord injury: acute phase treatment in critical care

Adherence to international guidelines in neurocritical care of cervical traumatic spinal cord injury-a retrospective study

Which treatment provides the best neurological outcomes in acute spinal cord injury?

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