Spinal fixation surgery for acute traumatic spinal cord injury

Bagnall, Anne‐Marie; Jones, Lisa; Duffy, Steven; Riemsma, R.P.

doi:10.1002/14651858.cd004725.pub2

Cited by 23 publications

(18 citation statements)

References 14 publications

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“…There is still need for high-quality trials to examine the role of decompressive surgery in other, less obvious circumstances. 11 The final constituent of our treatment regimen was cooling. There has, over the years, been modest interest in therapeutic hypothermia for traumatic SCI, 27 with interest more recently focusing on systemic cooling.…”

Section: Discussionmentioning

confidence: 99%

Local cooling for traumatic spinal cord injury: outcomes in 20 patients and review of the literature

Hansebout

2014

SPI

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Object In this prospective study, the authors offered protocol-selected patients a combination of parenteral steroids, decompression surgery, and localized cooling to preserve viable spinal cord tissue and enhance functional recovery. Methods After acquiring informed consent, the authors offered this regimen with localized deep cord cooling (dural temperature 6°C) to 20 patients with a neurologically complete spinal cord injury to begin within 8 hours of injury. After decompression, the cord was locally cooled through the intact dura using a suspended extradural saddle at the site of injury for up to 4 hours, during which time spinal fusion was performed. Sensation and motor function were evaluated directly after the injury and again over a year later. The patients were evaluated using the 2011 amendment to the American Spinal Injury Association (ASIA) Impairment Scale. Results Eighty percent of the 20 patients (12 with cervical and 4 thoracic injuries) with an initial neurologically complete cord injury had some recovery of sensory or motor function. All patients initially had ASIA Grade A impairment. Of 14 patients with quadriplegia, 5 remained ASIA Grade A, 5 improved to ASIA Grade B, 3 to ASIA Grade C, and 1 to ASIA Grade D. The remaining 6 patients had suffered a thoracic spinal cord injury, and of these 2 remained ASIA Grade A, 1 recovered to ASIA Grade B, 2 to ASIA Grade C, and 1 ASIA Grade D. All considered, of 20 patients, 35% remained ASIA Grade A, 30% improved to ASIA Grade B, and 25% to ASIA Grade C. Impairment in 2 (10%) of 20 patients improved to ASIA Grade D. The mean improvement in neurological level of injury in all patients was 1.05, the mean improvement in motor level was 1.7, and the mean improvement in sensory level was 2.8. Two patients recovered the ability to walk, 2 could extend their legs, 5 could sense bladder fullness, and 3 had partial ability to void voluntarily. Four males recovered subnormal ability to have voluntary erection sufficient for limited sexual activity. Conclusions The authors present here results of 20 patients with neurologically complete spinal cord injury treated with a combination of surgical decompression, glucocorticoid administration, and regional hypothermia. These patients experienced a better recovery than might have been expected had traditional forms of treatment been used. The benefit of steroid treatment for cord injury has been debated in the last decade, but the authors feel that research into the effects of cord cooling should be expanded. Given that the optimal neuroprotective temperature after acute trauma has not yet been defined, and may well be below that which is considered safely approachable through systemic cooling, methods that allow for the early attainment of such a temperature locally should be further explored. The results are encouraging enough to suggest the undertaking of controlled clinical trials of treatment using localized spinal cord cooling, where such treatment can be instituted within hours following injury.

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Section: Discussionmentioning

confidence: 99%

Local cooling for traumatic spinal cord injury: outcomes in 20 patients and review of the literature

Hansebout

2014

SPI

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“…[522] However, with reference to patients with “complete” deficits in particular, the need for surgery has remained even more controversial,[13] with several authors advocating nonoperative management of these patients showing outcomes either comparable or superior to patients who undergo surgical stabilization. [2] Therefore, management of these patients revolves around the prevention of complications, early rehabilitation, and re-integration into society. Hence, we aimed to compare the clinical outcomes and cost-effectiveness of surgical stabilization versus conservative management of spinal injury in patients with complete deficits, essentially from a developing country's point of view.…”

Section: Discussionmentioning

confidence: 99%

Low cost quality initiatives for management of neurosurgical patients in developing nations: Perspective from a tertiary care centre in Pakistan

Hussain¹,

Waqas²,

Shamim³

2017

Surg Neurol Int

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Background:Targeting resources on cost-effective care strategies is pertinent for developing nations, specifically for already burdened specialties such as neurosurgery, where without state support and insurance companies, expenses are borne by the patient themselves.Methods:This was a descriptive review of literary work published by the section of neurosurgery at Aga Khan University Hospital, Pakistan. We searched PubMed and CiNAHL databases to identify articles, which were then critically analyzed and discussed from a perspective of low-cost quality care.Results:We demonstrate the cost effectiveness of three initiatives, namely, blood ordering protocol for elective spine arthrodesis, nonoperative management being superior to surgical stabilization in spine injury patients with complete neurological deficits, and early tracheostomy in patients with isolated severe traumatic brain injury.Conclusion:Initiation and implementation of such cost-effective strategies without compromising quality health standards must be emphasized by neurosurgical centers throughout the developing world for smart allocation and utilization of funds.

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“…Penetrating injuries usually require surgery to assess for foreign bodies and to clean the wound to prevent infection. The timing of surgery is not clearly defined and remains controversial (30). Earlier studies suggested that medical complication rates are lower in patients who undergo early surgery, which translates into earlier mobilization and reduced hospital length of stay.…”

Section: Delay In Spinal Cord Injury Diagnosis Due To Sedation E415mentioning

confidence: 99%

Delay in Spinal Cord Injury Diagnosis Due to Sedation: A Case Report

Gawor¹,

Biese²,

Platts‐Mills³

2012

The Journal of Emergency Medicine

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Spinal fixation surgery for acute traumatic spinal cord injury

Abstract: The current evidence does not enable conclusions to be drawn about the benefits or harms of spinal fixation surgery in patients with traumatic SCI. Well-designed, prospective experimental studies with appropriately matched controls are needed.

Cited by 23 publications

References 14 publications

Local cooling for traumatic spinal cord injury: outcomes in 20 patients and review of the literature

Local cooling for traumatic spinal cord injury: outcomes in 20 patients and review of the literature

Low cost quality initiatives for management of neurosurgical patients in developing nations: Perspective from a tertiary care centre in Pakistan

Delay in Spinal Cord Injury Diagnosis Due to Sedation: A Case Report

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