Time to Surgery in Spinal Trauma: A Meta-Analysis of the World’s Literature Comparing High-Income Countries to Low-Middle Income Countries

Chanbour, Hani; Chen, Jeffrey; Ehtesham, Sofia A; Ivey, Camille; Pandey, Awadhesh Kumar; Dewan, Michael C.; Zuckerman, Scott L.

doi:10.1016/j.wneu.2022.07.140

Cited by 8 publications

(4 citation statements)

References 63 publications

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“…However, despite these positive developments, the outcomes of TSI patients in Tanzania still fall behind those observed in HICs. 2 It is worth noting that in our series, road traffic accidents account for nearly half of the cases. This underscores the urgent need for targeted interventions aimed at improving road safety.…”

Section: Areas Of Improvementmentioning

confidence: 68%

“…Traumatic spinal injury (TSI), which includes spinal column fractures and spinal cord injuries (SCIs), is a major global cause of disability and mortality. 1,2 The incidence is higher in low-and middle-income countries (LMICs), at 13.69 per 100,000 people, than in highincome countries (HICs), at 8.72 per 100,000 people. 3 Most patients with TSI require surgical intervention; however, surgery rates are low in LMICs due to limited access to health care, lack of trained personnel, financial barriers, limited infrastructure and resources, and cultural and societal factors.…”

Section: Introductionmentioning

confidence: 99%

“…3 Most patients with TSI require surgical intervention; however, surgery rates are low in LMICs due to limited access to health care, lack of trained personnel, financial barriers, limited infrastructure and resources, and cultural and societal factors. 2 LMICs account for only 3.5% Anatomically and functionally, the thoracolumbar (TL) spine refers to the region comprising the thoracic spine (T1-T10), the TL junction (T10-L2), and the lumbar spine (L3-L5). 8 TL spine injuries are prevalent and can cause substantial disability, deformity, and neurological deficit.…”

Section: Introductionmentioning

confidence: 99%

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Presentation, Management, and Outcomes of Thoracic, Thoracolumbar, and Lumbar Spine Trauma in East Africa: A Cohort Study

Ikwuegbuenyi,

Waterkeyn,

Okembo

et al. 2024

Int J Spine Surg

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Background: Trauma to the thoracic, thoracolumbar (TL), and lumbar spine is common and can cause disability and neurological deficits. Using a cohort of patients suffering from thoracic, TL, and lumbar spine trauma in a tertiary hospital in East Africa, the current study sought to: (1) describe demographics and operative treatment patterns, (2) assess neurologic outcomes, and (3) report predictors associated with undergoing surgery, neurologic improvement, and mortality.Methods: A retrospective cohort study of patient records from September 2016 to December 2020 was conducted at a prominent East Africa referral center. The study collected data on demographics, injury, and operative characteristics. Surgical indications were assessed using the AO (Arbeitsgemeinschaft für Osteosynthesefragen) TL fracture classification system and neurological function. Logistic regression analysis identified predictors for operative treatment, neurologic improvement, and mortality.Results: The study showed that 64.9% of the 257 TL spine trauma patients underwent surgery with a median postadmission day of 17.0. The mortality rate was 1.2%. Road traffic accidents caused 43.6% of the injuries. The most common fracture pattern was AO Type A fractures (78.6%). Laminectomy and posterolateral fusion were performed in 97.6% of the surgical cases. Patients without neurological deficits (OR: 0.27, 95% CI: 0.13-0.54, P < 0.001) and those with longer delays from injury to admission were less likely to have surgery (OR: 0.95, 95% CI: 0.92-0.99, P = 0.007). The neurologic improvement rate was 11.1%. Univariate analysis showed a significant association between surgery and neurologic improvement (OR: 3.83, 95% CI: 1.27-16.61, P < 0.001). However, this finding was lost in multivariate regression.Conclusions: This study highlights various themes surrounding the management of TL spine trauma in a low-resource environment, including lower surgery rates, delays from admission to surgery, safe surgery with low mortality, and the potential for surgery to lead to neurologic improvement.Clinical Relevance: Despite challenges such as surgical delays and limited resources in East Africa, there is potential for surgical intervention to improve neurologic outcomes in thoracic, TL, and lumbar spine trauma patients.

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Section: Areas Of Improvementmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Presentation, Management, and Outcomes of Thoracic, Thoracolumbar, and Lumbar Spine Trauma in East Africa: A Cohort Study

Ikwuegbuenyi,

Waterkeyn,

Okembo

et al. 2024

Int J Spine Surg

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“…Efforts to establish similar approaches with epidural technologies are ongoing using near-infrared spectroscopy which can non-invasively interrogate the spinal cord tissue with near-infrared light. 49 , 50 The technologies that emerge as effective at monitoring this space will fill an important knowledge gap in the hemodynamic management of acute SCI.…”

Section: Hemodynamic Managementmentioning

confidence: 99%

The 2023 AO Spine-Praxis Guidelines in Acute Spinal Cord Injury: What Have We Learned? What Are the Critical Knowledge Gaps and Barriers to Implementation?

Fehlings,

Moghaddamjou,

Evaniew

et al. 2024

Global Spine Journal

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Study Design Narrative summary of the 2023 AO Spine-Praxis clinical practice guidelines for management in acute spinal cord injury (SCI). Objectives The objective of this article is to summarize the key findings of the clinical practice guidelines for the optimal management of traumatic and intraoperative SCI (ISCI). This article will also highlight potential knowledge translation opportunities for each recommendation and discuss important knowledge gaps and areas of future research. Methods Systematic reviews were conducted according to accepted methodological standards to evaluate the current body of evidence and inform the guideline development process. The summarized evidence was reviewed by a multidisciplinary guidelines development group that consisted of international multidisciplinary stakeholders. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the certainty of the evidence for each critical outcome and the “evidence to recommendation” framework was used to formulate the final recommendations. Results The key recommendations regarding the timing of surgical decompression, hemodynamic management, and the prevention, diagnosis, and management of ISCI are summarized. While a strong recommendation was made for early surgery, further prospective research is required to define what constitutes sufficient surgical decompression, examine the role of ultra-early surgery, and assess the impact of early surgery in different SCI phenotypes, including central cord syndrome. Furthermore, additional investigation is required to evaluate the impact of mean arterial blood pressure targets on neurological recovery and to determine the utility of spinal cord perfusion pressure measurements. Finally, there is a need to examine the role of neuroprotective agents for the treatment of ISCI and to prospectively validate the new AO Spine-Praxis care pathway for the prevention, diagnosis, and management of ISCI. To optimize the translation of these guidelines into practice, important barriers to their implementation, particularly in underserved areas, need to be explored. Ultimately, these recommendations will help to establish more personalized approaches to care for SCI patients. Conclusions The recommendations from the 2023 AO Spine-Praxis guidelines not only highlight the current best practice in the management of SCI, but reveal critical knowledge gaps and barriers to implementation that will help to guide further research efforts in SCI.

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Quality of in-hospital care in traumatic spinal column and cord injuries (TSC/SCI) in I.R Iran

Sadeghi-Naini,

Jazayeri,

Kankam

et al. 2023

Eur Spine J

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Time to Surgery in Spinal Trauma: A Meta-Analysis of the World’s Literature Comparing High-Income Countries to Low-Middle Income Countries

Cited by 8 publications

References 63 publications

Presentation, Management, and Outcomes of Thoracic, Thoracolumbar, and Lumbar Spine Trauma in East Africa: A Cohort Study

Presentation, Management, and Outcomes of Thoracic, Thoracolumbar, and Lumbar Spine Trauma in East Africa: A Cohort Study

The 2023 AO Spine-Praxis Guidelines in Acute Spinal Cord Injury: What Have We Learned? What Are the Critical Knowledge Gaps and Barriers to Implementation?

Quality of in-hospital care in traumatic spinal column and cord injuries (TSC/SCI) in I.R Iran

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