A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (<= 24 hours versus > 24 hours) of decompressive surgery
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Published Version
Date
2017
Authors
Fehlings, Michael G.
Tetreault, Lindsay A.
Wilson, Jefferson R.
Aarabi, Bizhan
Anderson, Paul
Arnold, Paul M.
Brodke, Darrel S.
Burns, Anthony S.
Chiba, Kazuhiro
Dettori, Joseph R.
Journal Title
Journal ISSN
Volume Title
Publisher
Sage Publications
Published Version
Abstract
Objective: To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome. Methods: A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as "we recommend," whereas a weak recommendation is presented as "we suggest." Results: Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: "We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome" and "We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level." Quality of evidence for both recommendations was considered low. Conclusions: These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions.
Description
Keywords
Spinal cord injury , Center cord syndrome , Guideline , Surgery , Time of surgery
Citation
Fehlings, M. G., Tetreault, L. A., Wilson, J. R., Aarabi, B., Anderson, P., Arnold, P. M., Brodke, D. S., Burns, A. S., Chiba, K., Dettori, J. R., Furlan, J. C., Hawryluk, G., Holly, L. T., Howley, S., Jeji, T., Kalsi-Ryan, S., Kotter, M., Kurpad, S., Marino, R. J., Martin, A. R., Massicotte, E., Merli, G., Middleton, J. W., Nakashima, H., Nagoshi, N., Palmieri, K., Singh, A., Skelly, A. C., Tsai, E. C., Vaccaro, A., Yee, A. and Harrop, J. S. (2017) 'A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (<= 24 hours versus > 24 hours) of decompressive surgery', Global Spine Journal, 7(3S), pp. 195-202. doi: 10.1177/2192568217706367