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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dc.contributor.author Fehlings, Michael G.
dc.contributor.author Tetreault, Lindsay A.
dc.contributor.author Wilson, Jefferson R.
dc.contributor.author Aarabi, Bizhan
dc.contributor.author Anderson, Paul
dc.contributor.author Arnold, Paul M.
dc.contributor.author Brodke, Darrel S.
dc.contributor.author Burns, Anthony S.
dc.contributor.author Chiba, Kazuhiro
dc.contributor.author Dettori, Joseph R.
dc.contributor.author Furlan, Julio C.
dc.contributor.author Hawryluk, Gregory
dc.contributor.author Holly, Langston T.
dc.contributor.author Howley, Susan
dc.contributor.author Jeji, Tara
dc.contributor.author Kalsi-Ryan, Sukhvinder
dc.contributor.author Kotter, Mark
dc.contributor.author Kurpad, Shekar
dc.contributor.author Marino, Ralph J.
dc.contributor.author Martin, Allan R.
dc.contributor.author Massicotte, Eric
dc.contributor.author Merli, Geno
dc.contributor.author Middleton, James W.
dc.contributor.author Nakashima, Hiroaki
dc.contributor.author Nagoshi, Narihito
dc.contributor.author Palmieri, Katherine
dc.contributor.author Singh, Anoushka
dc.contributor.author Skelly, Andrea C.
dc.contributor.author Tsai, Eve C.
dc.contributor.author Vaccaro, Alexander
dc.contributor.author Yee, Albert
dc.contributor.author Harrop, James S.
dc.date.accessioned 2018-03-09T12:55:06Z
dc.date.available 2018-03-09T12:55:06Z
dc.date.issued 2017
dc.identifier.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 en
dc.identifier.volume 7
dc.identifier.issued 3S
dc.identifier.startpage 195
dc.identifier.endpage 202
dc.identifier.issn 2192-5682
dc.identifier.uri http://hdl.handle.net/10468/5595
dc.identifier.doi 10.1177/2192568217706367
dc.description.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. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Sage Publications en
dc.relation.uri http://journals.sagepub.com/doi/10.1177/2192568217706367
dc.rights © 2017, the Authors. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/ ) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). en
dc.rights.uri http://www.creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject Spinal cord injury en
dc.subject Center cord syndrome en
dc.subject Guideline en
dc.subject Surgery en
dc.subject Time of surgery en
dc.title 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 en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Lindsay A. Tetreault, Medicine, University College Cork, Cork, Ireland. +353-21-490-3000 Email: 116100017@umail.ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder AOSpine
dc.contributor.funder Ontario Neurotrauma Foundation
dc.contributor.funder American Association of Neurological Surgeons
dc.contributor.funder Congress of Neurological Surgeons
dc.contributor.funder Gerald and Tootsie Halbert Chair in Neural Repair and Regeneration
dc.contributor.funder DeZwirek Family Foundation
dc.contributor.funder Krembil Foundation
dc.description.status Peer reviewed en
dc.identifier.journaltitle Global Spine Journal en


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© 2017, the Authors. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/ ) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Except where otherwise noted, this item's license is described as © 2017, the Authors. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/ ) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
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