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.authorFehlings, Michael G.
dc.contributor.authorTetreault, Lindsay A.
dc.contributor.authorWilson, Jefferson R.
dc.contributor.authorAarabi, Bizhan
dc.contributor.authorAnderson, Paul
dc.contributor.authorArnold, Paul M.
dc.contributor.authorBrodke, Darrel S.
dc.contributor.authorBurns, Anthony S.
dc.contributor.authorChiba, Kazuhiro
dc.contributor.authorDettori, Joseph R.
dc.contributor.authorFurlan, Julio C.
dc.contributor.authorHawryluk, Gregory
dc.contributor.authorHolly, Langston T.
dc.contributor.authorHowley, Susan
dc.contributor.authorJeji, Tara
dc.contributor.authorKalsi-Ryan, Sukhvinder
dc.contributor.authorKotter, Mark
dc.contributor.authorKurpad, Shekar
dc.contributor.authorMarino, Ralph J.
dc.contributor.authorMartin, Allan R.
dc.contributor.authorMassicotte, Eric
dc.contributor.authorMerli, Geno
dc.contributor.authorMiddleton, James W.
dc.contributor.authorNakashima, Hiroaki
dc.contributor.authorNagoshi, Narihito
dc.contributor.authorPalmieri, Katherine
dc.contributor.authorSingh, Anoushka
dc.contributor.authorSkelly, Andrea C.
dc.contributor.authorTsai, Eve C.
dc.contributor.authorVaccaro, Alexander
dc.contributor.authorYee, Albert
dc.contributor.authorHarrop, James S.
dc.contributor.funderAOSpine
dc.contributor.funderOntario Neurotrauma Foundation
dc.contributor.funderAmerican Association of Neurological Surgeons
dc.contributor.funderCongress of Neurological Surgeons
dc.contributor.funderGerald and Tootsie Halbert Chair in Neural Repair and Regeneration
dc.contributor.funderDeZwirek Family Foundation
dc.contributor.funderKrembil Foundation
dc.date.accessioned2018-03-09T12:55:06Z
dc.date.available2018-03-09T12:55:06Z
dc.date.issued2017
dc.description.abstractObjective: 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.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationFehlings, 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: 10.1177/2192568217706367en
dc.identifier.doi10.1177/2192568217706367
dc.identifier.endpage202
dc.identifier.issn2192-5682
dc.identifier.issued3S
dc.identifier.journaltitleGlobal Spine Journalen
dc.identifier.startpage195
dc.identifier.urihttps://hdl.handle.net/10468/5595
dc.identifier.volume7
dc.language.isoenen
dc.publisherSage Publicationsen
dc.relation.urihttp://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.urihttp://www.creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectSpinal cord injuryen
dc.subjectCenter cord syndromeen
dc.subjectGuidelineen
dc.subjectSurgeryen
dc.subjectTime of surgeryen
dc.titleA 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 surgeryen
dc.typeArticle (peer-reviewed)en
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