Process Benchmarking Appraisal of Surgical Decompression of Spinal Cord following Traumatic Cervical Spinal Cord Injury: Opportunities To Reduce Delays in Surgical Management

2013 ◽  
Vol 30 (6) ◽  
pp. 487-491 ◽  
Author(s):  
Julio C. Furlan ◽  
Kayee Tung ◽  
Michael G. Fehlings
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Management ◽  
Cervical Spinal Cord ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury

scholarly journals Multivariate Analysis of Acute Magnetic Resonance Imaging Predicts Neurological Improvements in Patients With Cervical Spinal Cord Injury After Early Surgical Decompression

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Tomoo Inoue ◽  
Toshiki Endo ◽  
Shinsuke Suzuki ◽  
Hiroshi Uenohara ◽  
Teiji Tominaga
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Magnetic Resonance ◽  
Mr Imaging ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Principal Component ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Cord Injury

Abstract INTRODUCTION Patients with cervical spinal cord injury (SCI) show different clinical outcomes. There is a significant association between the acute magnetic resonance (MR) imaging of cervical SCI and neurological recovery of cervical SCI. We speculated that principal component analysis (PCA), a dimension reduction procedure, would detect clinically predictive patterns in complex MR imaging and predict neurological improvements assessed by the American Spinal Injury Association Impairment Scale (AIS) and Japanese Orthopaedic Association (JOA) score. METHODS We performed a retrospective analysis of 50 patients with cervical SCI who underwent early surgical decompression less than 48 h after the trauma. We analyzed 7 types of MR imaging assessments: axial grade assessed by the Brain and Spinal Injury Center score (BASIC), longitudinal intramedurallry lesion length, spinal cord signal intensity on T1 and T2 weighted image, maximum canal compromise, maximum spinal cord compression, Subaxial Cervical Spine Injury Classification System. PCA was applied on these multivariate data to identify factors that contribute to recovery after cervical SCI following surgery. AIS conversion was evaluated at 6 mo. RESULTS Nonlinear principal component (PC) evaluation detected 2 features of MR imaging. PCA revealed PC 1 (40.6%) explaining the intramedullary signal abnormalities that were negatively associated with postoperative AIS conversion. PC2 (18.5%) suggested extrinsic morphological variables, but did not predict outcomes. The BASIC score revealed the significant overall predictive value for AIS conversion at six months (AUC 0.86). This result suggested that the intramedullary signal abnormalities reflect delayed neurological improvements even after early surgical decompressions in patients with cervical SCI. CONCLUSION PCA could be a useful data-mining tool to show the complex relationships between acute MR imaging findings in cervical SCI. This study emphasized the importance of multivariable intramedullary MR imaging as clinical outcome predictors.

scholarly journals Window of opportunity for surgical decompression in patients with acute traumatic cervical spinal cord injury

2020 ◽  
Vol 32 (5) ◽  
pp. 633-641 ◽  
Author(s):  
Marko Jug ◽  
Nataša Kejžar ◽  
Matej Cimerman ◽  
Fajko F. Bajrović
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spinal Cord ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Neurological Recovery ◽  
Optimal Timing ◽  
Neurological Improvement ◽  
Severity Of Injury ◽  
Cord Injury

OBJECTIVEThe objective of this prospective study was to determine the optimal timing for surgical decompression (SD) in patients with acute traumatic cervical spinal cord injury (tSCI) within the first 24 hours of injury.METHODSIn successive patients with fracture and/or dislocation of the subaxial cervical spine and American Spinal Injury Association Impairment Scale (AIS) grades A–C, receiver operating characteristic curve analysis was used to determine the optimal timing for SD within the first 24 hours of cervical tSCI to obtain a neurological recovery of at least two AIS grades. Multivariate logistic regression was used to model significant neurological recovery with time to SD, degree of spinal canal compromise (SCC), and severity of injury.RESULTSIn this cohort of 64 patients, the optimal timing for SD to obtain a significant neurological improvement was within 4 hours of injury (95% confidence interval 4–9 hours). Increasing the delay from injury to SD or the degree of SCC significantly reduced the likelihood of significant neurological improvement. Due to the strong correlation with SCC, the severity of injury was a marginally significant predictor of neurological recovery.CONCLUSIONSThese findings indicate that in patients with acute cervical tSCI and AIS grades A–C, the optimal timing for SD is within the first 4–9 hours of injury, depending on the degree of SCC and the severity of injury. Further studies are required to better understand the interrelationships among the timing of SD, injury severity, and degree of SCC in these patients.

Cervical Spinal Cord Injury at the Victorian Spinal Cord Injury Service: Epidemiology of the Last Decade

2014 ◽  
Vol 5 ◽  
pp. CMTIM.S12939 ◽  
Author(s):  
Simon C.P. Lau ◽  
Nathan G. Myhill ◽  
Rekha Ganeshalingam ◽  
Gerald M.Y. Quan
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Management ◽  
Cervical Spinal Cord ◽  
Public Awareness ◽  
Cervical Spinal Cord Injury ◽  
Awareness Campaigns ◽  
Increased Risk ◽  
Eastern Australia ◽  
Cord Injury

Introduction Cervical spinal cord injury (CSCI) is a significant medical and socioeconomic problem. In Victoria, Australia, there has been limited research into the incidence of CSCI. The Austin Hospital's Victorian Spinal Cord Injury Service (VSCIS) is a tertiary referral hospital that accepts referrals for surgical management and ongoing neurological rehabilitation for south eastern Australia. The aim of this study was to characterise the epidemiology of CSCI managed operatively at the VSCIS over the last decade, in order to help fashion public health campaigns. Methods This was a retrospective review of medical records from January 2000 to December 2009 of all patients who underwent surgical management of acute CSCI in the VSCIS catchment region. Patients treated non-operatively were excluded. Outcome measures included: demographics, mechanism of injury and associated factors (like alcohol) and patient neurological status. Results Men were much more likely to have CSCI than women, with a 4:1 ratio, and the highest incidence of CSCI for men was in their 20s (39%). The most common cause of CSCI was transport related (52%), followed by falls (23%) and water-related incidents (16%). Falls were more prevalent among those >50 years. Alcohol was associated in 22% of all CSCIs, including 42% of water-related injuries. Discussion Our retrospective epidemiological study identified at-risk groups presenting to our spinal injury service. Young males in their 20s were associated with an increased risk of transport-related accidents, water-related incidents in the summer months and accidents associated with alcohol. Another high risk group were men >50 years who suffer falls, both from standing and from greater heights. Public awareness campaigns should target these groups to lower incidence of CSCI.

scholarly journals Ultra-Early (<12 Hours) Surgery Correlates With Higher Rate of American Spinal Injury Association Impairment Scale Conversion After Cervical Spinal Cord Injury

Neurosurgery ◽  
2018 ◽  
Vol 85 (2) ◽  
pp. 199-203 ◽  
Author(s):  
John F Burke ◽  
John K Yue ◽  
Laura B Ngwenya ◽  
Ethan A Winkler ◽  
Jason F Talbott ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Injury ◽  
Cervical Spinal Cord ◽  
Surgical Decompression ◽  
Cervical Spinal Cord Injury ◽  
Optimal Time ◽  
American Spinal Injury Association ◽  
Early Group ◽  
Cord Injury

Abstract BACKGROUND Cervical spinal cord injury (SCI) is a devastating condition with very few treatment options. It remains unclear if early surgery correlated with conversion of American Spinal Injury Association Impairment Scale (AIS) grade A injuries to higher grades. OBJECTIVE To determine the optimal time to surgery after cervical SCI through retrospective analysis. METHODS We collected data from 48 patients with cervical SCI. Based on the time from Emergency Department (ED) presentation to surgical decompression, we grouped patients into ultra-early (decompression within 12 h of presentation), early (within 12-24 h), and late groups (&gt;24 h). We compared the improvement in AIS grade from admission to discharge, controlling for confounding factors such as AIS grade on admission, injury severity, and age. The mean time from injury to ED for this group of patients was 17 min. RESULTS Patients who received surgery within 12 h after presentation had a relative improvement in AIS grade from admission to discharge: the ultra-early group improved on average 1.3. AIS grades compared to 0.5 in the early group (P = .02). In addition, 88.8% of patients with an AIS grade A converted to a higher grade (AIS B or better) in the ultra-early group, compared to 38.4% in the early and late groups (P = .054). CONCLUSION These data suggest that surgical decompression after SCI that takes place within 12 h may lead to a relative improved neurological recovery compared to surgery that takes place after 12 h.

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