scholarly journals Pursuing More Aggressive Timelines in the Surgical Treatment of Traumatic Spinal Cord Injury (TSCI): A Retrospective Cohort Study with Subgroup Analysis

2021 ◽  
Vol 10 (24) ◽  
pp. 5977
Author(s):  
Tobias Bock ◽  
Raban Arved Heller ◽  
Patrick Haubruck ◽  
Tim Friedrich Raven ◽  
Maximilian Pilz ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Subgroup Analysis ◽  
Neurological Recovery ◽  
Advanced Trauma Life Support ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury ◽  
Early Cohort ◽  
The Right ◽  
The Impact

Background: The optimal timing of surgical therapy for traumatic spinal cord injury (TSCI) remains unclear. The purpose of this study is to evaluate the impact of “ultra-early” (<4 h) versus “early” (4–24 h) time from injury to surgery in terms of the likelihood of neurologic recovery. Methods: The effect of surgery on neurological recovery was investigated by comparing the assessed initial and final values of the American Spinal Injury Association (ASIA) Impairment Scale (AIS). A post hoc analysis was performed to gain insight into different subgroup regeneration behaviors concerning neurological injury levels. Results: Datasets from 69 cases with traumatic spinal cord injury were analyzed. Overall, 19/46 (41.3%) patients of the “ultra-early” cohort saw neurological recovery compared to 5/23 (21.7%) patients from the “early” cohort (p = 0.112). The subgroup analysis revealed differences based on the neurological level of injury (NLI) of a patient. An optimal cutpoint for patients with a cervical lesion was estimated at 234 min. Regarding the prediction of neurological improvement, sensitivity was 90.9% with a specificity of 68.4%, resulting in an AUC (area under the curve) of 84.2%. In thoracically and lumbar injured cases, the estimate was lower, ranging from 284 (thoracic) to 245 min (lumbar) with an AUC of 51.6% and 54.3%. Conclusions: Treatment within 24 h after TSCI is associated with neurological recovery. Our hypothesis that intervention within 4 h is related to an improvement in the neurological outcome was not confirmed in our collective. In a clinical context, this suggests that after TSCI there is a time frame to get the right patient to the right hospital according to advanced trauma life support (ATLS) guidelines.

scholarly journals A geospatial examination of specialist care accessibility and impact on health outcomes for patients with acute traumatic spinal cord injury in NSW, Australia: a whole population record linkage study

2020 ◽  
Author(s):  
Lisa Nicole Sharwood ◽  
Bharat P Vaikuntam ◽  
Christiana L Cheng ◽  
Vanessa Noonan ◽  
Anthony P Joseph ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Record Linkage ◽  
Linkage Study ◽  
Traumatic Spinal Cord Injury ◽  
Specialist Care ◽  
Post Injury ◽  
Cord Injury ◽  
The Right ◽  
The Impact

Background Timely treatment is essential for achieving optimal outcomes after traumatic spinal cord injury (TSCI), and expeditious transfer to a specialist spinal cord injury unit (SCIU) is recommended within 24 hours from injury. Previous research in New South Wales (NSW) found only 57% of TSCI patients were admitted to SCIU for acute post-injury care; 73% transferred within 24 hours from injury. Methods This record linkage study included administrative pre-hospital, admissions and costs data for all patients aged ≥16 years with incident TSCI in NSW (2013-2016). Its aim was to examine potential geographical disparities in access to specialist care following TSCI using geospatial methods, and to better understand the impact of post-injury care pathways on patient outcomes. Results Of 316 cases with geospatial data, injury location analysis showed that over half (53%, n=168) of all patients were injured within 60 minutes road travel of a SCIU, yet only 28.6% (n=48) were directly transferred to a SCIU. Direct transfers received earlier operative intervention (median (IQR) 12.9(7.9) hours), compared with patients transferred indirectly to SCIU (median (IQR) 19.5(18.9) hours), and had lower risk of complications (OR 3.2 v 1.4, p<0.001). Conclusions Getting patients with acute TSCI patients to the right place at the right time is dependent on numerous factors; some are still being triaged directly to non-trauma services which delays specialist and surgical care and increases complication risks. More stringent adherence to recommended guidelines would prioritise direct SCIU transfer for patients injured within 60 minutes radius, enabling the benefits of specialised care.   

scholarly journals Complete Traumatic Spinal Cord Injury: Current Insights Regarding Timing of Surgery and Level of Injury

2019 ◽  
Vol 10 (3) ◽  
pp. 324-331 ◽  
Author(s):  
Paula Valerie ter Wengel ◽  
Yvette De Haan ◽  
Ricardo E. Feller ◽  
F. Cumhur Oner ◽  
William Peter Vandertop
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Beneficial Effect ◽  
Surgical Intervention ◽  
Surgical Decompression ◽  
Sensory Function ◽  
Neurological Recovery ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury ◽  
The Impact

Study Design: A narrative literature review. Objectives: To review the neurological recovery patterns in traumatic spinal cord injury (tSCI) patients with a complete lack of motor and sensory function below the level of injury (ie, ASIA A [American Spinal Injury Association scale]), as well as the impact of level of injury and timing of surgical intervention. Results: Spontaneous neurological recovery in patients with complete tSCI differs per level of injury: patients with cervical and thoracolumbar tSCI recover ≥1 ASIA grade in 17.3% to 34.0% 1 year after injury, compared with 10.7% to 18.6% in thoracic tSCI. Surgical decompression within 24 hours has a beneficial effect on neurological recovery in patients with complete cervical tSCI, whereas this effect is less clear for thoracic and thoracolumbar tSCI. A 1- or 2-grade improvement in the ASIA scale does not necessarily result in functional recovery. Conclusion: In complete tSCI, the level of injury as well as surgical timing affect neurological recovery. There appears to be a beneficial effect of early surgical decompression in patients with complete cervical tSCI, more so than for thoracic and thoracolumbar tSCI. Frequently, the effect of surgical intervention is evaluated by an improvement in ASIA grade, but it is unclear whether this scale is sensitive enough to evaluate meaningful effectiveness of the intervention and desired outcome for patients with tSCI.

Neurological Recovery Is Impaired by Concurrent but Not by Asymptomatic Pre-existing Spinal Cord Compression After Traumatic Spinal Cord Injury

Spine ◽  
2012 ◽  
Vol 37 (17) ◽  
pp. 1448-1455 ◽  
Author(s):  
Kensuke Kubota ◽  
Hirokazu Saiwai ◽  
Hiromi Kumamaru ◽  
Kazu Kobayakawa ◽  
Takeshi Maeda ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Neurological Recovery ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury

Neuregulin-1 positively modulates glial response and improves neurological recovery following traumatic spinal cord injury

Glia ◽  
2017 ◽  
Vol 65 (7) ◽  
pp. 1152-1175 ◽  
Author(s):  
Arsalan Alizadeh ◽  
Scott M. Dyck ◽  
Hardeep Kataria ◽  
Ghazaleh M. Shahriary ◽  
Dung H. Nguyen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Neurological Recovery ◽  
Traumatic Spinal Cord Injury ◽  
Neuregulin 1 ◽  
Cord Injury
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