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

Michael G. Fehlings, Lindsay A. Tetreault, Jefferson R. Wilson, Bizhan Aarabi, Paul Anderson, Paul M. Arnold, Darrel S. Brodke, Anthony S. Burns, Kazuhiro Chiba, Joseph R. Dettori, Julio C. Furlan, Gregory Hawryluk, Langston T. Holly, Susan Howley, Tara Jeji, Sukhvinder Kalsi-Ryan, Mark Kotter, Shekar Kurpad, Ralph J. Marino, Allan R. MartinEric Massicotte, Geno Merli, James W. Middleton, Hiroaki Nakashima, Narihito Nagoshi, Katherine Palmieri, Anoushka Singh, Andrea C. Skelly, Eve C. Tsai, Alexander Vaccaro, Albert Yee, James S. Harrop

Research output: Contribution to journalArticle

34 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)195S-202S
JournalGlobal Spine Journal
Volume7
Issue number3_supplement
DOIs
Publication statusPublished - 2017 Sep 1

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Central Cord Syndrome
Practice Management
Spinal Cord Injuries
Practice Guidelines
Surgical Decompression
Rehabilitation
Guidelines
Decompression
Inpatients
Therapeutics

Keywords

  • center cord syndrome
  • guideline
  • spinal cord injury
  • surgery
  • time of surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

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. / 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.; Furlan, Julio C.; Hawryluk, Gregory; Holly, Langston T.; Howley, Susan; Jeji, Tara; Kalsi-Ryan, Sukhvinder; Kotter, Mark; Kurpad, Shekar; Marino, Ralph J.; Martin, Allan R.; Massicotte, Eric; Merli, Geno; Middleton, James W.; Nakashima, Hiroaki; Nagoshi, Narihito; Palmieri, Katherine; Singh, Anoushka; Skelly, Andrea C.; Tsai, Eve C.; Vaccaro, Alexander; Yee, Albert; Harrop, James S.

In: Global Spine Journal, Vol. 7, No. 3_supplement, 01.09.2017, p. 195S-202S.

Research output: Contribution to journalArticle

Fehlings, MG, Tetreault, LA, Wilson, JR, Aarabi, B, Anderson, P, Arnold, PM, Brodke, DS, Burns, AS, Chiba, K, Dettori, JR, Furlan, JC, Hawryluk, G, Holly, LT, Howley, S, Jeji, T, Kalsi-Ryan, S, Kotter, M, Kurpad, S, Marino, RJ, Martin, AR, Massicotte, E, Merli, G, Middleton, JW, Nakashima, H, Nagoshi, N, Palmieri, K, Singh, A, Skelly, AC, Tsai, EC, Vaccaro, A, Yee, A & Harrop, JS 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, vol. 7, no. 3_supplement, pp. 195S-202S. https://doi.org/10.1177/2192568217706367
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. ; Furlan, Julio C. ; Hawryluk, Gregory ; Holly, Langston T. ; Howley, Susan ; Jeji, Tara ; Kalsi-Ryan, Sukhvinder ; Kotter, Mark ; Kurpad, Shekar ; Marino, Ralph J. ; Martin, Allan R. ; Massicotte, Eric ; Merli, Geno ; Middleton, James W. ; Nakashima, Hiroaki ; Nagoshi, Narihito ; Palmieri, Katherine ; Singh, Anoushka ; Skelly, Andrea C. ; Tsai, Eve C. ; Vaccaro, Alexander ; Yee, Albert ; Harrop, James S. / 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. In: Global Spine Journal. 2017 ; Vol. 7, No. 3_supplement. pp. 195S-202S.
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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.",
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AU - Tetreault, Lindsay A.

AU - Wilson, Jefferson R.

AU - Aarabi, Bizhan

AU - Anderson, Paul

AU - Arnold, Paul M.

AU - Brodke, Darrel S.

AU - Burns, Anthony S.

AU - Chiba, Kazuhiro

AU - Dettori, Joseph R.

AU - Furlan, Julio C.

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AU - Singh, Anoushka

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AU - Yee, Albert

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