P V Ter Wengel1,2, R E Feller1, A Stadhouder3, D Verbaan1,4, F C Oner5, J C Goslings6, W P Vandertop7,8,9. 1. Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands. 2. Department of Neurosurgery, Slotervaart Hospital, Amsterdam, The Netherlands. 3. Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, The Netherlands. 4. Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. 5. Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 6. Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands. 7. Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands. wp.vandertop@vumc.nl. 8. Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. wp.vandertop@vumc.nl. 9. Department of Neurosurgery, VU University Medical Center, 2F-020, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. wp.vandertop@vumc.nl.
Abstract
PURPOSE: The optimal surgical timeframe for neurological recovery in traumatic spinal cord injury (tSCI) still remains unknown. Recent guidelines have recommended performing surgery within 24 h for all patients with tSCI regardless of initial neurological deficit. It remains unclear whether patients with complete, incomplete tSCI, or traumatic central cord injury (TCCI) will experience the same degree of improvement after urgent surgical intervention. We investigated if the severity of initial neurological injury influenced surgeons on their decision-making of surgical timing in tSCI. METHODS: With a web-based survey, we investigated the current opinion in The Netherlands on timing of surgical decompression and stabilization, depending on the initial degree of neurological injury. RESULTS: Surgeons prefer to perform more urgent surgery for incomplete tSCI compared to complete tSCI. In addition, 43% of patients with complete tSCI are not preferably operated within the recommended 24 h. Even though TCCI is the most common form of incomplete tSCI, these patients are preferably managed less urgently than patients with other types of incomplete tSCI. CONCLUSION: The severity of initial neurological injury seems to play an important role in the urgency of surgical timing for tSCI. A substantial number of patients with complete tSCI are not preferably treated within the recommended surgical timeframe, while patients with incomplete tSCI are preferably operated far more urgent than recommended in the current guidelines. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: The optimal surgical timeframe for neurological recovery in traumatic spinal cord injury (tSCI) still remains unknown. Recent guidelines have recommended performing surgery within 24 h for all patients with tSCI regardless of initial neurological deficit. It remains unclear whether patients with complete, incomplete tSCI, or traumatic central cord injury (TCCI) will experience the same degree of improvement after urgent surgical intervention. We investigated if the severity of initial neurological injury influenced surgeons on their decision-making of surgical timing in tSCI. METHODS: With a web-based survey, we investigated the current opinion in The Netherlands on timing of surgical decompression and stabilization, depending on the initial degree of neurological injury. RESULTS: Surgeons prefer to perform more urgent surgery for incomplete tSCI compared to complete tSCI. In addition, 43% of patients with complete tSCI are not preferably operated within the recommended 24 h. Even though TCCI is the most common form of incomplete tSCI, these patients are preferably managed less urgently than patients with other types of incomplete tSCI. CONCLUSION: The severity of initial neurological injury seems to play an important role in the urgency of surgical timing for tSCI. A substantial number of patients with complete tSCI are not preferably treated within the recommended surgical timeframe, while patients with incomplete tSCI are preferably operated far more urgent than recommended in the current guidelines. These slides can be retrieved under Electronic Supplementary Material.
Authors: F M Maynard; M B Bracken; G Creasey; J F Ditunno; W H Donovan; T B Ducker; S L Garber; R J Marino; S L Stover; C H Tator; R L Waters; J E Wilberger; W Young Journal: Spinal Cord Date: 1997-05 Impact factor: 2.772
Authors: Michael G Fehlings; Doron Rabin; William Sears; David W Cadotte; Bizhan Aarabi Journal: Spine (Phila Pa 1976) Date: 2010-10-01 Impact factor: 3.468
Authors: Marko Jug; Nataša Kejžar; Miloš Vesel; Said Al Mawed; Marko Dobravec; Simon Herman; Fajko F Bajrović Journal: J Neurotrauma Date: 2015-04-22 Impact factor: 5.269
Authors: Michael G Fehlings; Alexander Vaccaro; Jefferson R Wilson; Anoushka Singh; David W Cadotte; James S Harrop; Bizhan Aarabi; Christopher Shaffrey; Marcel Dvorak; Charles Fisher; Paul Arnold; Eric M Massicotte; Stephen Lewis; Raja Rampersaud Journal: PLoS One Date: 2012-02-23 Impact factor: 3.240
Authors: 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 Martin; Eric 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 Journal: Global Spine J Date: 2017-09-05
Authors: Juan P Cabrera; Ratko Yurac; Alfredo Guiroy; Charles A Carazzo; Andrei F Joaquim; Juan J Zamorano; Marcelo Valacco Journal: World Neurosurg Date: 2020-05-18 Impact factor: 2.104
Authors: Jefferson R Wilson; Christopher D Witiw; Jetan Badhiwala; Brian K Kwon; Michael G Fehlings; James S Harrop Journal: Global Spine J Date: 2020-01-06
Authors: Edoardo Picetti; Corrado Iaccarino; Raul Coimbra; Fikri Abu-Zidan; Giovanni D Tebala; Zsolt J Balogh; Walter L Biffl; Federico Coccolini; Deepak Gupta; Ronald V Maier; Ingo Marzi; Chiara Robba; Massimo Sartelli; Franco Servadei; Philip F Stahel; Fabio S Taccone; Andreas W Unterberg; Marta Velia Antonini; Joseph M Galante; Luca Ansaloni; Andrew W Kirkpatrick; Sandro Rizoli; Ari Leppaniemi; Osvaldo Chiara; Belinda De Simone; Mircea Chirica; Vishal G Shelat; Gustavo P Fraga; Marco Ceresoli; Luca Cattani; Francesco Minardi; Edward Tan; Imtiaz Wani; Massimo Petranca; Francesco Domenichelli; Yunfeng Cui; Laura Malchiodi; Emanuele Sani; Andrey Litvin; Andreas Hecker; Vito Montanaro; Solomon Gurmu Beka; Salomone Di Saverio; Sandra Rossi; Fausto Catena Journal: World J Emerg Surg Date: 2022-04-25 Impact factor: 8.165
Authors: Ibrahim Alnaami; Saleh Alsaleh; Mohammed S Al-Amri; Ayman Al-Alamri; Fares Al-Zahrani; Mohammed A Al-Amri; Mohammed Abid Khan Journal: J Family Med Prim Care Date: 2021-04-29