Othman Bin-Alamer1, Lokeshwar S Bhenderu2, Caren Stuebe2, Navraj S Sagoo3, Paolo Palmisciano4, Maryam Haider5, Salah G Aoun6, Ali S Haider2,7. 1. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Oabinalamer@gmail.com. 2. Texas A&M University College of Medicine, Houston, TX, USA. 3. Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy. 5. Department of Radiology, Baylor College of Medicine, Houston, TX, USA. 6. Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. 7. Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Abstract
OBJECTIVE: To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications. METHODS: PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI). RESULTS: We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16-70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p < 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p < 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3-1.64; I2 = 44%, p = 0.13) nor for incomplete SCIs (OR:1.15, 95% CI, 0.64-2,06; I2 = 40%, p = 0.12). CONCLUSION: Surgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.
OBJECTIVE: To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications. METHODS: PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI). RESULTS: We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16-70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p < 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p < 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3-1.64; I2 = 44%, p = 0.13) nor for incomplete SCIs (OR:1.15, 95% CI, 0.64-2,06; I2 = 40%, p = 0.12). CONCLUSION: Surgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.
Authors: Kevin D Morrow; Adam G Podet; Casey P Spinelli; Lindsay M Lasseigne; Clifford L Crutcher; Jason D Wilson; Gabriel C Tender; Anthony M DiGiorgio Journal: Neurosurg Focus Date: 2019-03-01 Impact factor: 4.047
Authors: Pedram Heidari; Heidari Pedram; Mohammad Reza Zarei; Zarei Mohammad Reza; Mohammad Reza Rasouli; Rasouli Mohammad Reza; Alexander R Vaccaro; Vafa Rahimi-Movaghar; Rahimi-Movaghar Vafa Journal: Chin J Traumatol Date: 2010-02