Timing of surgery in traumatic spinal cord injury: a national, multidisciplinary survey.

Autor: Ter Wengel PV; Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.; Department of Neurosurgery, Slotervaart Hospital, Amsterdam, The Netherlands., Feller RE; Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands., Stadhouder A; Department of Orthopedic Surgery, VU University Medical Center, Amsterdam, The Netherlands., Verbaan D; Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.; Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands., Oner FC; Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Goslings JC; Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands., Vandertop WP; Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands. wp.vandertop@vumc.nl.; Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. wp.vandertop@vumc.nl.; Department of Neurosurgery, VU University Medical Center, 2F-020, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. wp.vandertop@vumc.nl.
Jazyk: angličtina
Zdroj: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2018 Aug; Vol. 27 (8), pp. 1831-1838. Date of Electronic Publication: 2018 Mar 23.
DOI: 10.1007/s00586-018-5551-y
Abstrakt: 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.
Databáze: MEDLINE
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