Therapeutic strategy for acute spinal cord paralysis by epidural hematoma derived from the application of non-operative observation and the optimal timing to convert to surgical intervention
| Autor: | Keisuke Ito, Tetsuo Sakamoto, Youhei Ishimine, Yoshiro Musha, Sumito Kinjo, Yuya Takesue |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Anesthesia
Epidural Male medicine.medical_specialty Time Factors Clinical Decision-Making 03 medical and health sciences 0302 clinical medicine Epidural hematoma Physiology (medical) Intervention (counseling) Paralysis Medicine Humans Start time Watchful Waiting Therapeutic strategy business.industry General Medicine medicine.disease Hematoma Epidural Spinal Surgery Spinal cord paralysis Neurology Spinal Cord 030220 oncology & carcinogenesis Epidural block Acute Disease Female Neurology (clinical) medicine.symptom business 030217 neurology & neurosurgery Lumbosacral joint |
| Zdroj: | Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 86 |
| ISSN: | 1532-2653 |
| Popis: | Some cases of acute spinal cord paralysis by epidural hematoma have made complete recovery through natural progression. This group cannot be ignored in choosing a therapy. We have considered the applications of non-operative observation and the optimal timing to convert to surgical intervention. Of the 454 cases reported, cases that were of trauma/post-operative, undergone epidural block, lumbosacral level, paralysis-free, were excluded. 10 clinical items were identified as factors related to the outcome of therapy, and a total of 142 cases (73 surgical and 69 non-surgical/observation cases) which included all items in its record, were extracted for this study. 104 cases that made complete recovery from spinal paralysis (CR) includes 65 cases without surgical intervention (NOP-CR). Using "paralysis recovery start time (PRST)", ROC analysis was conducted to show the diagnostic time needed to detect the cases of CR and NOP-CR. Clinical characteristics of CR and NOP-CR were identified using multiple logistics regression analysis. CR probability were higher at PRST 15 h from the onset and NOP-CR was even higher at 11 h. Three clinical items: incomplete motor paralysis, no use of anti-coagulant therapy, and PRST within 15 h were found to be the characteristics of CR and NOP-CR. The case with all 3 items; especially PRST within 11 h from onset, is applicable to non-operative observation. Immediate surgical intervention at 6-hours is recommended in cases that presented with unchanged complete motor paralysis. Observation treatment is discontinued and converted to surgery if motor usefulness is not regained at 15-hours. |
| Databáze: | OpenAIRE |
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