Current Practice in the Timing of Surgical Intervention in Spinal Cord Injury
Current Practice in the Timing of Surgical Intervention in Spinal Cord Injury
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DOI：
10.1097/brs.0b013e3181f386f6
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发表时间：
2010-10-01
期刊：
影响因子：
3
通讯作者：
Aarabi, Bizhan
中科院分区：
文献类型：
--
作者：
Fehlings, Michael G.;Rabin, Doron;Aarabi, Bizhan
研究设计.文献的系统回顾和前瞻性调查研究。描述关于损伤脊髓减压手术时机的专家意见，并严格总结急性脊髓损伤（SCI）早期手术干预的证据。急性脊髓损伤减压手术的最佳时机是有争议的，导致临床实践中相当大的差异。此外，目前脊柱外科医生关于SCI后手术的最佳时机的意见是未知的。我们对SCI后减压时机的临床前和临床已发表数据进行了系统回顾。一份由20个问题组成的调查问卷被发送给世界各地的骨科和神经外科脊柱外科医生。在6种不同的临床情况下，根据应答者的人口统计学和对手术减压时机的偏好编制应答频率。χ（2）统计用于比较基于专业和奖学金培训的应答频率。共有971名脊柱外科医生回答了调查。在几乎所有的临床情况下，除了中央脊髓综合征，大多数受访者（>= 80%）更喜欢在24小时内脊髓损伤。46.2%的被调查者认为完全性颈脊髓损伤最好在6小时内减压，而72.9%的被调查者认为不完全性颈脊髓损伤最好在6小时内减压。大多数脊柱外科医生喜欢在24小时内对急性损伤的脊髓进行复位。大多数脊柱外科医生更喜欢在24小时内对完全或不完全颈椎脊髓损伤患者进行颈椎重建。早期减压（24小时内）应被视为任何SCI患者治疗管理的一部分，尤其是颈椎SCI患者。对于不完全性颈脊髓损伤的患者，应考虑尽早减压（12小时内）（中央脊髓综合征可能除外）。
Study Design. Systematic review of the literature and prospective survey study.Objective. To characterize expert opinion regarding the timing of surgery for decompression of the injured spinal cord and critically summarize the evidence for early surgical intervention for acute spinal cord injury (SCI).Summary of Background Data. The optimal timing of decompressive surgery for acute SCI is controversial, resulting in considerable variability in clinical practice. Moreover, the current opinion of spine surgeons regarding the optimal timing of surgery after SCI is unknown.Methods. We undertook a systematic review of the applied preclinical and clinical published data regarding the timing of decompression following SCI. A 20-question survey was sent to orthopedic and neurosurgical spine surgeons across the world. Response frequencies were compiled for respondent demographics and preference for timing of surgical decompression in 6 distinct clinical scenarios. chi(2) statistics were used to compare response frequencies based on specialty and fellowship training.Results. A total of 971 spine surgeons responded to the survey. In almost every clinical scenario, with the exception of central cord syndrome, the majority of respondents (>= 80%) preferred to decompress the spinal cord within 24 hours. A complete cervical SCI would preferably be decompressed within 6 hours by 46.2% of respondents, but 72.9% would operate within 6 hours for an incomplete SCI in an otherwise identical clinical scenario.Conclusion. The majority of spine surgeons prefer to decompress the acutely injured spinal cord within 24 hours. The majority of spine surgeons prefer to decompress the cervical spine for patients with complete or incomplete cervical SCI within 24 hours. Early decompression (within 24 hours) should be considered as part of the therapeutic management of any patient with SCI, particularly those with cervical SCI. Very early decompression (within 12 hours) should be considered for a patient with an incomplete cervical SCI (with the possible exception of central cord syndrome).