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Global Spine J. 2017 Sep;7(3 Suppl):195S-202S. doi: 10.1177/2192568217706367. Epub 2017 Sep 5.

A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury and Central Cord Syndrome: Recommendations on the Timing (≤24 Hours Versus >24 Hours) of Decompressive Surgery.

Author information

1
Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
2
University of Toronto, Toronto, Ontario, Canada.
3
University College Cork, Cork, Ireland.
4
St. Michael's Hospital, Toronto, Ontario, Canada.
5
University of Maryland, Baltimore, MD, USA.
6
University of Wisconsin, Madison, WI, USA.
7
University of Kansas Medical Center, The University of Kansas, Kansas City, KS, USA.
8
University of Utah, Salt Lake City, UT, USA.
9
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
10
National Defense Medical College, Saitama, Japan.
11
Spectrum Research, Inc, Tacoma, WA, USA.
12
University of California at Los Angeles, CA, USA.
13
Christopher & Dana Reeve Foundation, Short Hills, NJ, USA.
14
Ontario Neurotrauma Foundation, Toronto, Ontario, Canada.
15
University of Cambridge, Cambridge, England.
16
Medical College of Wisconsin, Milwaukee, WI, USA.
17
Thomas Jefferson University Hospital, Philadelphia, PA, USA.
18
University of Sydney, Sydney, New South Wales, Australia.
19
Nagoya University, Nagoya, Japan.
20
Keio University, Keio, Japan.
21
The University of Kansas, Kansas City, KS, USA.
22
University of Ottawa, Ottawa, Ontario, Canada.
23
Department of Orthopedic Surgery, Jefferson Health, Thomas Jefferson University, Philadelphia, PA, USA.
24
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
25
Thomas Jefferson University, Philadelphia, PA, USA.

Abstract

Objective:

To develop recommendations on the timing of surgical decompression in patients with traumatic spinal cord injury (SCI) and central cord syndrome.

Methods:

A systematic review of the literature was conducted to address key relevant questions. A multidisciplinary guideline development group used this information, along with their clinical expertise, to develop recommendations for the timing of surgical decompression in patients with SCI and central cord syndrome. Based on GRADE, a strong recommendation is worded as "we recommend," whereas a weak recommendation is presented as "we suggest."

Results:

Conclusions from the systematic review included (1) isolated studies reported statistically significant and clinically important improvements following early decompression at 6 months and following discharge from inpatient rehabilitation; (2) in one study on acute central cord syndrome without instability, a marginally significant improvement in total motor scores was reported at 6 and 12 months in patients managed with early versus late surgery; and (3) there were no significant differences in length of acute care/rehabilitation stay or in rates of complications between treatment groups. Our recommendations were: "We suggest that early surgery be considered as a treatment option in adult patients with traumatic central cord syndrome" and "We suggest that early surgery be offered as an option for adult acute SCI patients regardless of level." Quality of evidence for both recommendations was considered low.

Conclusions:

These guidelines should be implemented into clinical practice to improve outcomes in patients with acute SCI and central cord syndrome by promoting standardization of care, decreasing the heterogeneity of management strategies, and encouraging clinicians to make evidence-informed decisions.

KEYWORDS:

center cord syndrome; guideline; spinal cord injury; surgery; time of surgery

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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