TY - JOUR
T1 - A Practical Classification System for Acute Cervical Spinal Cord Injury Based on a Three-Phased Modified Delphi Process From the AOSpine Spinal Cord Injury Knowledge Forum
AU - Hachem, Laureen D.
AU - Zhu, Mary
AU - Aarabi, Bizhan
AU - Davies, Benjamin
AU - DiGiorgio, Anthony
AU - Evaniew, Nathan
AU - Fehlings, Michael G.
AU - Ganau, Mario
AU - Graves, Daniel
AU - Guest, James
AU - Ha, Yoon
AU - Harrop, James
AU - Hofstetter, Christopher
AU - Koljonen, Paul
AU - Kurpad, Shekar
AU - Marco, Rex
AU - Martin, Allan R.
AU - Nagoshi, Narihito
AU - Nouri, Aria
AU - Rahimi-Movaghar, Vafa
AU - Rodrigues-Pinto, Ricardo
AU - Wengel, Valerie ter
AU - Tetreault, Lindsay
AU - Kwon, Brian
AU - Wilson, Jefferson R.
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2024/3
Y1 - 2024/3
N2 - Study Design: A modified Delphi study. Objective: To assess current practice patterns in the management of cervical spinal cord injury (SCI) and develop a simplified, practical classification system which offers ease of use in the acute setting, incorporates modern diagnostic tools and provides utility in determining treatment strategies for cervical SCI. Methods: A three-phase modified Delphi procedure was performed between April 2020 and December 2021. During the first phase, members of the AOSpine SCI Knowledge forum proposed variables of importance for classifying and treating cervical SCI. The second phase involved an international survey of spine surgeons gauging practices surrounding the role and timing of surgery for cervical SCI and opinions regarding factors which most influence these practices. For the third phase, information obtained from phases 1 and 2 were used to draft a new classification system. Results: 396 surgeons responded to the survey. Neurological status, spinal stability and cord compression were the most important variables influencing decisions surrounding the role and timing of surgery. The majority (>50%) of respondents preferred to perform surgery within 24 hours post-SCI in clinical scenarios in which there was instability, severe cord compression or severe neurology. Situations in which <50% of respondents were inclined to operate early included: SCI with mild neurological impairments, with cord compression but without instability (with or without medical comorbidities), and SCI without cord compression or instability. Conclusions: Spinal stability, cord compression and neurological status are the most important variables influencing surgeons’ practices surrounding the surgical management of cervical SCI. Based on these results, a simplified classification system for acute cervical SCI has been proposed.
AB - Study Design: A modified Delphi study. Objective: To assess current practice patterns in the management of cervical spinal cord injury (SCI) and develop a simplified, practical classification system which offers ease of use in the acute setting, incorporates modern diagnostic tools and provides utility in determining treatment strategies for cervical SCI. Methods: A three-phase modified Delphi procedure was performed between April 2020 and December 2021. During the first phase, members of the AOSpine SCI Knowledge forum proposed variables of importance for classifying and treating cervical SCI. The second phase involved an international survey of spine surgeons gauging practices surrounding the role and timing of surgery for cervical SCI and opinions regarding factors which most influence these practices. For the third phase, information obtained from phases 1 and 2 were used to draft a new classification system. Results: 396 surgeons responded to the survey. Neurological status, spinal stability and cord compression were the most important variables influencing decisions surrounding the role and timing of surgery. The majority (>50%) of respondents preferred to perform surgery within 24 hours post-SCI in clinical scenarios in which there was instability, severe cord compression or severe neurology. Situations in which <50% of respondents were inclined to operate early included: SCI with mild neurological impairments, with cord compression but without instability (with or without medical comorbidities), and SCI without cord compression or instability. Conclusions: Spinal stability, cord compression and neurological status are the most important variables influencing surgeons’ practices surrounding the surgical management of cervical SCI. Based on these results, a simplified classification system for acute cervical SCI has been proposed.
KW - central cord syndrome
KW - classification system
KW - spinal cord injury
KW - timing of surgery
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U2 - 10.1177/21925682221114800
DO - 10.1177/21925682221114800
M3 - Article
AN - SCOPUS:85138317004
SN - 2192-5682
VL - 14
SP - 535
EP - 545
JO - Global Spine Journal
JF - Global Spine Journal
IS - 2
ER -