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Spinal Cord Injury


Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS).
Fehlings MG, Vaccaro A, Wilson JR, Singh A, W Cadotte D, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R.
PLoS One. 2012;7(2):e32037.

Rationale for inclusion: A prospective observational study of patients who underwent decompression of the cervical spinal cord before or after 24hrs revealed the early surgery group were nearly 3x as likely to achieve a 2 grade ASIA impairment scale improvement at 6 months.

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A systematic review of the evidence supporting a role for vasopressor support in acute SCI.
Ploumis A, Yadlapalli N, Fehlings MG, Kwon BK, Vaccaro AR.
Spinal Cord. 2010 May;48(5):356-62.

Rationale for inclusion: A systematic review of a topic with limited evidentiary support.

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Methylprednisolone for acute spinal cord injury: an inappropriate standard of care.
Hurlbert RJ.
J Neurosurg. 2000 Jul;93(1 Suppl):1-7.

Rationale for inclusion: Results from the NASCIS II and III trials were reanalyzed without post-hoc comparisons and failed to show any benefit from the use of methylprednisolone and recovery from SCI.

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Recent trends in mortality and causes of death among persons with spinal cord injury.
DeVivo MJ, Krause JS, Lammertse DP.
Arch Phys Med Rehabil. 1999 Nov;80(11):1411-9.

Rationale for inclusion: Mortality improved over a 25 year period from 1973 to 1998 in spinal cord injury care systems and Shriner's Hospitals.

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Surgical management of spinal epidural hematoma: relationship between surgical timing and neurological outcome.
Lawton MT, Porter RW, Heiserman JE, Jacobowitz R, Sonntag VK, Dickman CA.
J Neurosurg. 1995 Jul;83(1):1-7.

Rationale for inclusion: Preoperative neurologic status correlated and time to surgical evacuation correlated with outcomes.

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Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study.
Bracken MB, Shepard MJ, Collins WF Jr, Holford TR, Baskin DS, Eisenberg HM, Flamm E, Leo-Summers L, Maroon JC, Marshall LF, et al.
J Neurosurg. 1992 Jan;76(1):23-31.

Rationale for inclusion: Results from the NASCIS II trial were preserved at 1 year followup.

CAVEAT: Later reanalyzed and failed to show improvement in primary outcome measures.

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A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study.
Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, Eisenberg HM, Flamm E, Leo-Summers L, Maroon J, et al.
N Engl J Med. 1990 May 17;322(20):1405-11.

Rationale for inclusion: Patients treated with methylprednisolone within 8 hours of SCI had improved neurologic recovery at 6 months.

CAVEAT: Later reanalyzed and failed to show improvement in primary outcome measures.

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