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Maroufi SF, Azadnajafabad S, Pour-Rashidi A, Jazayeri SB, Ghodsi Z, Ghawami H, Kheyri M, Farahbakhsh F, Azarhomayoun A, Bahreini M, Arab Kheradmand J, Faghih Jouibari M, Zareh M, Fehlings MG, Rahimi-Movaghar V. Adopting and adapting clinical practice guidelines for timing of decompressive surgery in acute spinal cord injury from a developed world context to a developing region. Acta Neurochir (Wien) 2023; 165:1401-1406. [PMID: 37074391 DOI: 10.1007/s00701-023-05591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/09/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE The proper application of high-quality clinical practice guidelines improves trauma patients' care and outcomes. This study aimed to adopt and adapt guidelines on the timing of decompressive surgery in acute spinal cord injury (SCI) in Iranian clinical settings. METHODS This study followed a systematic search and review of the literature to enter them into the selection process. The source guidelines' clinical suggestions were converted into clinical scenarios for clinical questions on the timing of decompressive surgery. After summarizing the scenarios, we prepared an initial list of recommendations based on the status of the Iranian patients and the health system. The ultimate conclusion was reached with the help of a national interdisciplinary expert panel comprising 20 experts throughout the country. RESULTS A total of 408 records were identified. After title and abstract screening, 401 records were excluded, and the full texts of the remaining seven records were reviewed. Based on our screening process, only one guideline included recommendations on the topic of interest. All of the recommendations were accepted by the expert panel with slight changes due to resource availability in Iran. The final two recommendations were the consideration of early surgery (≤24 h) as a treatment option in adult patients with traumatic central cord syndrome and in adult patients with acute SCI regardless of the level of injury. CONCLUSION Considering early surgery for adult patients with acute traumatic SCI regardless of the level of injury was the final recommendation for Iran. Although most of the recommendations are adoptable in developing countries, issues with infrastructure and availability of resources are the limitations.
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Affiliation(s)
- Seyed Farzad Maroufi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pour-Rashidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Heshmatollah Ghawami
- Neuropsychology Division, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Kheyri
- National Board in Community and Preventive Medicine, Treatment Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Farzin Farahbakhsh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Azarhomayoun
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Mohammad Zareh
- Department of Orthopedic Surgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, Toronto, ON, Canada
- Krembil Neuroscience Centre, University Health Network, Toronto, ON, Canada
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.
- Visiting Professor, Spine Program, University of Toronto, Toronto, Canada.
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Rahimi-Movaghar V, Niakan A, Haghnegahdar A, Shahlaee A, Saadat S, Barzideh E. Early versus late surgical decompression for traumatic thoracic/thoracolumbar (T1-L1) spinal cord injured patients. Primary results of a randomized controlled trial at one year follow-up. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2014; 19:183-91. [PMID: 24983279 PMCID: PMC4727651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To assess the efficacy of surgical decompression <24 (early) versus 24-72 hours (late) in thoracic/thoracolumbar traumatic spinal cord injury (TSCI). METHODS A randomized controlled trial (RCT) of 35 T1-L1 TSCI patients including early (n=16) and late (n=19) surgical decompression was conducted in the neurosurgery department of Shahid Rajaee Hospital from September 2010. Pre- and postoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS), ASIA motor/sensory scores, length of hospitalization, complications, postoperative vertebral height restoration/rebuilding and angle reduction, and 12-month loss of height restoration/rebuilding and angle reduction were evaluated. RESULTS Sixteen patients (46%) had complete TSCI. No AIS change was seen in 17 (52%) patients. Complete TSCI patients had no motor improvement. The AIS change in this group was solely due to increased sensory scores. For incomplete TSCI, the mean motor score improved from 77 (± 22) to 92 (± 12) in early, and from 68 (± 22) to 82 (± 16) in late surgery. One deep vein thrombosis was observed in each group. There were 2 wound infections, one CSF leak, one case of meningitis, and one decubitus ulcer in the late surgery group. Six screw revisions were required. CONCLUSION Our primary results show overall AIS and motor score improvement in both groups. Motor improvement was only observed in incomplete TSCI. Two-grade improvements in AIS were seen in 3 early, and one late surgery patient.
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Affiliation(s)
- Vafa Rahimi-Movaghar
- From the Sina Trauma and Surgery Research Center (Rahimi-Movaghar, Shahlaee, Saadat), Sina Hospital, the Students’ Scientific Research Center (Shahlaee), Tehran University of Medical Sciences, Tehran, the Department of Neurosurgery (Niakan, Haghnegahdar, Barzideh), and the Trauma Research Center (Niakan, Haghnegahdar, Barzideh), Shahid Rajaee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran,Address correspondence and reprint request to: Dr. Vafa Rahimi-Movaghar, Professor of Neurosurgery, Sina Trauma and Surgery Research Center, Sina Hospital, Hassan-Abad Square, Imam Khomeini Ave, Tehran University of Medical Sciences, Tehran 11365-3876, Iran. Tel. +98 (915) 3422682 / +98 (216) 6757010. Fax. +98 (216) 6757009. E-mail: /
| | - Amin Niakan
- From the Sina Trauma and Surgery Research Center (Rahimi-Movaghar, Shahlaee, Saadat), Sina Hospital, the Students’ Scientific Research Center (Shahlaee), Tehran University of Medical Sciences, Tehran, the Department of Neurosurgery (Niakan, Haghnegahdar, Barzideh), and the Trauma Research Center (Niakan, Haghnegahdar, Barzideh), Shahid Rajaee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Haghnegahdar
- From the Sina Trauma and Surgery Research Center (Rahimi-Movaghar, Shahlaee, Saadat), Sina Hospital, the Students’ Scientific Research Center (Shahlaee), Tehran University of Medical Sciences, Tehran, the Department of Neurosurgery (Niakan, Haghnegahdar, Barzideh), and the Trauma Research Center (Niakan, Haghnegahdar, Barzideh), Shahid Rajaee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abtin Shahlaee
- From the Sina Trauma and Surgery Research Center (Rahimi-Movaghar, Shahlaee, Saadat), Sina Hospital, the Students’ Scientific Research Center (Shahlaee), Tehran University of Medical Sciences, Tehran, the Department of Neurosurgery (Niakan, Haghnegahdar, Barzideh), and the Trauma Research Center (Niakan, Haghnegahdar, Barzideh), Shahid Rajaee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soheil Saadat
- From the Sina Trauma and Surgery Research Center (Rahimi-Movaghar, Shahlaee, Saadat), Sina Hospital, the Students’ Scientific Research Center (Shahlaee), Tehran University of Medical Sciences, Tehran, the Department of Neurosurgery (Niakan, Haghnegahdar, Barzideh), and the Trauma Research Center (Niakan, Haghnegahdar, Barzideh), Shahid Rajaee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Barzideh
- From the Sina Trauma and Surgery Research Center (Rahimi-Movaghar, Shahlaee, Saadat), Sina Hospital, the Students’ Scientific Research Center (Shahlaee), Tehran University of Medical Sciences, Tehran, the Department of Neurosurgery (Niakan, Haghnegahdar, Barzideh), and the Trauma Research Center (Niakan, Haghnegahdar, Barzideh), Shahid Rajaee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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