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Al-Shawwa A, Ost K, Anderson D, Cho N, Evaniew N, Jacobs WB, Martin AR, Gaekwad R, Tripathy S, Bouchard J, Casha S, Cho R, duPlessis S, Lewkonia P, Nicholls F, Salo PT, Soroceanu A, Swamy G, Thomas KC, Yang MMH, Cohen-Adad J, Cadotte DW. Advanced MRI metrics improve the prediction of baseline disease severity for individuals with degenerative cervical myelopathy. Spine J 2024:S1529-9430(24)00193-1. [PMID: 38679077 DOI: 10.1016/j.spinee.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 04/05/2024] [Accepted: 04/23/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND CONTEXT Degenerative cervical myelopathy (DCM) is the most common form of atraumatic spinal cord injury globally. Degeneration of spinal discs, bony osteophyte growth and ligament pathology results in physical compression of the spinal cord contributing to damage of white matter tracts and grey matter cellular populations. This results in an insidious neurological and functional decline in patients which can lead to paralysis. Magnetic resonance imaging (MRI) confirms the diagnosis of DCM and is a prerequisite to surgical intervention, the only known treatment for this disorder. Unfortunately, there is a weak correlation between features of current commonly acquired MRI scans ("community MRI, cMRI") and the degree of disability experienced by a patient. PURPOSE This study examines the predictive ability of current MRI sequences relative to "advanced MRI" (aMRI) metrics designed to detect evidence of spinal cord injury secondary to degenerative myelopathy. We hypothesize that the utilization of higher fidelity aMRI scans will increase the effectiveness of machine learning models predicting DCM severity and may ultimately lead to a more efficient protocol for identifying patients in need of surgical intervention. STUDY DESIGN/SETTING Single institution analysis of imaging registry of patients with DCM. PATIENT SAMPLE A total of 296 patients in the cMRI group and 228 patients in the aMRI group. OUTCOME MEASURES Physiologic measures: accuracy of machine learning algorithms to detect severity of DCM assessed clinically based on the modified Japanese Orthopedic Association (mJOA) scale. METHODS Patients enrolled in the Canadian Spine Outcomes Research Network registry with DCM were screened and 296 cervical spine MRIs acquired in cMRI were compared with 228 aMRI acquisitions. aMRI acquisitions consisted of diffusion tensor imaging, magnetization transfer, T2-weighted, and T2*-weighted images. The cMRI group consisted of only T2-weighted MRI scans. Various machine learning models were applied to both MRI groups to assess accuracy of prediction of baseline disease severity assessed clinically using the mJOA scale for cervical myelopathy. RESULTS Through the utilization of Random Forest Classifiers, disease severity was predicted with 41.8% accuracy in cMRI scans and 73.3% in the aMRI scans. Across different predictive model variations tested, the aMRI scans consistently produced higher prediction accuracies compared to the cMRI counterparts. CONCLUSIONS aMRI metrics perform better in machine learning models at predicting disease severity of patients with DCM. Continued work is needed to refine these models and address DCM severity class imbalance concerns, ultimately improving model confidence for clinical implementation.
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Affiliation(s)
- Abdul Al-Shawwa
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N4N1, Canada
| | - Kalum Ost
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N4N1, Canada
| | - David Anderson
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, HMRB 231, 3330 Hospital Drive NW, Calgary, Alberta, T2N4N1, Canada
| | - Newton Cho
- Department of Neurosurgery, University of Toronto,149 College Street, 5th Floor, Toronto, Ontario, M5T1P5, Canada
| | - Nathan Evaniew
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 1403 29 Street NW, T2N2T9, Calgary, Alberta, T2N2T9, Canada
| | - W Bradley Jacobs
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta, T2N2T9, Canada
| | - Allan R Martin
- Department of Neurological Surgery, University of California - Davis, 3301 C Street, Suite 1500, Sacramento, CA, 95816, USA
| | - Ranjeet Gaekwad
- Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta, T2N2T9, Canada
| | - Saswati Tripathy
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada
| | - Jacques Bouchard
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 1403 29 Street NW, T2N2T9, Calgary, Alberta, T2N2T9, Canada
| | - Steve Casha
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta, T2N2T9, Canada
| | - Roger Cho
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 1403 29 Street NW, T2N2T9, Calgary, Alberta, T2N2T9, Canada
| | - Stephen duPlessis
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta, T2N2T9, Canada
| | - Peter Lewkonia
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 1403 29 Street NW, T2N2T9, Calgary, Alberta, T2N2T9, Canada
| | - Fred Nicholls
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 1403 29 Street NW, T2N2T9, Calgary, Alberta, T2N2T9, Canada
| | - Paul T Salo
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 1403 29 Street NW, T2N2T9, Calgary, Alberta, T2N2T9, Canada
| | - Alex Soroceanu
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 1403 29 Street NW, T2N2T9, Calgary, Alberta, T2N2T9, Canada
| | - Ganesh Swamy
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 1403 29 Street NW, T2N2T9, Calgary, Alberta, T2N2T9, Canada
| | - Kenneth C Thomas
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, 1403 29 Street NW, T2N2T9, Calgary, Alberta, T2N2T9, Canada
| | - Michael M H Yang
- Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta, T2N2T9, Canada
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Pavillon Lassonde 2700 Ch de la Tour, Montreal, Quebec, H3T1N8, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, 4565 Queen Mary Rd, Montreal, Quebec, H3W1W5, Canada; Mila - Quebec AI Institute, 6666 Saint-Urbain Street, #200, Montreal, Quebec, H2S3H1, Canada
| | - David W Cadotte
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N4N1, Canada; Combined Orthopedic and Neurosurgery Spine Program, University of Calgary, 1409 29 Street NW, Calgary, Alberta, T2N2T9, Canada; Department of Clinical Neurosciences, Section of Neurosurgery, Cumming School of Medicine, University of Calgary, 1403 29th Street NW, Calgary, Alberta, T2N2T9, Canada.
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Krysa JA, Pohar Manhas KJ, Loyola-Sanchez A, Casha S, Kovacs Burns K, Charbonneau R, Ho C, Papathanassoglou E. Mobilizing registry data for quality improvement: A convergent mixed-methods analysis and application to spinal cord injury. Front Rehabil Sci 2023; 4:899630. [PMID: 37077292 PMCID: PMC10109451 DOI: 10.3389/fresc.2023.899630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
IntroductionThe rising prevalence of complex chronic conditions and growing intricacies of healthcare systems emphasizes the need for interdisciplinary partnerships to advance coordination and quality of rehabilitation care. Registry databases are increasingly used for clinical monitoring and quality improvement (QI) of health system change. Currently, it is unclear how interdisciplinary partnerships can best mobilize registry data to support QI across care settings for complex chronic conditions.PurposeWe employed spinal cord injury (SCI) as a case study of a highly disruptive and debilitating complex chronic condition, with existing registry data that is underutilized for QI. We aimed to compare and converge evidence from previous reports and multi-disciplinary experts in order to outline the major elements of a strategy to effectively mobilize registry data for QI of care for complex chronic conditions.MethodsThis study used a convergent parallel-database variant mixed design, whereby findings from a systematic review and a qualitative exploration were analyzed independently and then simultaneously. The scoping review used a three-stage process to review 282 records, which resulted in 28 articles reviewed for analysis. Concurrent interviews were conducted with multidisciplinary-stakeholders, including leadership from condition-specific national registries, members of national SCI communities, leadership from SCI community organizations, and a person with lived experience of SCI. Descriptive analysis was used for the scoping review and qualitative description for stakeholder interviews.ResultsThere were 28 articles included in the scoping review and 11 multidisciplinary-stakeholders in the semi-structured interviews. The integration of the results allowed the identification of three key learnings to enhance the successful design and use of registry data to inform the planning and development of a QI initiative: enhance utility and reliability of registry data; form a steering committee lead by clinical champions; and design effective, feasible, and sustainable QI initiatives.ConclusionThis study highlights the importance of interdisciplinary partnerships to support QI of care for persons with complex conditions. It provides practical strategies to determine mutual priorities that promote implementation and sustained use of registry data to inform QI. Learnings from this work could enhance interdisciplinary collaboration to support QI of care for rehabilitation for persons with complex chronic conditions.
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Affiliation(s)
- Jacqueline A. Krysa
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Kiran J. Pohar Manhas
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adalberto Loyola-Sanchez
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Steve Casha
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Katharina Kovacs Burns
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Clinical Quality Metrics, Alberta Health Services, Edmonton, AB, Canada
| | - Rebecca Charbonneau
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Correspondence: Elizabeth Papathanassoglou
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Glennie RA, Bailey CS, Abraham E, Manson N, Casha S, Thomas K, Paquet J, McIntosh G, Hall H, Fisher CG, Rampersaud YR. Variation in surgical treatment of degenerative spondylolisthesis in Canada: surgeon assessment of stability and impact on treatment. Eur Spine J 2021; 30:3709-3719. [PMID: 34327542 DOI: 10.1007/s00586-021-06928-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 07/12/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Controversy exists regarding the optimal surgical treatment of degenerative lumbar spondylolisthesis (DS). Not all DS patients are the same, and the degree to which inherent stability may dictate treatment is unknown. The purpose of this study was to determine the variability in surgical approach relative to surgeon classified stability. The secondary objective was to compare patient-reported outcomes (PROs) across different surgical techniques and grades of stability. METHODS Patients prospectively enrolled from eleven tertiary care institutions and followed from 2015 to 2019. The surgical technique was at the surgeon's discretion. Surgeons were asked to grade the degree of instability based on the degenerative spondylolisthesis instability classification system (DSIC). DSIC categorizes three different types (I-stable, II-potentially unstable, and III-unstable). One-year changes in PROs were compared between each group. Multivariable regression was used to identify any characteristics that explained variability in treatment. RESULTS There were 323 patients enrolled in this study. Surgeons' stability classification versus procedure [decompression alone (D)/decompression and posterolateral fusion (D-PL)/and decompression with posterior/transforaminal lumbar interbody fusion (D-PLIF/TLIF)] were as follows: type I (n = 91): D-41%/D-PL-13%/D-PLIF/TLIF-46%; type II (n = 175): D-23%/D-PL-17%/D-PLIF/TLIF-60%; and type III (n = 57):(D-0%/D-PL-14%/D-PLIF/TLIF-86%). Type I patients undergoing D-PL had some improvements in EQ-5D and NRS versus those undergoing D-PLIF/TLIF but otherwise there were no other significant differences between groups. Regression analysis demonstrated advanced age (OR = 1.06, CI 1.02-10.12) and type I (OR = 2.61, CI 1.17-5.81) were associated with receiving decompression surgery alone. CONCLUSIONS There exists considerable variation in surgical management of DS in Canada. Given similar PROs in two of the three groups, there is potential to tailor surgical intervention and improve resource utilization.
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Affiliation(s)
- R Andrew Glennie
- Department of Surgery, Dalhousie University, Halifax, NS, Canada.
| | | | | | - Neil Manson
- Canada East Spine Center, Saint John, NB, Canada
| | - Steve Casha
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Kenneth Thomas
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Jerome Paquet
- CHU Laval: Centre Hospitalier de l'Universite Laval, Quebec, Canada
| | - Greg McIntosh
- The University of British Columbia, Vancouver, BC, Canada
| | - Hamiton Hall
- University of Toronto Faculty of Medicine, Toronto, ON, Canada
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Power JD, Glennie A, Rogers S, Aziz M, Singh S, Dandurand C, Tauh S, Richard-Denis A, Morris S, Richard-Denis A, Lim V, Mputu PM, Soroceanu A, Sadiq I, Daly C, Dandurand C, Larouche J, Correale M, Sharma A, Charest-Morin R, Lee J, Ajoku U, Moskven E, Asif H, Al-attar ENM, Mishreky A, Rocos B, Rocos B, Rocos B, Srivastava SK, Patgaonkar P, Cummins D, Bednar D, Chan V, Bowker R, Evaniew N, Hathi K, Hall H, Ludwig T, Ludwig T, Truong VT, Passalent L, Wang S, Shaikh N, Pelletier-Roy R, Shen J, Wang Z, Singh S, Machida M, Machida M, Fernandes R, Fernandes R, Marathe N, Kerr J, Magnan MC, Visva S, Jarvis J, Jarvis J, Jentzsch T, Cherry A, Cherry A, Cherry A, Dandurand C, Rampersaud R, Sundararajan K, Levasseur A, Fernandes R, Fernandes R, Fullerton K, Malone H, Daly C, Peloza J, Peloza J, Walden K, Elsemin O, MacLean MA, Rose J, Oppermann M, Ferguson D, Hindi M, Dermott JA, DeVries Z, Lebel D, Ayling O, Singh V, Craig M, Lasswell T, Perruccio AV, Canizares M, McIntosh G, Rampersaud YR, Urquhart J, Koto P, Rasoulinejad P, Sequeira K, Miller T, Watson J, Rosedale R, Gurr K, Siddiqi F, Bailey C, Manson N, Bigney E, Vandewint A, Richardson E, El-Mughayyar D, McPhee R, Abraham E, Weber M, McIntosh G, Kelly A, Santaguida C, Ouellet J, Reindl R, Jarzem P, Lasry O, Dea N, Fisher C, Street J, Boyd M, Charest-Morin R, Rhines L, Boriani S, Charest-Morin R, Gokaslan Z, Gasbarrini A, Saghal A, Laufer II, Lazary A, Bettegowda C, Kawahara N, Clarke M, Rampersaud YR, Reynolds J, Disch A, Chou D, Shin JH, Wei F, Hornicek FJ, Barzilai O, Fisher C, Dea N, Nickel D, Thorpe L, Brown J, Weiler R, Linassi G, Fourney D, Dionne A, Bégin J, Mac-Thiong JM, Yung A, George S, Prevost V, Bauman A, Kozlowski P, Samadi F, Fournier C, Parker L, Dong K, Streijger F, Moore GW, Laule C, Kwon B, Gravel LF, Dionne A, Bourassa-Moreau E, Maurais G, Khoueir P, Mac-Thiong JM, Richard-Denis A, Dionne A, Bourassa-Moreau É, Bégin J, Mac-Thiong JM, Beausejour M, Richard-Denis A, Begin J, Dionne A, Mac-Thiong JM, Scheer J, Protopsaltis T, Gupta M, Passias P, Gum J, Smith J, Bess S, Lafage V, Ames C, Klineberg E, Frederick A, Nicholls F, Lewkonia P, Thomas K, Jacobs B, Swamy G, Miller N, Tanguay R, Soroceanu A, Nevin J, Bourassa-Moreau E, Dvorak M, Fisher C, Paquette S, Kwon B, Dea N, Ailon T, Charest-Morin R, Street J, Hindi M, Kwon B, Dvorak M, Ailon T, Paquette S, Fisher C, Charest-Morin R, Dea N, Street J, Finkelstein J, Bowes J, Ford M, Yee A, Soever L, Rachevitz M, Bigness A, Robertson S, Wilson R, Wong W, Nugent J, Frantzeskos S, Duffy M, Rampersaud R, Marathe N, Agarwal R, Bailey CS, Paquet J, Dea N, Goytan M, McIntosh G, Street J, Fisher C, Jacobs B, Johnson M, Paquet J, Hall H, Bailey C, Christie S, Nataraj A, Manson N, Phan P, Rampersaud R, Thomas K, McIntosh G, Abraham E, Glennie A, Jarzem P, Ahn H, Blanchard J, Hogan G, Kelly A, Charest-Morin R, Tohidi M, Hopman W, Yen D, Parent S, Miyanji F, Murphy J, El-Hawary R, Lebel D, Zeller R, Reda L, Dodds M, Lebel D, Zeller R, Zeller R, Marathe N, Bhosale S, Raj A, Marathe N, Goyal V, Theologis A, Witiw C, Fehlings M, Morash K, Yaszay B, Andras L, Sturm P, Sponseller P, El-Hawary R, Swamy G, Jacobs WB, Bouchard J, Cho R, Manson NA, Rampersaud YR, Paquet J, Bailey CS, Johnson M, Attabib N, Fisher CG, McIntosh G, Thomas KC, Bigney E, Richardson E, Alugo T, El-Mughayyar D, Vandewint A, Manson N, Abraham E, Attabib N, Prostko R, Cheng B, Haring K, Fischer M, Bourget-Murray J, Sridharan S, Frederick A, Johnston K, Edwards B, Nicholls F, Soroceanu A, Bouchard J, Shedid D, Al-Shakfa F, Shen J, Boubez G, Yuh SJ, Wang Z, Sundararajan K, Perruccio A, Coyte P, Bombardier C, Bloom J, Hawke C, Haroon N, Inman R, Rampersaud YR, Hebert J, Abraham E, Vandewint A, Bigney E, Richardson E, El-Mughayyar D, Attabib N, Small C, Manson N, Zhang H, Beresford-Cleary N, Street J, Wilson D, Oxland T, Richard-Denis A, Jean S, Bourassa-Moreau É, Fleury J, Beauchamp-Vien G, Bégin J, Mac-Thiong JM, Boudier-Revéret M, Majdalani C, Truong VT, Wang Z, Shedid D, Najjar A, Yuh SJ, Boubez G, Sebaaly A, McIntosh G, Ailon T, Dea N, Fisher C, Charest-Morin R, Lebel D, Rocos B, Zabjek K, Zeller R, Zabjek K, Rocos B, Lebel D, Zeller R, Gee A, Schneider N, Kanawati A, Schemitsch E, Bailey C, Rasoulinejad P, Zdero R, Schneider N, Gee A, Kanawati A, Zdero R, Bailey C, Rasoulinejad P, Lohkamp LN, Fehlings M, Abraham E, Vandewint A, Bigney E, Hebert J, Richardson E, El-Mughayyar D, Chorney J, El-Hawary R, Manson N, Wai E, Phan P, Kingwell S, Tierney S, Stratton A, AlDuwaisan A, Moravek D, Wai E, Kingwell S, Stratton A, Phan P, Devries Z, Barrowman N, Smit K, Tice A, Devries Z, Barrowman N, Smit K, Tice A, Sundararajan K, Rampersaud YR, Oitment C, Wunder J, Ferguson P, Rampersaud R, Rampersaud R, Rampersaud R, Ailon T, Dvorak M, Kwon B, Paquette S, Charest-Morin R, Dea N, Fisher C, Street J, Bailey C, Casha S, Glennie A, Fox R, McIntosh G, Yee A, Fisher C, Perruccio A, Perruccio A, Rampersaud YR, Mac-Thiong JM, Richard-Denis A, Gee A, Kanawati A, Rasoulinejad P, Zdero R, Bailey C, Gee A, Kanawati A, Rasoulinejad P, Zdero R, Bailey C, Klein G, Emmenegger U, Finkelstein J, Lyons F, Whyne C, Hardisty M, Millgram M, Guyer R, Harel R, Ashkenazi E, Dvorak M, Fisher C, Paquette S, Street J, Dea N, Ailon T, Charest-Morin R, Kwon B, Millgram M, Guyer R, Le Huec JC, Ashkenazi E, Millgram M, Guyer R, Harel R, Kutz S, Ashkenazi E, Parsons J, Bailey CS, Dhaliwal P, Fourney DR, Noonan V, Mac-Thiong JM, Beausejour M, Sassine S, Joncas J, Barchi S, Le May S, Cobetto N, Fortin C, Carl-Éric A, Parent S, Labelle H, Bailey C, Fisher C, Rampersaud R, Glennie A, Manson N, Bigney E, Vandewint A, Hebert J, El-Mughayyar D, Richardson E, Ghallab N, Flood M, Attabib N, Abraham E, Swamy G, Nicholls F, Thomas K, Jacobs WB, Soroceanu A, Evaniew N, Stevens M, Dunning C, Oxner W, Glennie A, Dandurand C, Paquette S, Kwon B, Ailon T, Dvorak M, Dea N, Charest-Morin R, Fisher C, Street J, Kim D, Lebel DE, Jarvis J, Tice A, Smit K, Campbell F, Mashida M, Isaac L, Bath N, Stocki D, Levin D, Koyle M, Ruskin D, Stinson J, Ailon T, Dea N, Fisher C, Evaniew N, Soroceanu A, Nicholls F, Jacobs WB, Thomas K, Cho R, Lewkonia P, Swamy G, Lasry O, Ailon T, Zamani N, Rampersaud R, Rasoulinejad P. 2021 Canadian Spine Society Abstracts. Can J Surg 2021; 64:S1-S36. [PMID: 34296831 PMCID: PMC8410468 DOI: 10.1503/cjs.012621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Missiuna P, Shen J, Nahle I, Shen J, Alanazi M, Rutges J, Rocos B, Miyanji F, Lohkamp L, Grootjen L, Hachem L, Aldebeyan S, Machida M, Padhye K, Rushton P, Jentzsch T, Jentzsch T, Lewis S, Passias P, Pierce K, Lewis S, Passias P, Nielsen C, Glennie A, Crawford E, Schneider N, Ayling O, Christie S, Greene R, Singh S, Beauchamp-Chalifour P, Balasuberamaniam P, Singh S, Mercure-Cyr R, Wilson J, Evaniew N, Martin A, Rienmueller A, Martin A, Karim M, Martin A, Cheung A, Badhiwala J, Diotalevi L, Jaja B, Fallah N, Badhiwala J, Wasim A, Manson N, Lasry O, Crawford E, Brown A, MacLean MA, Khan O, Badhiwala J, Odai KG, Bailly N, Khan O, Evaniew N, Yamamoto S, Singh M, Kashigar A, Persad A, Fernandes RJR, Malakoutian M, Ahuja C, Morris S, Stukas S, Chen T, Babadagli E, Xu M, Nater A, Oitment C, Karim M, Aziz M, Pahuta M, Versteeg A, Sundararajan K, Tanguay R, Stratton A, Cushnie D, Correale M, Sadiq I, Badhiwala J, Passias P, Badhiwala J, McGregor S, Passias P, Badhiwala J, Chen T, Singh S, Ayling O, Bond M, Rienmueller A, Chen T, Lasry O, Lyons F, Ahmed U, Inglis T, Waheed Z, Wilson J, Nater A, Pahuta M, Klein G, McKibben N, Kassam F, Clement A, Kanawati A, Shaikh N, Kanawati A, Alshammari A, Kanawati A, Yamamoto S, Hamilton K, Huschi Z, Peng YN, Huschi Z, Filgueira É, Goulet J, Kashigar A, Chen T, Hadgaonkar S, MacLean M, Chen T, Kerr HL, Meagher J, Wilson J, Stevens M, Rocos B, Pai A, Kingwell S, Thibault J, Touchette C, Moskven E, Greene R, DeVries Z, Sarraj M, Bosakhar B, Thornley P, Donnellan J, Kishta W, Darby P, Nahle I, Alzakri A, Roy-Beaudry M, Joncas J, Turgeon I, Parent S, Shen J, Alzakri A, Roy-Beaudry M, Joncas J, Turgeon I, Parent S, Samson N, Lamontagne-Proulx J, Soulet D, Tremblay Y, Praud JP, Parent S, Parent S, Gross D, Renkens J, Schlösser T, Stadhouder A, Kruyt M, Mostert A, Tee J, de Klerk L, De Kleuver M, Castelein R, Zeller R, Lewis S, Tan T, Lebel D, Rushton P, Petcharaporn M, Samdani A, Newton P, Marks M, Drake J, Dirks P, Rutka J, Kulkarni A, Ibrahim G, Taylor M, Dewan M, Zeller R, Donze S, Damen L, Rutges J, Hokken-Koelega A, Mathieu F, Lamberti-Pasculi M, Hanak B, Zeller R, Kulkarni A, Drake J, Ibrahim G, Rushton P, Ghag R, Miyanji F, Zeller R, Lewis S, Lebel D, Peiro-Garcia A, Benavides B, Parsons D, Ferri-de-Barros F, Aldebeyan S, Ghag R, Miyanji F, Kutschke L, Laux C, Kabelitz M, Schüpbach R, Böni T, Farshad M, Nielsen C, Lewis S, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Alas H, Kim HJ, Lafage R, Soroceanu A, Hockley A, Ames C, Klineberg E, Burton D, Diebo B, Bess S, Line B, Shaffrey C, Smith J, Schwab F, Lafage V, Passias P, Lafage R, Soroceanu A, Hockley A, Line B, Klineberg E, Bess S, Protopsaltis T, Shaffrey C, Schwab F, Scheer J, Smith J, Lafage V, Ames C, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Bortz C, Pierce K, Alas H, Brown A, Soroceanu A, Hockley A, Vira S, Ahmad W, Naessig S, Diebo B, Raman T, Protopsaltis T, Buckland A, Gerling M, Lafage R, Lafage V, Lewis S, Lenke L, Shaffrey C, Cheung K, Berven S, Qiu Y, Matsuyama Y, Pellisé-Urquiza F, Polly D, Sembrano J, Dahl B, Kelly M, de Kleuver M, Spruit M, Alanay A, Bailey C, Rampersaud R, Fisher C, Chen T, McIntosh G, Rampersaud R, Karim M, Urquhart J, Fisher C, Street J, Dvorak M, Paquette S, Charest-Morin R, Ailon T, Glennie A, Manson N, Rampersaud R, Thomas K, Rasoulinejad P, Bailey C, Ailon T, Fisher C, Greene R, Glennie A, Duquette D, LeBlanc D, Martell B, Schmidt M, Christie S, Wong DBT, Di Paola C, Ailon T, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Street J, Flexman A, Charest-Morin R, Wasim A, Schwartz C, Stark R, Shrikumar M, Finkelstein J, Gara A, Banaszek D, Wong T, Ailon T, Bryce E, Charest-Morin R, Dea N, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Persad A, Spiess M, Wu A, Woo A, Hnenny L, Fourney D, Joshi H, Khan O, Badhiwala J, Rampersaud R, Lewis S, Massicotte E, Fehlings M, Cadotte D, Bailey C, Christie S, Dea N, Fisher C, Paquet J, Soroceanu A, Thomas KC, Rampersaud YR, Wilson J, Manson N, Johnson M, Hall H, McIntosh G, Jacobs B, Kalsi-Ryan S, Akbar MA, Badhiwala J, Wilson J, Tetreault L, Nouri A, Rienmuller A, Massicotte E, Fehlings M, Kalsi-Ryan S, Riehm L, Martin A, Badhiwala J, Akbar M, Massicotte E, Fehlings M, Kalsi-Ryan S, Akbar MA, Badhiwala J, Wilson J, Tetreault L, Nouri A, Rienmuller A, Massicotte E, Fehlings M, Jacobs B, Johnson M, Bailey C, Christie S, Paquet J, Nataraj A, Cadotte D, Wilson J, Manson N, Hall H, Thomas K, Rampersaud R, McIntosh G, Fisher C, Dea N, Wilson J, Jentzsch T, Jiang F, Badhiwala J, Moghaddamjou A, Akbar MA, Nater A, Rienmuller A, Ganau M, Massicotte E, Fehlings M, Tu L, Manouchehri N, Kim KT, So K, Webster M, Fisk S, Tigchelaar S, Dalkilic S, Sayre E, Streijger F, Macnab A, Kwon B, Shadgan B, Wilson J, Fehlings M, Bailly N, Wagnac E, Mac-Thiong JM, Goulet J, Petit Y, Badhiwala J, Grossman R, Geisler F, Fehlings M, Wilson J, Rivers C, Kwon B, Waheed Z, Buenaventura J, Humphreys S, Noonan V, Evaniew N, Dvorak M, Wilson J, Fehlings M, Shrikumar M, Balasuberamaniam P, Rapkin B, Schwartz C, Stark R, Finkelstein J, Bigney E, Darling M, Richardson E, El-Mughayyar D, Abraham E, Street J, Radomski L, Rampersaud R, Pierce K, Bortz C, Alas H, Naessig S, Ahmad W, Vira S, Diebo B, Sciubba D, Hassanzadeh H, Hockley A, Soroceanu A, Protopsaltis T, Buckland A, Passias P, Greene R, Christie SD, Badhiwala J, Fehlings M, Witiw C, Wilson J, Fehlings M, Nessek H, Wai E, Phan P, Diotalevi L, Beauséjour MH, Wagnac E, Mac-Thiong JM, Petit Y, Badhiwala J, Fehlings M, Mazlouman S, Belley-Côté E, Jacobs B, Kwon B, Malakoutian M, Theret M, Street J, Brown S, Rossi F, Oxland T, Singh P, Chandra S, Laratta J, Carreon L, Bisson E, Ghogawala Z, Yew A, Mkorombindo T, Mummaneni P, Glassman S, Kindrachuk M, Hnenny L, Wu A, Norton J, Fourney D, Gee A, Kerr HL, Kanawati A, Zdero R, Gurr K, Bailey C, Rasoulinejad P, Yamamoto S, Sadaram S, Speidel J, Liu J, Street J, Brown S, Oxland T, Khazaei M, Walji I, Dadabhoy M, Gulati N, Aiyar N, Ostmeier S, Hasan A, Senthilnathan V, Punjani N, Yao Y, Yue S, Ozdemir G, Lou Z, Luong W, Post A, Tootsi A, Chan P, Fehlings M, Yung A, George S, Prevost V, Bauman A, Kozlowski P, Samadi F, Fournier C, Parker L, Dong K, Streijger F, Moore W, Laule C, Kwon B, Gill J, Cooper J, Dong K, Streijger F, Street J, Paquette S, Ailon T, Charest-Morin R, Fisher C, Dvorak M, Dhall S, Mac-Thiong JM, Parent S, Bailey C, Christie S, Wellington C, Kwon B, Crawford E, Zhang Y, Hardisty M, Finkelstein J, Kureshi N, Julien L, Abidi R, Christie S, Parashin S, Gascoyne T, Goytan M, Chuang J, Liu K, Quraishi N, Pasku D, Wilson J, Fehlings M, Bozzo A, Reinmuller A, Martin A, Hananel SY, Thornley P, Gazendam A, Aoude A, Nielsen C, Rampersaud R, Dea N, Versteeg A, Sahgal A, Verlaan JJ, Morin RC, Rhines L, Sciubba D, Schuster J, Weber M, Lazary A, Fehlings M, Clarke M, Arnold P, Boriani S, Laufer I, Gokaslan Z, Fisher C, Rosenzweig D, Weber M, Fisk F, Versteeg A, Fisher C, Sahgal A, Gokaslan Z, Rhines L, Boriani S, Bettegowda C, Dea N, Gal R, Charest-Morin R, Verlaan JJ, Verkooijen L, Fisher C, Perruccio A, Rampersaud R, Eckenswiller D, Yu A, Klassen K, Lewkonia P, Thomas K, Jacobs B, Miller N, Swamy G, Yang M, Soroceanu A, Phan P, Wai E, Kingwell S, Moravek D, Tierney S, Street J, Sundararajan K, Bosma R, Faclier G, Di Renna T, Rampersaud R, Frederick A, Kassam F, Nicholls F, Swamy G, Lewkonia P, Thomas K, Jacobs B, Miller N, Tanguay R, Soroceanu A, Platt A, Traynelis V, Witiw C, Horn S, Weiser-Horwitz S, Bortz C, Segreto F, Pierce K, Lafage R, Hockley A, Vira S, Lafage V, Witiw C, Wilson J, Nassiri F, da Costa L, Nathens A, Fehlings M, Jacobs B, Alas H, Pierce K, Brown A, Bortz C, Hockley A, Soroceanu A, Vira S, Naessig S, Ahmad W, Lafage R, Lafage V, Witiw C, Wilson J, da Costa L, Nathens A, Fehlings M, Crawford E, McIntosh G, Rampersaud R, Fisher C, Manson N, Thomas K, Hall H, Rampersaud R, Dea N, McIntosh G, Charest-Morin R, Investigators CSORN, Ailon T, Fisher C, Evaniew N, Aldebeyan S, Thomas K, Sundararajan K, Oitment C, Lewis S, Perruccio A, Rampersaud R, Christie S, Yee A, Fisher C, Jarzem P, Roy JF, Bouchard J, Evans D, Kwon B, Splawinski J, Warren D, Street J, Morris S, Costello J, Farrell M, Humphreys S, Kurban D, Rivers C, Jeffrey M, Juutilainen S, Casha S, Christie S, Clarke T, Drew B, Ethans K, Fehlings M, Fox R, Linassi G, Marion T, O’Connell C, Paquet J, Reid J, Scott L, Fourney D, Schouten R, Rivers C, Chen M, Nunnerley J, Croot T, Young L, Patel A, Dvorak M, Kwon B, Rivers C, Buenaventura J, Humphreys S, Noonan V, Fallah N, Evaniew N, Dvorak M, Cronin S, Badhiwala J, Ginsberg H, Fehlings M, Kwon B, Jaglal S, Wilson J, Fehlings M, Fisk F, Versteeg A, Fisher C, Sahgal A, Gokaslan Z, Rhines L, Boriani S, Bettegowda C, Dea N, Martel A, Sahgal A, Finkelstein J, Whyne C, Hardisty M, Baksh N, Nguyen T, Brown S, Jaboin J, Lin C, Yach J, Hardisty M, Whyne C, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Zhang H, Shewchuk J, Street J, Wilson D, Oxland T, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Algarni N, Aljarboa N, Jarzem P, Fernandez R, Gee A, Urquhart J, Bailey C, Rasoulinejad P, Whyte T, Van Toen C, Melnyk A, Shewchuk J, Street J, Cripton P, Oxland T, Avila M, Hurlbert RJ, Neuburger L, Ahmed SU, Cheng Y, Fourney D, Hsu HC, Kao CH, Neuburger L, Ahmed SU, Cheng Y, Fourney D, Meves R, de Oliveira AI, da Silva HC, Richard-Denis A, Petit Y, Diotalevi L, Mac-Thiong JM, Laratta J, Bisson E, Carreon L, Yew A, Mkorombindo T, Glassman S, Christie S, Bouchard J, Fisher C, Roy JF, Yee A, Jarzem P, Khurjekar K, Kothari A, Zawar A, Sanchetui P, Shyam A, Touchette C, Han JH, Christie S, Pickett G, Yee A, Bouchard J, Christie S, Fisher C, Jarzem P, Roy JF, Hashem L, Urquhart J, Rasoulinejad P, Gurr K, Siddiqi F, Bailey C, Attabib N, Bigney E, Richardson E, El-Mughayyar D, Darling M, Manson N, Abraham E, Badhiwala J, Jiang F, Wilson J, Fehlings M, Dunning C, Oxner W, Stewart S, Glennie A, Hutchinson J, Oxland T, Zhang H, Shewchuk J, Wilson D, Street J, Wilk S, Wai E, Phan P, Stratton A, Mohammed S, Tsai E, Alkerayf F, Michalowski W, Phan P, Wai E, Hoda M, MacLean M, Brunette-Clément T, Abduljabba F, Weber M, Fourney D, Charest-Morin R, Flexman A, Street J, Frey M, Mackey S, De Carvalho D, Barrowman N, Smit K, Tice A, Mervitz D, Jarvis J, Kingwell S. Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from birth to 3 monthsPresentation CPSS5: Test–retest reliability and minimum detectable change of the English translation of the Italian Spine Youth Quality of Life questionnaire in adolescents with idiopathic scoliosisPresentation B1. Abstract 31: Incidence of delayed spinal cord injury in pediatric spine deformity surgery seems to be higher than previously assumedPresentation B2. Abstract 155: What is the optimal surgical method for achieving successful symptom relief in pediatric high-grade spondylolisthesis?Presentation B3. Abstract 47: Vertebral body tethering: Truly motion preserving or rather limiting?Presentation B4. Abstract 180: Fusion rates in pediatric patients after posterior cervical spine instrumentationPresentation B5. Abstract 102: Effects of 8 years of growth hormone treatment on the onset and progression of scoliosis in children with Prader–Willi syndromePresentation B6. Abstract 144: Klippel–Feil syndrome: clinical phenotypes associated with surgical treatmentPresentation B7. Abstract 123: Anterior release for idiopathic scoliosis: Is it necessary for curve correction?Presentation B8. Abstract 62: Severe scoliosis: Do we know a better way? A retrospective comparative studyPresentation B9. Abstract 21: Intraoperative skull femoral traction in adolescent idiopathic scoliosis: the correlation of traction with side-bending radiographsPresentation B10. Abstract 147: What is the effect of intraoperative halo-femoral traction on correction of adolescent idiopathic scoliosis?Presentation B11. Abstract 174: Extreme long-term outcome of surgically versus non-surgically treated patients with adolescent idiopathic scoliosisPresentation B12. Abstract 172: The influence of multilevel spinal deformity surgery on the clinical outcome in the elderly: a prospective, observational, multicentre studyPresentation B13. Abstract 49: Demographics of a prospective evaluation of elderly deformity surgery: a prospective international observational multicentre studyPresentation B14. Abstract 119: Timing of conversion to cervical malalignment and proximal junctional kyphosis following surgical correction of adult spinal deformityPresentation B15. Abstract 44: Prioritization of realignment associated with superior clinical outcomes for surgical cervical deformity patientsPresentation B16. Abstract 50: Outcome of multilevel spinal deformity surgery in patients over 60 years of age: a multicentre international prospective studyPresentation B17. Abstract 122: A simpler, modified frailty index weighted by complication occurrence correlates to pain and disability for adult spinal deformity patientsPresentation B18. Abstract 75: Change in Oswestry Disability Index at 24 months following multilevel spinal deformity surgery in patients over 60 years of age: a multicentre international prospective studyPresentation C19. Abstract 19: A prospective cohort study evaluating trends in the surgical treatment of degenerative spondylolisthesis in Canada and the utility of a novel surgical decision aidPresentation C20. Abstract 154: Decompression compared with decompression and fusion for degenerative lumbar spondylolisthesis: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation C21. Abstract ID 77: Lumbar degenerative spondylolisthesis: factors impacting decision to fusePresentation C22. Abstract 27: Patient-reported outcomes following surgery for lumbar disc herniation: comparison of a universal and multitier health care systemPresentation C23. Abstract 151: Do patients with recurrent lumbar disc herniations fair worse with discectomy than primary operations? A retrospective analysis from the Canadian Spine Outcomes and Research NetworkPresentation C24. Abstract 136: A province-wide assessment of the appropriateness of lumbar spine MRIPresentation D25. Abstract 32: Surgical site infection reduction — a 10-year quality improvement journeyPresentation D26. Abstract 34: The impact of frailty on patient-reported outcome measures following elective thoraco-lumbar spine surgeryPresentation D27. Abstract 8: Moving toward better health: exercise practice is associated with improved outcomes after spine surgeryPresentation D28. Abstract 33: Preoperative decolonization does not adversely affect the microbiologic spectrum of spine surgical site infectionPresentation D29. Abstract 61: Feedback: reducing after-hours spine cases using an encrypted messaging systemPresentation D30. Abstract 177: Complex spine surgery is safe and effective in the extremely elderly age group: results from an ambispective study of 722 patients over 75 years old from a single institutionPresentation E31. Abstract 38: Clinical predictors of achieving minimal clinically important difference after surgery for cervical spondylotic myelopathy: an external validation study from the Canadian Spine Outcomes and Research NetworkPresentation E32. Abstract 66: The natural history of degenerative cervical myelopathy: an ambispective longitudinal cohort studyPresentation E33. Abstract 159: Quantitative assessment of gait characteristics in degenerative cervical myelopathy (DCM): a prospective studyPresentation E34. Abstract 130: Prognostic factors in degenerative cervical myelopathy (DCM) for patients managed operatively and nonoperativelyPresentation E35. Abstract 175: Efficacy of surgical decompression in patients with cervical spondylotic myelopathy: results of a Canadian prospective multicentre studyPresentation E36. Abstract 67: Interobserver reliability of the modified Japanese Orthopedic Association (mJOA) score in degenerative cervical myelopathyPresentation F37. Abstract 128: Continuous optical monitoring of spinal cord hemodynamics during the first 7 days after injury in a porcine model of acute spinal cord injuryPresentation F38. Abstract 106: Development of a prediction model for central cord syndrome: an evaluation of motor recovery and the effectiveness of early surgery in a prospective, multicentre cohortPresentation F39. Abstract 135: Spinal cord dynamics under different clinical configurations of thoracolumbar burst fractures through numerical simulationsPresentation F40. Abstract 60: Predicting the heterogeneity of outcome following sensorimotor complete cervical spinal cord injury: trajectory-based analysis of 655 prospectively enrolled patientsPresentation F41. Abstract 167: Mortality in the year following discharge to the community from inpatient care for acute traumatic spinal cord injury: When and why?Presentation F42. Abstract 104: A novel method to classify patients with cervical incomplete spinal cord injury based on potential for recovery: a group-based trajectory analysis using prospective, multicentre data from over 800 patientsPresentation G43. Abstract 7: Responsiveness of standard spine outcome tools: Do they measure up?Presentation G44. Abstract 142: Patient outcomes: important psychological measuresPresentation G45. Abstract 84: Accuracy of surveillance for surgical site infections after spine surgery: a Bayesian latent class analysis using 4 independent data sourcesPresentation G46. Abstract 169: Econometric modelling: development of a surgical cost calculator for degenerative conditions of the lumbar spinePresentation G47. Abstract 124: The economic impact of nonreimbursable events in open, minimally invasive and robot-assisted lumbar fusion surgeryPresentation G48. Abstract 164: Are there sex differences in preoperative health status and health care delivery for patients undergoing scheduled lumbar surgery? An analysis from the Canadian Spine Outcomes and Research NetworkPresentation H49. Abstract 41: Patient phenotypes associated with functional outcomes after spinal cord injury: a principal component analysis in 1119 patientsPresentation H50. Abstract 103: Early versus late surgical decompression for acute traumatic spinal cord injury: a pooled analysis of prospective, multicentre data in 1548 patientsPresentation H51. Abstract 79: Clinical outcome correlation of diffusion tensor imaging and magnetic resonance imaging values: a systematic reviewPresentation H52. Abstract 137: A numerical study on the pathogenesis of central cord syndromePresentation H53. Abstract 42: Feasibility and utility of machine learning in prediction of bladder outcomes after spinal cord injury: analysis of 1250 patients from the European Multicenter Study about Spinal Cord Injury (EMSCI) registryPresentation H54. Abstract 18: Interventions to optimize spinal cord perfusion in patients with acute traumatic spinal cord injuries: a systematic reviewPresentation i55. Abstract 55: The effect of posterior lumbar spinal surgery on passive stiffness of rat paraspinal muscles 13 weeks post-surgeryPresentation i56. Abstract 43: A computed tomographic based morphometric analysis of the axis in adult populationPresentation i57. Abstract 92: Is there value to flexion–extension x-rays for degenerative spondylolisthesis? A multicentre retrospective studyPresentation i58. Abstract 98: The novel “7/20 EMG protocol” in combination with O-arm image-guided navigation for accurate lumbar pedicle placement while minimizing diagnostic radiation exposurePresentation i59. Abstract 148: Comparative biomechanical study of 2 types of transdiscal fixation implants for high-grade L5/S1 spine spondylolisthesis in a porcine modelPresentation i60. Abstract 85: The effects of fibre bundle size and vertebral level on passive stiffness of the lumbar paraspinal muscles in a rat modelPresentation J61. Abstract 157: A self-assembling peptide biomaterial to enhance human neural stem cell-based regeneration of the injured spinal cordPresentation J62. Abstract 162: Measuring demyelination, axonal loss and inflammation after human spinal cord injury with quantitative magnetic resonance imaging and histopathologyPresentation J63. Abstract 179: Characterization of ubiquitin C-terminal hydrolase L1 (UCH-L1) as a fluid biomarker of human traumatic spinal cord injuryPresentation J64. Abstract 13: Utility and role of virtual reality based simulation models in spinal decompression trainingPresentation J65. Abstract 160: Investigating the determinants for predicting surgical patient outcomes through the application of machine learning methodsPresentation J66. Abstract 143: Comparison of screw design and technique on cervical lateral mass screw fixationPresentation K67. Abstract 57: Development of clinical prognostic models for postoperative survival and quality of life in patients with surgically treated metastatic epidural spinal cord compressionPresentation K68. Abstract 170: Sarcomas of the spine: a 20-year survey of disease and treatment strategy in Ontario, CanadaPresentation K69. Abstract 15: Metastatic spine disease: Should patients with short life expectancy be denied surgical care? An international retrospective cohort studyPresentation K70. Abstract 29: Nanoparticle-functionalized polymethyl methacrylate bone cement for sustained chemotherapeutic drug deliveryPresentation K71. Abstract 90: Development of the Spine Oncology Study Group Outcomes Questionnaire – 8 Domain (SOSGOQ-8D)Presentation K72. Abstract 6: Treatment expectations of patients with spinal metastases: What do we tell our patients?Presentation L73. Abstract 48: Factors related to risk of opioid abuse in primary care patients with low back painPresentation L74. Abstract 65: QI/QA of a transitional outpatient pain program for spinePresentation L75. Abstract 168: The effect of preoperative opioid use on hospital length of stay in patients undergoing elective spine surgeryPresentation L76. Abstract 163: Disability or pain: Which best predicts patient satisfaction with surgical outcome? A Canadian Spine Outcomes and Research Network (CSORN) studyPresentation L77. Abstract 58: Rapid access to interventional pain management for lumbar nerve root pain through collaborative interprofessional provider networksPresentation L78. Abstract 63: Chronic preoperative opioid use associated with higher perioperative resource utilization and complications in adult spinal deformity patientsPresentation M79. Abstract 108: Cervical disc arthroplasty versus anterior cervical discectomy and fusion: a longitudinal analysis of reoperationsPresentation M80. Abstract 46: Preliminary results of randomized controlled trial investigating the role of psychological distress on cervical spine surgery outcomes: a baseline analysisPresentation M81. Abstract 110: Operative versus nonoperative treatment of geriatric odontoid fractures: a study of North American trauma centresPresentation M82. Abstract 74: Clinical outcome of posterior cervical foraminotomy versus anterior cervical discectomy and fusionPresentation M83. Abstract 45: “Reverse Roussouly”: ratios of cervical to thoracic shape curvature in an adult cervical deformity populationPresentation M84. Abstract 109: Treatment of acute traumatic central cord syndrome: a study of North American trauma centresPresentation N85. Abstract 118: Comparing minimally invasive versus traditional open lumbar decompression and fusion surgery: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation N86. Abstract 54: Time to return to work after lumbar spine surgeryPresentation N87. Abstract 28: Patient-reported outcomes following surgery for lumbar spinal stenosis: comparison of a universal and multitier health care systemPresentation N88. Abstract 93: Outcomes of surgery in older adults with lumbar spinal stenosisPresentation N89. Abstract 162: Functional objective assessment using the TUG test is a useful tool to evaluate outcome in lumbar spinal stenosisPresentation N90. Abstract 36: A Canadian Spine Outcomes and Research Network (CSORN) matched-cohort study comparing lumbar fusion and disk arthroplastyPresentation o91. Abstract 171: Development of clinical practice guidelines for the management of traumatic spinal column and cord injuries in British Columbia: an approach to standardizing care of spine trauma patientsPresentation o92. Abstract 22: Notes from a small island: stemming the tide of a spinal deluge. The use of encrypted software applications to ensure accountability, quality control and surgical consensus in a national acute adult spinal surgery centrePresentation o93. Abstract 129: Traumatic spinal cord injuries among Aboriginal and non-Aboriginal populations in Canada: an ambispective outcomes studyPresentation o94. Abstract 132: Traumatic spinal cord injury in New Zealand and Canada: a comparative analysisPresentation o95. Abstract 150: Exploring the reasons for readmission following traumatic spinal cord injuryPresentation o96. Abstract 59: Exploring the epidemiology and impact of spinal cord injury in the elderly: a 15-year Canadian population-based cohort studyPresentation P1. Abstract 139: Incidence and management of spinal metastasis in Ontario: a population-based studyPresentation P2. Abstract 91: A general population utility valuation study for the Spine Oncology Study Group Outcomes Questionnaire – 8DPresentation P3. Abstract 158: Metastatic vertebrae segmentation by augmented 3D convolutional neural networkPresentation P4. Abstract 73: Risk factors for failure of radiation therapy for spinal metastasesPresentation P5. Abstract 68: Significance of extracanalicular cement extravasation in thoracolumbar kyphoplastyPresentation P6. Abstract 120: Modelling fracture in osteoblastic vertebraePresentation P7. Abstract 97: The development of novel 2-in-1 patient-specific, 3D-printed laminar osteotomy guides with integrated pedicle screw guidesPresentation P8. Abstract 56: Effect of pelvic retroversion on pelvic geometry and muscle morphometry from upright magnetic resonance imagingPresentation P9. Abstract 161: Anatomic relationship between the accessory process of the lumbar spine and the pedicle screw entry pointPresentation P10. Abstract 20: Novel chair to measure lumbar spine extensors strength in adultsPresentation P11. Abstract 95: Error measurement between human spine, 3D scans, CT-based models, and 3D-printed modelsPresentation P12. Abstract 52: The diagnostic precision of computed tomography for traumatic cervical spine injury: an in vitro investigationPresentation P13. Abstract 94: Epidural abscess causing spinal cord infarctionPresentation P14. Abstract 83: The nerve root sedimentation sign on magnetic resonance imaging is not only correlated with neurogenic claudication: association with all types of leg-dominant mechanical painPresentation P15. Abstract 3: Accuracy of robot-assisted compared with freehand pedicle screw placement in spine surgery: a meta-analysis of randomized controlled trialsPresentation P16. Abstract 82: A positive nerve root sedimentation sign on magnetic resonance imaging is associated with improved surgical outcomes in patients with back dominant painPresentation P17. Abstract 16: Thoracolumbar burst fracture: McCormack load-sharing classification —systematic review and single-arm meta-analysisPresentation P18. Abstract 86: Morphological features of thoracolumbar burst fractures associated with neurologic recovery after thoracolumbar traumatic spinal cord injuryPresentation P19. Abstract 89: Radiographic parameters of listhesis and instability are not associated with health status or clinical outcomes in grade 1 degenerative spondylolisthesisPresentation P20. Abstract 37: Predictive socioeconomic factors following lumbar disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation P21. Abstract 25: Effect of in situ fusion in lumbar spondylolisthesis on clinical outcomes and spino-pelvic sagittal balancingPresentation P22. Abstract 10: Sex differences in the surgical management of lumbar degenerative disease: a systematic reviewPresentation P23. Abstract 35: Two-year results of lumbar disk arthroplasty: a Canadian Spine Outcomes and Research Network (CSORN) studyPresentation P24. Abstract 78: Does disc morphology affect the success of nonoperative treatment of chronic sciatica from a lumbar disc herniation?Presentation P25. Abstract 141: Opioid prescribing patterns: preliminary investigationPresentation P26. Abstract 133: Frailty is a better predictor of complications than age alone after surgical treatment of degenerative cervical myelopathy: an ambispective study of 5107 elderly patients from the National Surgical Quality Improvement Program databasePresentation P27. Abstract 26: Pathway analysis in spine surgery: a model for evaluating length of stayPresentation P29. Abstract 156: Patients with adolescent idiopathic scoliosis (AIS) have different cervical lordosis than the normal populationPresentation P31. Abstract 64: Investigation of thoracic spinal muscle morphology with upright magnetic resonance imagingPresentation P32. Abstract 80: Postoperative complication prediction between spinal surgeons and a machine learning model: a comparative studyPresentation P33. Abstract 81: Is using a simplified procedural classification as accurate as using current procedural terminology codes to predict future complications in spinal surgery?Presentation P34. Abstract 88: Preoperative patient performance status and frailty phenotype as predictive factors of outcome in surgically treated patients with metastatic spinal disease: a systematic literature reviewPresentation P35. Abstract 101: The measurements of frailty and their application to spine surgeryPresentation P36. Abstract 131: The effect of prolonged sitting on muscle reflexes of the low backPresentation P37. Abstract 87: Implementing a rapid discharge pathway for adolescent idiopathic scoliosis in Canada. Can J Surg 2020. [DOI: 10.1503/cjs.014720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Curt A, Hsieh J, Schubert M, Hupp M, Friedl S, Freund P, Huber E, Pfyffer D, Sutter R, Jutzeler C, Wüthrich RP, Min K, Casha S, Fehlings MG, Guzman R. The Damaged Spinal Cord Is a Suitable Target for Stem Cell Transplantation. Neurorehabil Neural Repair 2020; 34:758-768. [PMID: 32698674 DOI: 10.1177/1545968320935815] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. Given individuals with spinal cord injury (SCI) approaching 2 million, viable options for regenerative repair are desperately needed. Human central nervous system stem cells (HuCNS-SC) are self-renewing, multipotent adult stem cells that engraft, migrate, and differentiate in appropriate regions in multiple animal models of injured brain and spinal cord. Preclinical improved SCI locomotor function provided rationale for the first-in-human SCI clinical trial of HuCNS-SC cells. Evidence of feasibility and long-term safety of cell transplantation into damaged human cord is needed to foster translational progression of cellular therapies. Methods. A first-ever, multisite phase I/IIa trial involving surgical transplantation of 20 million HuCNS-SC cells into the thoracic cord in 12 AIS A or B subjects (traumatic, T2-T11 motor-complete, sensory-incomplete), aged 19 to 53 years, demonstrated safety and preliminary efficacy. Six-year follow-up data were collected (sensory thresholds and neuroimaging augmenting clinical assessments). Findings. The study revealed short- and long-term surgical and medical safety (well-tolerated immunosuppression in population susceptible to infections). Preliminary efficacy measures identified 5/12 with reliable sensory improvements. Unfortunately, without thoracic muscles available for manual muscle examination, thoracic motor changes could not be measured. Lower limb motor scores did not change during the study. Cervical cord imaging revealed, no tumor formation or malformation of the lesion area, and secondary supralesional structural changes similar to SCI control subjects. Interpretation. Short- and long-term safety and feasibility support the consideration of cell transplantation for patients with complete and incomplete SCI. This report is an important step to prepare, foster, and maintain the therapeutic development of cell transplantation for human SCI.
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Affiliation(s)
- Armin Curt
- Balgrist University Hospital, Zurich, Switzerland
| | - Jane Hsieh
- Balgrist University Hospital, Zurich, Switzerland
| | | | - Markus Hupp
- Balgrist University Hospital, Zurich, Switzerland
| | | | | | | | | | - Reto Sutter
- Balgrist University Hospital, Zurich, Switzerland
| | | | | | - Kan Min
- Balgrist University Hospital, Zurich, Switzerland
| | - Steve Casha
- University of Calgary, Calgary, Alberta, Canada
| | - Michael G Fehlings
- Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Stratton A, Wai E, Kingwell S, Phan P, Roffey D, El Koussy M, Christie S, Jarzem P, Rasoulinejad P, Casha S, Paquet J, Johnson M, Abraham E, Hall H, McIntosh G, Thomas K, Rampersaud R, Manson N, Fisher C. Opioid use trends in patients undergoing elective thoracic and lumbar spine surgery. Can J Surg 2020; 63:E306-E312. [PMID: 32463627 DOI: 10.1503/cjs.018218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Opioid use in North America has increased rapidly in recent years. Preoperative opioid use is associated with several negative outcomes. Our objectives were to assess patterns of opioid use over time in Canadian patients who undergo spine surgery and to determine the effect of spine surgery on 1-year postoperative opioid use. Methods A retrospective analysis was performed on prospectively collected data from the Canadian Spine Outcomes and Research Network for patients undergoing elective thoracic and lumbar surgery. Self-reported opioid use at baseline, before surgery and at 1 year after surgery was compared. Baseline opioid use was compared by age, sex, radiologic diagnosis and presenting complaint. All patients meeting eligibility criteria from 2008 to 2017 were included. Results A total of 3134 patients provided baseline opioid use data. No significant change in the proportion of patients taking daily (range 32.3%-38.2%) or intermittent (range 13.7%-22.5%) opioids was found from pre-2014 to 2017. Among patients who waited more than 6 weeks for surgery, the frequency of opioid use did not differ significantly between the baseline and preoperative time points. Significantly more patients using opioids had a chief complaint of back pain or radiculopathy than neurogenic claudication (p < 0.001), and significantly more were under 65 years of age than aged 65 years or older (p < 0.001). Approximately 41% of patients on daily opioids at baseline remained so at 1 year after surgery. Conclusion These data suggest that additional opioid reduction strategies are needed in the population of patients undergoing elective thoracic and lumbar spine surgery. Spine surgeons can be involved in identifying patients taking opioids preoperatively, emphasizing the risks of continued opioid use and referring patients to appropriate evidence-based treatment programs.
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Affiliation(s)
- Alexandra Stratton
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Eugene Wai
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Stephen Kingwell
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Philippe Phan
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Darren Roffey
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Mohamed El Koussy
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Sean Christie
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Peter Jarzem
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Parham Rasoulinejad
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Steve Casha
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Jerome Paquet
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Michael Johnson
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Edward Abraham
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Hamilton Hall
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Greg McIntosh
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Kenneth Thomas
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Raja Rampersaud
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Neil Manson
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
| | - Charles Fisher
- From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher)
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Ben-Israel D, Jacobs WB, Casha S, Lang S, Ryu WHA, de Lotbiniere-Bassett M, Cadotte DW. The impact of machine learning on patient care: A systematic review. Artif Intell Med 2020; 103:101785. [DOI: 10.1016/j.artmed.2019.101785] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 12/11/2019] [Accepted: 12/30/2019] [Indexed: 01/04/2023]
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Casha S, Rice T, Stirling DP, Silva C, Gnanapavan S, Giovannoni G, Hurlbert RJ, Yong VW. Cerebrospinal Fluid Biomarkers in Human Spinal Cord Injury from a Phase II Minocycline Trial. J Neurotrauma 2018; 35:1918-1928. [DOI: 10.1089/neu.2018.5899] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Steve Casha
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Tiffany Rice
- Department of Anesthesia, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David P. Stirling
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- KY Spinal Injury Research Center, University of Louisville, Louisville, Kentucky
| | - Claudia Silva
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Sharmilee Gnanapavan
- Department of Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Gavin Giovannoni
- Department of Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - R. John Hurlbert
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Division of Neurosurgery, University of Arizona, Tucson, Arizona
| | - V. Wee Yong
- Hotchkiss Brain Institute and the Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Tong B, Jutzeler CR, Cragg JJ, Grassner L, Schwab JM, Casha S, Geisler F, Kramer JLK. Serum Albumin Predicts Long-Term Neurological Outcomes After Acute Spinal Cord Injury. Neurorehabil Neural Repair 2017; 32:7-17. [DOI: 10.1177/1545968317746781] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background. There is a need to identify reliable biomarkers of spinal cord injury recovery for clinical practice and clinical trials. Objective. Our objective was to correlate serum albumin levels with spinal cord injury neurological outcomes. Methods. We performed a secondary analysis of patients with traumatic spinal cord injury (n = 591) participating in the Sygen clinical trial. Serum albumin concentrations were obtained as part of routine blood chemistry analysis, at trial entry (24-72 hours), 1, 2, and 4 weeks after injury. The primary outcomes were “marked recovery” and lower extremity motor scores, derived from the International Standards for the Neurological Classification of Spinal Cord Injury. Data were analyzed with multivariable logistic and linear regression to adjust for potential confounders. Results. Serum albumin was significantly associated with spinal cord injury neurological outcomes. Higher serum albumin concentrations at 1, 2, and 4 weeks were associated with higher 52-week lower extremity motor score. Similarly, the odds of achieving “marked neurological recovery” was greater for individuals with higher serum albumin concentrations. The association between serum albumin concentrations and neurological outcomes was independent of initial injury severity, treatment with GM-1, and polytrauma. Conclusions. In spinal cord injury, serum albumin is an independent marker of long-term neurological outcomes. Serum albumin could serve as a feasible biomarker for prognosis at the time of injury and stratification in clinical trials.
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Affiliation(s)
- Bobo Tong
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine R. Jutzeler
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacquelyn J. Cragg
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Lukas Grassner
- Center for Spinal Cord Injuries and Department of Neurosurgery, Trauma Center, Murnau, Germany
- Institute of Molecular Regenerative Medicine, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Jan M. Schwab
- Wexner Medical Center, The Ohio State University, Spinal Cord Injury Medicine, Columbus, OH, USA
| | - Steve Casha
- University of Calgary, Calgary, Alberta, Canada
| | - Fred Geisler
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John L. K. Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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Wilson JR, Tetreault LA, Kwon BK, Arnold PM, Mroz TE, Shaffrey C, Harrop JS, Chapman JR, Casha S, Skelly AC, Holmer HK, Brodt ED, Fehlings MG. Timing of Decompression in Patients With Acute Spinal Cord Injury: A Systematic Review. Global Spine J 2017; 7:95S-115S. [PMID: 29164038 PMCID: PMC5684838 DOI: 10.1177/2192568217701716] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To conduct a systematic review and synthesis of the literature to assess the comparative effectiveness, safety, and cost-effectiveness of early (≤24 hours) versus late decompression (>24 hours) in adults with acute spinal cord injury (SCI). METHODS A systematic search was conducted of Medline, EMBASE, the Cochrane Collaboration Library, and Google Scholar to identify studies published through November 6, 2014. Studies published in any language, in humans, and with an abstract were considered for inclusion. Included studies were critically appraised and the overall strength of evidence was determined using methods proposed by the Grading of Recommendation Assessment, Development and Evaluation working group. RESULTS The search yielded 449 potentially relevant citations. Sixteen additional primary studies were identified through other sources. Six studies met inclusion criteria. All but 2 studies were considered to have moderately high risk of bias. Across studies and injury levels, the impact of early surgical decompression (≤24 hours) on clinically important improvement in neurological status was variable. Isolated studies reported statistically significant and clinically important improvements at 6 months (cervical injury, low strength of evidence) and following discharge from inpatient rehabilitation (all levels, very low strength of evidence) but not at other time points; another study observed a statistically significant 6 point improvement in ASIA Impairment Scale (AIS) among patients with AIS B, C, or D, but not for those with AIS A (very low strength of evidence). In one study of acute central cord syndrome without instability, a clinically and statistically meaningful improvement in total motor scores was reported at 6 and 12 months in patients treated early (versus late). There were, however, no significant differences in AIS improvement between early and late surgical groups at 6- or 12-months (very low strength of evidence). One of 3 studies found a shorter length of hospital stay associated with early surgical decompression. Of 3 studies reporting on safety, no significant differences in rates of complications (including mortality, neurologic deterioration, pneumonia or pressure ulcers) were noted between early and late decompression groups. CONCLUSIONS Results surrounding the efficacy of early versus late decompressive surgery, as well as the quality of evidence available, were variable depending on the level of SCI, timing of follow-up, and specific outcome considered. Existing evidence supports improved neurological recovery among cervical SCI patients undergoing early surgery; however, evidence regarding remaining SCI populations and clinical outcomes was inconsistent.
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Affiliation(s)
- Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada,St Michael’s Hospital, Toronto, Ontario, Canada
| | - Lindsay A. Tetreault
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada,University College Cork, Cork, Ireland
| | - Brian K. Kwon
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Paul M. Arnold
- University of Kansas Medical Center, The University of Kansas, Kansas City, KS, USA
| | | | | | | | | | - Steve Casha
- University of Calgary, Calgary, Alberta, Canada
| | | | | | | | - Michael G. Fehlings
- University of Toronto, Toronto, Ontario, Canada,St Michael’s Hospital, Toronto, Ontario, Canada
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Arnold PM, Harrop JS, Merli G, Tetreault LG, Kwon BK, Casha S, Palmieri K, Wilson JR, Fehlings MG, Holmer HK, Norvell DC. Efficacy, Safety, and Timing of Anticoagulant Thromboprophylaxis for the Prevention of Venous Thromboembolism in Patients With Acute Spinal Cord Injury: A Systematic Review. Global Spine J 2017; 7:138S-150S. [PMID: 29164021 PMCID: PMC5684847 DOI: 10.1177/2192568217703665] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The objective of this study was to answer 5 key questions: What is the comparative effectiveness and safety of (1a) anticoagulant thromboprophylaxis compared to no prophylaxis, placebo, or another anticoagulant strategy for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) after acute spinal cord injury (SCI)? (1b) Mechanical prophylaxis strategies alone or in combination with other strategies for preventing DVT and PE after acute SCI? (1c) Prophylactic inferior vena cava filter insertion alone or in combination with other strategies for preventing DVT and PE after acute SCI? (2) What is the optimal timing to initiate and/or discontinue anticoagulant, mechanical, and/or prophylactic inferior vena cava filter following acute SCI? (3) What is the cost-effectiveness of these treatment options? METHODS A systematic literature search was conducted to identify studies published through February 28, 2015. We sought randomized controlled trials evaluating efficacy and safety of antithrombotic strategies. Strength of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS Nine studies satisfied inclusion criteria. We found a trend toward lower risk of DVT in patients treated with enoxaparin. There were no significant differences in rates of DVT, PE, bleeding, and mortality between patients treated with different types of low-molecular-weight heparin or between low-molecular-weight heparin and unfractionated heparin. Combined anticoagulant and mechanical prophylaxis initiated within 72 hours of SCI resulted in lower risk of DVT than treatment commenced after 72 hours of injury. CONCLUSION Prophylactic treatments can be used to lower the risk of venous thromboembolic events in patients with acute SCI, without significant increase in risk of bleeding and mortality and should be initiated within 72 hours.
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Affiliation(s)
| | | | - Geno Merli
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | | | - Brian K. Kwon
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Casha
- University of Calgary, Calgary, Alberta, Canada
| | | | - Jefferson R. Wilson
- University of Toronto, Toronto, Ontario, Canada
- St Michael’s Hospital, Toronto, Ontario, Canada
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Aleem I, Xu Y, Rampersaud YR, Pahuta M, St-Pierre GH, Crawford E, Zarrabian M, St-Pierre GH, Yang M, Scheer J, St-Pierre GH, Lou E, Malleck S, Soroceanu A, Soroceanu A, White B, Holtz KA, Fallah N, Noonan V, Finkelstein J, Rivers C, Tee J, Paquet J, Rutges J, Martin AR, Martin AR, Jack A, Malakoutian M, Kwon B, St-Pierre GH, Nater A, Versteeg A, Pahuta M, Fenton E, Nagoshi N, Tetreault L, Witiw C, Santaguida C, Aziz M, Khashan M, Tomkins-Lane C, Miyanji F, Johnson M, Tee J, Roffey DM, Evaniew N, Nouri A, Tetreault L, Arnold P, Tetreault L, Fehlings M, Wilson J, Smith JS, Charest-Morin R, Charest-Morin R, Marion T, Marion T, Kato S, Miyanji F, Enright A, Daly E, Fehlings M, Dakson A, Dakson A, Leck E, Khashan M, Abraham E, Manson N, Pahuta M, Duncan J, Ahmed A, Eck J, Rhee J, Currier B, Nassr A, Yen D, Johnson A, Bidos A, Schultz S, Fanti C, Young B, Drew B, Puskas D, Henry D, Frombach A, Mitera G, Coyle D, Werier J, Wai E, Hurlbert J, Ravinsky R, Bidos A, Rampersaud YR, Bidos A, Fanti C, Young B, Drew B, Puskas D, Rampersaud R, Yang M, Hurlbert J, Thomas K, St-Pierre GH, Duplessis S, Ailon T, Smith J, Shaffrey C, Klineberg E, Schwab F, Ames C, Yang M, Hurlbert J, Thomas K, Nataraj A, Zheng R, Hill D, Moreau M, Hedden D, Southon S, Johnson M, Goytan M, Passmore S, McIntosh G, Smith J, Lafage V, Klineberg E, Ailon T, Ames C, Shaffrey C, Gupta M, Kebaish K, Scubbia D, Hart R, Hostin R, Schwab F, Kelly M, Smith J, Scheer J, Lafage V, Protopsaltis T, Lafage R, Hostin R, Kebaish K, Gupta M, Hart R, Schwab F, Ames C, Dea N, Street J, Dvorak M, Lipson R, Noonan VK, Kwon BK, Mills PB, Noonan V, Shum J, Rivers C, Street J, Park SE, Chan E, Plashkes T, Dvorak M, Fallah N, Bedi M, Chan E, Rivers C, Street J, Plashkes T, Dvorak M, Noonan V, Fallah N, Ho C, Tsai E, Rivers C, Truchon C, Linassi AG, O’Connell C, Townson A, Ahn H, Drew B, Dvorak M, Fehlings MG, Schwartz C, Noreau L, Warner F, Noonan V, Fallah N, Fisher C, O’Connell C, Tsai E, Ahn H, Attabib N, Christie S, Drew B, Finkelstein J, Fourney D, Paquet J, Parent S, Kuerban D, Dvorak M, Paquet J, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Kuerban D, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Fisher C, Dvorak M, Noonan V, Kwon B, Tsai E, Christie S, Rivers C, Ahn H, Attabib N, Bailey C, Drew B, Fehlings M, Finkelstein J, Fourney D, Hurlbert RJ, Parent S, Kuerban D, Dvorak M, Kwon B, Dvorak M, Aleksanderek I, Cohen-Adad J, Cadotte DW, Kalsi-Ryan S, De Leener B, Wang J, Crawley A, Mikulis DJ, Ginsberg H, Fehlings MG, Aleksanderek I, Cohen-Adad J, Tarmohamed Z, Tetreault L, Smith N, Cadotte DW, Crawley A, Ginsberg H, Mikulis DJ, Fehlings MG, Nataraj A, Fouad K, Street J, Wilke HJ, Stavness I, Dvorak M, Fels S, Oxland T, Streijger F, Fallah N, Noonan V, Paquette S, Boyd M, Ailon T, Street J, Fisher C, Dvorak M, Hurlbert J, Fehlings M, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A, Dea N, Boriani S, Varga PP, Luzzati A, Fehlings M, Bilsky M, Rhines L, Reynolds J, Dekutoski M, Gokaslan Z, Germscheid N, Fisher C, van Walraven C, Coyle D, Werier J, Wai E, Mercier P, Bains I, Jacobs WB, Tetreault L, Nakashima H, Nouri A, Fehlings M, Kopjar B, Wilson J, Arnold P, Fehlings M, Tetreault L, Kopjar B, Massicotte E, Fehlings M, Fehlings M, Kopjar B, Arnold P, Defino H, Kale S, Yoon ST, Barbagallo G, Bartels R, Zhou Q, Vaccaro A, Johnson M, Passmore S, Goytan M, Glazebrook C, Golan J, McIntosh G, Barker J, Weber M, Hu R, Norden J, Sinha A, Smuck M, Desai S, Samdani AF, Shah SA, Asghar J, Yaszay B, Shufflebarger HL, Betz RR, Newton P, Passmore S, McCammon J, Goytan M, McIntosh G, Fisher C, Alfasi A, Hashem EL, Papineau GD, Kingwell SP, Wai EK, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF, Tetreault L, Dalzell K, Zamorano JJ, Fehlings M, Shamji M, Rhee J, Wilson J, Andersson I, Dembek A, Pagarigan K, Dettori J, Fehlings M, Kopjar B, Tetreault L, Nakashima H, Fehlings M, Kopjar B, Arnold P, Kotter M, Fehlings M, Wilson J, Arnold P, Shaffrey C, Shamji M, Mroz T, Skelly A, Chapman J, Tetreault L, Aarabi B, Casha S, Jaglal S, Voth J, Yee A, Fehlings M, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, Protopsaltis T, Scheer JK, Ailon T, Ramachandran S, Daniels A, Mundis G, Gupta M, Deviren V, Ames CP, Street J, Stobart L, Ryerson CJ, Flexman A, Street J, Flexman A, Rivers C, Kuerban D, Cheng C, Noonan V, Dvorak M, Fisher C, Kwon B, Street J, Ailon T, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Lewis S, Reilly C, Shah SA, Clements DH, Samdani AF, Desai S, Lonner BS, Shufflebarger HL, Betz RR, Newton P, Johnson M, Passmore S, Goytan M, Manson N, Bigney E, Wagg K, Abraham E, Nater A, Tetreault L, Kopjar B, Arnold P, Dekutoski M, Finkelstein J, Fisher C, France J, Gokaslan Z, Massicotte E, Rhines L, Rose P, Sahgal A, Schuster J, Vaccaro A, Leck E, Christie S, Leck E, Christie S, Dakson A, Christie S, Weber M, McIntosh G, Barker J, Golan J, Wagg K, Armstrong M, Bigney E, Daly E, Manson N, Bigney E, Wagg K, Daly E, Abraham E, Perruccio A, Badley E, Rampersaud R. 2016 Canadian Spine Society Abstracts. Can J Surg 2016; 59:S39-63. [PMID: 27240290 DOI: 10.1503/cjs.006916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Casha S, Yong VW, Hurlbert RJ. Reply: When is the time right for a phase III clinical study in spinal cord injury (P = 0.05)? Brain 2012. [DOI: 10.1093/brain/aws219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shamji M, Moon ES, Glennie R, Soroceanu A, Lin C, Bailey C, Simmonds A, Fehlings M, Dodwell E, Dold A, El-Hawary R, Hashem M, Dold A, Dold A, Jones S, Bailey C, Karadimas S, Whitehurst D, Norton J, Norton J, Manson N, Kesani A, Bednar D, Lundine K, Hartig D, Fichadi A, Fehlings M, Kim S, Harris S, Lin C, Gill J, Abraham E, Shamji M, Choi S, Goldstein C, Wang Z, McCabe M, Noonan V, Nadeau M, Ferrara S, Kelly A, Melnyk A, Arora D, Quateen A, Dea N, Ranganathan A, Zhang Y, Casha S, Rajamanickam K, Santos A, Santos A, Wilson J, Wilson J, Street J, Wilson J, Lewis R, Noonan V, Street J, El-Hawary R, Egge N, Lin C, Schouten R, Lin C, Kim A, Kwon B, Huang E, Hwang P, Allen K, Jing L, Mata B, Gabr M, Richardson W, Setton L, Karadimas S, Fehlings M, Fleming J, Bailey C, Gurr K, Bailey S, Siddiqi F, Lawendy A, Sanders D, Staudt M, Canacari E, Brown E, Robinson A, McGuire K, Chrysostoum C, Rampersaud YR, Dvorak M, Thomas K, Boyd M, Gurr K, Bailey S, Nadeau M, Fisher C, Batke J, Street J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Vaccaro A, Chapman J, Arnold P, Shaffrey C, Kopjar B, Snyder B, Wright J, Lewis S, Zeller R, El-Hawary R, Moroz P, Bacon S, Jarzem P, Hedden D, Howard J, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Parent E, Hill D, Hedden D, Moreau M, Mahood J, Lewis S, Bodrogi A, Abbas H, Goldstein S, Bronstein Y, Bacon S, Chua S, Magana S, Van Houwelingen A, Halpern E, Jhaveri S, Lewis S, Lim A, Leelapattana P, Fleming J, Siddiqqi F, Bailey S, Gurr K, Moon ES, Satkunendrarajah K, Fehlings M, Noonan V, Dvorak M, Bryan S, Aronyk K, Fox R, Nataraj A, Pugh J, Elliott R, McKeon M, Abraham E, Fleming J, Gurr K, Bailey S, Siddiqi F, Bailey C, Davis G, Rogers M, Staples M, Quan G, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Shamji M, Hurlbert R, Jacobs W, Duplessis S, Casha S, Jha N, Hewson S, Massicotte E, Kopjar B, Mortaz S, Coyte P, Rampersaud Y, Rampersaud Y, Goldstein S, Andrew B, Modi H, Magana S, Lewis S, Roffey D, Miles I, Wai E, Manson N, Eastwood D, Elliot R, McKeon M, Bains I, Yong E, Sutherland G, Hurlbert R, Rampersaud Y, Chan V, Persaud O, Koshkin A, Brull R, Hassan N, Petis S, Kowalczuk M, Petrisor B, Drew B, Bhandari M, DiPaola C, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, McLachlin S, Bailey S, Gurr K, Bailey C, Dunning C, Fehlings M, Vaccaro A, Wing P, Itshayek E, Biering-Sorensen F, Dvorak M, McLachlin S, Bailey S, Gurr K, Dunning C, Bailey C, Bradi A, Pokrupa R, Batke J, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, Street J, Kelly A, Wen T, Kingwell S, Chak J, Singh V, Cripton P, Fisher C, Dvorak M, Oxland T, Wali Z, Yen D, Alfllouse A, Alzahrani A, Jiang H, Mahood J, Kortbeek F, Fox R, Nataraj A, Street J, Boyd M, Paquette S, Kwon B, Batke J, Dvorak M, Fisher C, Reddy R, Rampersaud R, Hurlbert J, Yong W, Casha S, Zygun D, McGowan D, Bains I, Yong V, Hurlbert R, Mendis B, Chakraborty S, Nguyen T, Tsai E, Chen A, Atkins D, Noonan V, Drew B, Tsui D, Townson A, Dvorak M, Chen A, Atkins D, Noonan V, Drew B, Dvorak M, Craven C, Ford M, Ahn H, Drew B, Fehlings M, Kiss A, Vaccaro A, Harrop J, Grossman R, Frankowski R, Guest J, Dvorak M, Aarabi B, Fehlings M, Noonan V, Cheung A, Sun B, Dvorak M, Vaccaro A, Harrop J, Massicotte E, Dvorak M, Fisher C, Rampersaud R, Lewis S, Fehlings M, Marais L, Noonan V, Queyranne M, Fehlings M, Dvorak M, Atkins D, Hurlbert R, Fox R, Fourney D, Johnson M, Fehlings M, Ahn H, Ford M, Yee A, Finkelstein J, Tsai E, Bailey C, Drew B, Paquet J, Parent S, Christie S, Dvorak M, Noonan V, Cheung A, Sun B, Dvorak M, Sturm P, Cahill P, Samdani A, Vitale M, Gabos P, Bodin N, d’Amato C, Harris C, Smith J, Lange J, DiPaola C, Lapinsky A, Connolly P, Eck J, Rabin D, Zeller R, Lewis S, Lee R, Boyd M, Dvorak M, Fisher C, Kwon B, Paquette S, DiPaola C, Street J, Bodrogi A, Goldstein S, Sofia M, Lewis S, Shin J, Tung K, Ahn H, Lee R, Batke J, Ghag R, Noonan V, Dvorak M, Goyal T, Littlewood J, Bains I, Cho R, Thomas K, Swamy G. Canadian Spine Society abstracts1.1.01 Supraspinal modulation of gait abnormalities associated with noncompressive radiculopathy may be mediated by altered neurotransmitter sensitivity1.1.02 Neuroprotective effects of the sodium-glutamate blocker riluzole in the setting of experimental chronic spondylotic myelopathy1.1.03 The effect of timing to decompression in cauda equina syndrome using a rat model1.2.04 Intraoperative waste in spine surgery: incidence, cost and effectiveness of an educational program1.2.05 Looking beyond the clinical box: the health services impact of surgical adverse events1.2.06 Brace versus no brace for the treatment of thoracolumbar burst fractures without neurologic injury: a multicentre prospective randomized controlled trial1.2.07 Adverse event rates in surgically treated spine injuries without neurologic deficit1.2.08 Functional and quality of life outcomes in geriatric patients with type II odontoid fracture: 1-year results from the AOSpine North America Multi-Center Prospective GOF Study1.3.09 National US practices in pediatric spinal fusion: in-hospital complications, length of stay, mortality, costs and BMP utilization1.3.10 Current trends in the surgical treatment of adolescent idiopathic scoliosis in Canada1.3.11 Sagittal spinopelvic parameters help predict the risk of proximal junctional kyphosis for children treated with posterior distraction-based implants1.4.12 Correlations between changes in surface topography and changes in radiograph measurements from before to 6 months after surgery in adolescents with idiopathic scoliosis1.4.13 High upper instrumented vertebra (UIV) sagittal angle is associated with UIV fracture in adult deformity corrections1.4.14 Correction of adult idiopathic scoliosis using intraoperative skeletal traction1.5.01 Cauda equina: using management protocols to reduce delays in diagnosis1.5.02 Predicting the need for tracheostomy in patients with acute traumatic spinal cord injury1.5.03 A novel animal model of cervical spondylotic myelopathy: an opportunity to identify new therapeutic targets1.5.04 A review of preference-based measures of health-related quality of life in spinal cord injury research1.5.05 Predicting postoperative neuropathic pain following surgery involving nerve root manipulation based on intraoperative electromyographic activity1.5.06 Detecting positional injuries in prone spinal surgery1.5.07 Percutaneous thoracolumbar stabilization for trauma: surgical morbidity, clinical outcomes and revision surgery1.5.08 Systemic inflammatory response syndrome in spinal cord injury patients: Does its presence at admission affect patient outcomes?2.1.15 One hundred years of spine surgery — a review of the evolution of our craft and practice in the spine surgical century [presentation]2.1.16 Prevalence of preoperative MRI findings of adjacent segment disc degeneration in patients undergoing anterior cervical discectomy and fusion2.1.17 Adverse event rates of surgically treated cervical spondylopathic myelopathy2.1.18 Morphometricand dynamic changes in the cervical spine following anterior cervical discectomy and fusion and cervical disc arthroplasty2.1.19 Is surgery for cervical spondylotic myelopathy cost-effective? A cost–utility analysis based on data from the AO Spine North American Prospective Multicentre CSM Study2.2.20 Cost–utility of lumbar decompression with or without fusion for patients with symptomatic degenerative lumbar spondylolisthesis (DLS)2.2.21 Minimally invasive surgery lumbar fusion for low-grade isthmic and degenerative spondylolisthesis: 2- to 5-year follow-up2.2.22 Results and complications of posterior-only reduction and fusion for high-grade spondylolisthesis2.3.23 Fusion versus no fusion in patients with central lumbar spinal stenosis and foraminal stenosis undergoing decompression surgery: comparison of outcomes at baseline and follow-up2.3.24 Two-year results of interspinous spacers (DIAM) as an alternative to arthrodesis for lumbar degenerative disorders2.3.25 Treatment of herniated lumbar disc by sequestrectomy or conventional discectomy2.4.26 No sustained benefit of continuous epidural analgesia for minimally invasive lumbar fusion: a randomized double-blinded placebo controlled study2.4.27 Evidence and current practice in the radiologic assessment of lumbar spine fusion2.4.28 Wiltse versus midline approach for decompression and fusion of the lumbar spine2.5.09 The effect of soft tissue restraints following type II odontoid fractures in the elderly — a biomechanical study2.5.10 Development of an international spinal cord injury (SCI) spinal column injury basic data set2.5.11 Evaluation of instrumentation techniques for a unilateral facet perch and fracture using a validated soft tissue injury model2.5.12 Decreasing neurologic consequences in patients with spinal infection: the testing of a novel diagnostic guideline2.5.13 Prospective analysis of adverse events in surgical treatment of degenerative spondylolisthesis2.5.14 Load transfer characteristics between posterior fusion devices and the lumbar spine under anterior shear loading: an in vitro investigation2.5.15 Preoperative predictive clinical and radiographic factors influencing functional outcome after lumbar discectomy2.5.16 A Thoracolumbar Injury Classification and Severity Score (TLICS) of 4: What should we really do?3.1.29 Adverse events in emergent oncologic spine surgery: a prospective analysis3.1.30 En-bloc resection of primary spinal and paraspinal tumours with critical vascular involvement3.1.31 The treatment impact of minocycline on quantitative MRI in acute spinal cord injury3.1.32 Benefit of minocycline in spinal cord injury — results of a double-blind randomized placebo-controlled study3.2.33 Improvement of magnetic resonance imaging correlation with unilateral motor or sensory deficits using diffusion tensor imaging3.2.34 Comparing care delivery for acute traumatic spinal cord injury in 2 Canadian centres: How do the processes of care differ?3.2.35 Improving access to early surgery: a comparison of 2 centres3.3.36 The effects of early surgical decompression on motor recovery after traumatic spinal cord injury: results of a Canadian multicentre study3.3.37 A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors3.3.38 Effect of motor score on adverse events and quality of life in patients with traumatic spinal cord injury3.4.39 The impact of facet dislocation on neurologic recovery after cervical spinal cord injury: an analysis of data on 325 patients from the Surgical Trial in Acute Spinal Cord Injury Study (STASCIS)3.4.40 Toward a more precise understanding of the epidemiology of traumatic spinal cord injury in Canada3.4.41 Access to care (ACT) for traumatic SCI: a survey of acute Canadian spine centres3.4.42 Use of the Spine Adverse Events Severity (SAVES) instrument for traumatic spinal cord injury3.5.17 Does the type of distraction-based growing system for early onset scoliosis affect postoperative sagittal alignment?3.5.18 Comparison of radiation exposure during thoracolumbar fusion using fluoroscopic guidance versus anatomic placement of pedicle screws3.5.19 Skeletal traction for intraoperative reduction in adolescent idiopathic scoliosis3.5.20 Utility of intraoperative cone-beam computed tomography (O-ARM) and stereotactic navigation in acute spinal trauma surgery3.5.21 Use of a central compression rod to reduce thoracic level spinal osteotomies3.5.22 ICD-10 coding accuracy for spinal cord injured patients3.5.23 Feasibility of patient recruitment in acute SCI trials3.5.24 Treatment of adult degenerative scoliosis with DLIF approaches. Can J Surg 2012. [DOI: 10.1503/cjs.012212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Parent S, Barchi S, LeBreton M, Casha S, Fehlings MG. The impact of specialized centers of care for spinal cord injury on length of stay, complications, and mortality: a systematic review of the literature. J Neurotrauma 2011; 28:1363-70. [PMID: 21410318 DOI: 10.1089/neu.2009.1151] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Specialized centers of care for spinal cord injury (SCI) were first established in 1944 in England. The objective of these centers is to improve care and neurological recovery of patients suffering from a spinal cord injury. An interdisciplinary group of experts composed of medical and surgical specialists treating patients with SCI formulated the following questions: (1) Is there any evidence to suggest that specialized centers of care in SCI decrease the length of patient stay? and (2) Is there evidence that specialized centers of care for SCI reduce mortality and secondary complications? A systematic review of the current evidence was performed using multiple databases to answer these two specific questions. Two independent reviewers graded each paper using the Black and Downs method. Recommendations were then formulated based on the evidence available and were reviewed by a panel of experts using a modified Delphi approach. Two recommendations were formulated and both received complete agreement from a panel of experts. The first recommendation is "Early transfer of a patient with traumatic SCI to a specialized center of care should be done promptly to decrease overall length of stay." The second recommendation is "Early transfer of patients with traumatic SCI to an integrated multidisciplinary specialized center of care decreases overall mortality, and the number and severity of complications."
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Affiliation(s)
- Stefan Parent
- Department of Orthopaedics, Ste-Justine Hospital, Ste-Catherine, Montreal, Quebec, Canada.
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Kwon BK, Casha S, Hurlbert RJ, Yong VW. Inflammatory and structural biomarkers in acute traumatic spinal cord injury. Clin Chem Lab Med 2011; 49:425-33. [DOI: 10.1515/cclm.2011.068] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
It has been estimated that cerebrospinal fluid (CSF) contains approximately 80 proteins that significantly increase or decrease in response to various clinical conditions. Here we have evaluated the CSF protein PrP(C) (cellular prion protein) for possible increases or decreases following spinal cord injury. The physiological function of PrP(C) is not yet completely understood; however, recent findings suggest that PrP(C) may have neuroprotective properties. Our results show that CSF PrP(C) is decreased in spinal cord injured patients 12 h following injury and is absent at 7 days. Given that normal PrP(C) has been proposed to be neuroprotective we speculate that the decrease in CSF PrP(C) levels may influence neuronal cell survival following spinal cord injury.
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Affiliation(s)
- Anna Carnini
- Hotchkiss Brain Institute, Department of Physiology and Pharmacology, University of Calgary, Calgary, AL, CA
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Al-Habib AF, Attabib N, Ball J, Bajammal S, Casha S, Hurlbert RJ. Clinical predictors of recovery after blunt spinal cord trauma: systematic review. J Neurotrauma 2010; 28:1431-43. [PMID: 19831845 DOI: 10.1089/neu.2009.1157] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Several clinical, imaging, and therapeutic factors affecting recovery following spinal cord injury (SCI) have been described. A systematic review of the topic is still lacking. Our primary aim was to systematically review clinical factors that may predict neurological and functional recovery following blunt traumatic SCI in adults. Such work would help guide clinical care and direct future research. Both Medline and Embase (to April 2008) were searched using index terms for various forms of SCI, paraplegia, or quadri/tetraplegia, and functional and neurological recovery. The search was limited to published articles that were in English and included human subjects. Article selection included class I and II evidence, blunt traumatic SCI, injury level above L1-2, baseline assessment within 72 h of injury, use of American Spinal Injury Association (ASIA) scoring system for clinical assessment, and functional and neurological outcome. A total of 1526 and 1912 citations were located from Medline and Embase, respectively. Two surgeons reviewed the titles, abstracts, and full text articles for each database. Ten articles were identified, only one of which was level 1 evidence. Age and gender were identified as two patient-related predictors. While motor and functional recovery decreased with advancing age for complete SCI, there was no correlation considering incomplete ones. Therefore, treatment should not be restructured based on age in incomplete SCI. Among injury-related predictors, severity of SCI was the most significant. Complete injuries correlated with increased mortality and worse neurological and functional outcomes. Other predictors included SCI level, energy transmitted by the injury, and baseline electrophysiological testing.
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Affiliation(s)
- Amro F Al-Habib
- Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Xue M, Mikliaeva EI, Casha S, Zygun D, Demchuk A, Yong VW. Improving outcomes of neuroprotection by minocycline: guides from cell culture and intracerebral hemorrhage in mice. Am J Pathol 2010; 176:1193-202. [PMID: 20110416 DOI: 10.2353/ajpath.2010.090361] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Minocycline ameliorates deficits in models of acute and chronic neurological diseases, but many publications do not replicate these results. We tested the hypothesis that a key factor in achieving neurological benefits is the exposure of neural cells to local high concentrations of minocycline. This hypothesis was evaluated by using human neurons in culture and in a mouse model of intracerebral hemorrhage (ICH). In culture, neurons were very vulnerable to blood-induced toxicity, with 60% lost within 24 hours in an environment of 5% blood in culture medium. Minocycline reduced blood-induced neurotoxicity in a concentration-dependent manner. In vivo, the introduction of blood into the striatum of mice to simulate ICH resulted in a massive lesion by 24 hours. When minocycline was mixed with the blood used to inflict ICH, the resulting extent of neuropathology was significantly less than that achieved with intraperitoneal administration of medication. The combination of intracerebral and intraperitoneal minocycline improved neuroprotection compared with either alone. We then delayed minocycline treatment and injected it into the hematoma 1 hour after ICH. We found greater alleviation of brain damage and neuronal death with increasing concentrations of minocycline injected locally, which was reflected in limited behavioral and histological recovery. We conclude that the prospect of neuroprotection with minocycline is improved by high concentrations of minocycline delivered locally into the central nervous system with supplementation from systemic administration.
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Affiliation(s)
- Mengzhou Xue
- Hotchkiss Brain Institute, Clara Christie Centre for Mouse Genomics and Modelling of Human Disease, Department of Clinical Neurosciences, University of Calgary, 3330 Hospital Drive, Calgary, Alberta T2N 4N1, Canada
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Casha S, Yong VW, Midha R. Minocycline for axonal regeneration after nerve injury: A double-edged sword. Exp Neurol 2008; 213:245-8. [DOI: 10.1016/j.expneurol.2008.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 06/26/2008] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
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Casha S, Yu WR, Fehlings MG. FAS deficiency reduces apoptosis, spares axons and improves function after spinal cord injury. Exp Neurol 2005; 196:390-400. [PMID: 16202410 DOI: 10.1016/j.expneurol.2005.08.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2005] [Revised: 07/15/2005] [Accepted: 08/25/2005] [Indexed: 12/30/2022]
Abstract
After spinal cord injury (SCI), apoptosis of neurons and oligodendrocytes is associated with axonal degeneration and loss of neurological function. Recent data have suggested a potential role for FAS death receptor-mediated apoptosis in the pathophysiology of SCI. In this study, we examined the effect of FAS deficiency on SCI in vitro and in vivo. FAS(Lpr/lpr) mutant mice and wildtype background-matched mice were subjected to a T5-6 clip compression SCI, and complementary studies were done in an organotypic slice culture model of SCI. Post-traumatic apoptosis in the spinal cord, which was seen in neurons and oligodendrocytes, was decreased in the FAS-deficient mice both in vivo and in vitro particularly in oligodendrocytes. FAS deficiency was also associated with improved locomotor recovery, axonal sparing and preservation of oligodendrocytes and myelin. However, FAS deficiency did not result in a significant increase in surviving neurons in the spinal cord at 6 weeks after injury, likely reflecting the importance of other cell death mechanisms for neurons. We conclude that inhibition of the FAS pathway may be a clinically attractive neuroprotective strategy directed towards oligodendroglial and axonal preservation in the treatment of SCI and neurotrauma.
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Affiliation(s)
- S Casha
- Spinal Program, Krembil Neuroscience Center, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario, Canada M5T 2S8
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Casha S, Yu WR, Fehlings MG. Oligodendroglial apoptosis occurs along degenerating axons and is associated with FAS and p75 expression following spinal cord injury in the rat. Neuroscience 2001; 103:203-18. [PMID: 11311801 DOI: 10.1016/s0306-4522(00)00538-8] [Citation(s) in RCA: 313] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Apoptosis or programmed cell death has been reported after CNS trauma. However, the significance of this mechanism in the pathophysiology of spinal cord injury, in particular at the cervical level, requires further investigation. In the present study, we used the extradural clip compression model in the rat to examine the cellular distribution of apoptosis following cervical spinal cord injury, the relationship between glial apoptosis and post-traumatic axonal degeneration and the possible role of apo[apoptosis]-1, CD95 (FAS) and p75 in initiating post-traumatic glial apoptosis. In situ terminal-deoxy-transferase mediated dUTP nick end labeling revealed apoptotic cells, largely oligodendrocytes as identified by cell specific markers, in grey and white matter following spinal cord injury. Apoptotic cell death was confirmed using electron microscopy and by the demonstration of DNA laddering on agarose gel electrophoresis. Beta-amyloid precursor protein was used as a molecular marker of axonal degeneration on western blots and immunohistochemistry. Degeneration of axons was temporally and spatially co-localized with glial apoptosis. FAS and p75 protein expression was seen in astrocytes, oligodendrocytes and microglia, and was also seen in some apoptotic glia after cord injury. Both FAS and p75 increased in expression in a temporal course, which mirrored the development of cellular apoptosis. The downstream caspases 3 and 8, which are linked to FAS and p75, demonstrated activation at times of maximal apoptosis, while FLIP-L an inhibitor of caspase 8, decreased at times of maximal apoptosis. We conclude that axonal degeneration after traumatic spinal cord injury is associated with glial, in particular oligodendroglial, apoptosis. Activation of the FAS and p75 death receptor pathways may be involved in initiating this process.
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Affiliation(s)
- S Casha
- Division of Neurosurgery, Toronto Western Research, The University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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