A Practical Classification System for Acute Cervical Spinal Cord Injury Based on a Three-Phased Modified Delphi Process From the AOSpine Spinal Cord Injury Knowledge Forum.
Publication/Presentation Date
3-1-2024
Abstract
STUDY DESIGN: A modified Delphi study.
OBJECTIVE: To assess current practice patterns in the management of cervical spinal cord injury (SCI) and develop a simplified, practical classification system which offers ease of use in the acute setting, incorporates modern diagnostic tools and provides utility in determining treatment strategies for cervical SCI.
METHODS: A three-phase modified Delphi procedure was performed between April 2020 and December 2021. During the first phase, members of the AOSpine SCI Knowledge forum proposed variables of importance for classifying and treating cervical SCI. The second phase involved an international survey of spine surgeons gauging practices surrounding the role and timing of surgery for cervical SCI and opinions regarding factors which most influence these practices. For the third phase, information obtained from phases 1 and 2 were used to draft a new classification system.
RESULTS: 396 surgeons responded to the survey. Neurological status, spinal stability and cord compression were the most important variables influencing decisions surrounding the role and timing of surgery. The majority (>50%) of respondents preferred to perform surgery within 24 hours post-SCI in clinical scenarios in which there was instability, severe cord compression or severe neurology. Situations in which < 50% of respondents were inclined to operate early included: SCI with mild neurological impairments, with cord compression but without instability (with or without medical comorbidities), and SCI without cord compression or instability.
CONCLUSIONS: Spinal stability, cord compression and neurological status are the most important variables influencing surgeons' practices surrounding the surgical management of cervical SCI. Based on these results, a simplified classification system for acute cervical SCI has been proposed.
Volume
14
Issue
2
First Page
535
Last Page
545
ISSN
2192-5682
Published In/Presented At
Hachem, L. D., Zhu, M., Aarabi, B., Davies, B., DiGiorgio, A., Evaniew, N., Fehlings, M. G., Ganau, M., Graves, D., Guest, J., Ha, Y., Harrop, J., Hofstetter, C., Koljonen, P., Kurpad, S., Marco, R., Martin, A. R., Nagoshi, N., Nouri, A., Rahimi-Movaghar, V., … Wilson, J. R. (2024). A Practical Classification System for Acute Cervical Spinal Cord Injury Based on a Three-Phased Modified Delphi Process From the AOSpine Spinal Cord Injury Knowledge Forum. Global spine journal, 14(2), 535–545. https://doi.org/10.1177/21925682221114800
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
36065656
Department(s)
Administration and Leadership
Document Type
Article