Fehlings Michael G, Tetreault Lindsay A, Wilson Jefferson R, Kwon Brian K, Burns Anthony S, Martin Allan R, Hawryluk Gregory, Harrop James S
Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
Global Spine J. 2017 Sep;7(3 Suppl):84S-94S. doi: 10.1177/2192568217703387. Epub 2017 Sep 5.
Acute spinal cord injury (SCI) is a traumatic event that results in disturbances to normal sensory, motor, or autonomic function and ultimately affects a patient's physical, psychological, and social well-being. The management of patients with SCI has drastically evolved over the past century as a result of increasing knowledge on injury mechanisms, disease pathophysiology, and the role of surgery. There still, however, remain controversial areas surrounding available management strategies for the treatment of SCI, including the use of corticosteroids such as methylprednisolone sodium succinate, the optimal timing of surgical intervention, the type and timing of anticoagulation prophylaxis, the role of magnetic resonance imaging, and the type and timing of rehabilitation. This lack of consensus has prevented the standardization of care across treatment centers and among the various disciplines that encounter patients with SCI. The objective of this guideline is to form evidence-based recommendations for these areas of controversy and outline how to best manage patients with SCI. The ultimate goal of these guidelines is to improve outcomes and reduce morbidity in patients with SCI by promoting standardization of care and encouraging clinicians to make evidence-informed decisions.
急性脊髓损伤(SCI)是一种创伤性事件,会导致正常感觉、运动或自主神经功能紊乱,最终影响患者的身体、心理和社会福祉。由于对损伤机制、疾病病理生理学以及手术作用的认识不断增加,在过去的一个世纪里,SCI患者的管理方式发生了巨大的演变。然而,围绕SCI治疗的现有管理策略仍存在争议领域,包括使用皮质类固醇如琥珀酸钠甲泼尼龙、手术干预的最佳时机、抗凝预防的类型和时机、磁共振成像的作用以及康复的类型和时机。这种缺乏共识的情况阻碍了各治疗中心以及处理SCI患者的不同学科之间护理的标准化。本指南的目的是针对这些争议领域形成基于证据的建议,并概述如何最好地管理SCI患者。这些指南的最终目标是通过促进护理标准化并鼓励临床医生做出基于证据的决策,来改善SCI患者的治疗效果并降低发病率。