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Redefining and Reclassifying Acute T...

Badhiwala, Jetan H.

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Redefining and Reclassifying Acute Traumatic Cervical Incomplete Spinal Cord Injury with Special Reference to Central Cord Syndrome: Implications for an Aging Population.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Redefining and Reclassifying Acute Traumatic Cervical Incomplete Spinal Cord Injury with Special Reference to Central Cord Syndrome: Implications for an Aging Population./
Author:	Badhiwala, Jetan H.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2020,
Description:	143 p.
Notes:	Source: Dissertations Abstracts International, Volume: 82-06, Section: B.
Contained By:	Dissertations Abstracts International82-06B.
Subject:	Neurosciences. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=27995352
ISBN:	9798698544920

Redefining and Reclassifying Acute Traumatic Cervical Incomplete Spinal Cord Injury with Special Reference to Central Cord Syndrome: Implications for an Aging Population.
Badhiwala, Jetan H.

Redefining and Reclassifying Acute Traumatic Cervical Incomplete Spinal Cord Injury with Special Reference to Central Cord Syndrome: Implications for an Aging Population. - Ann Arbor : ProQuest Dissertations & Theses, 2020 - 143 p.

Source: Dissertations Abstracts International, Volume: 82-06, Section: B.

Thesis (Ph.D.)--University of Toronto (Canada), 2020.

This item must not be sold to any third party vendors.

In the face of the global aging population and the shifting epidemiology of acute spinal cord injury (SCI), there is a critical need to revisit the definition and clinical management of central cord syndrome (CCS). This dissertation investigated the hypothesis that the neurological outcomes of patients with 'central cord syndrome' are heterogeneous and predicted more accurately by acute clinical variables and interventions, including early surgical decompression. First, a systematic review of the literature pertaining to CCS was performed to identify: 1) predictors of outcome; and 2) the efficacy of early (< 24 hrs) decompressive surgery. This revealed age and baseline severity of neurological injury (i.e., American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade, ASIA motor score [AMS]) to be the most important acute variables associated with neurological outcome; there was limited, very low quality evidence pertaining to the effect of early surgery. Second, the findings of the systematic review informed the development of a clinical prediction model for long-term motor outcome (AMS) in patients with CCS. Third, a propensity score-matched analysis was performed, which found early surgery (< 24 hrs) to be associated with superior motor recovery at 1 year in patients with CCS, as compared to late surgery (≥ 24 hrs). Finally, a novel methodology known as 'group-based trajectory modelling' was used to develop a classification system for cervical incomplete SCI that segregates patients into four subgroups based on the anticipated temporal profile of recovery; the key factors in predicting this classification were age, AIS grade, and neurological level. Future external validation studies are required. However, the findings presented herein suggest that: 1) the outcomes of CCS are not uniformly favorable, as historically thought; 2) there is significant heterogeneity in how patients with CCS recover, and some of this heterogeneity may be explained by acute variables, including time to surgery; 3) early surgery, within 24 hours of injury, in patients with CCS may be associated with superior long-term neurological outcomes, as compared to late surgery; and 4) an alternative classification of cervical incomplete SCI based on trajectory group may more meaningfully subset patients according to expected long-term prognosis.

ISBN: 9798698544920Subjects--Topical Terms:

588700
Neurosciences.
Subjects--Index Terms:

Biostatistics

Redefining and Reclassifying Acute Traumatic Cervical Incomplete Spinal Cord Injury with Special Reference to Central Cord Syndrome: Implications for an Aging Population.
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