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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 Publisher



Hachem LD1 ; Zhu M1 ; Aarabi B2 ; Davies B3 ; Digiorgio A4 ; Evaniew N5 ; Fehlings MG6 ; Ganau M7 ; Graves D8 ; Guest J9 ; Ha Y10 ; Harrop J11 ; Hofstetter C12 ; Koljonen P13 Show All Authors
Authors
  1. Hachem LD1
  2. Zhu M1
  3. Aarabi B2
  4. Davies B3
  5. Digiorgio A4
  6. Evaniew N5
  7. Fehlings MG6
  8. Ganau M7
  9. Graves D8
  10. Guest J9
  11. Ha Y10
  12. Harrop J11
  13. Hofstetter C12
  14. Koljonen P13
  15. Kurpad S14
  16. Marco R15
  17. Martin AR16
  18. Nagoshi N17
  19. Nouri A18
  20. Rahimimovaghar V19
  21. Rodriguespinto R20
  22. Wengel VT21
  23. Tetreault L22
  24. Kwon B23
  25. Wilson JR24
Show Affiliations
Authors Affiliations
  1. 1. University of Toronto, Toronto, ON, Canada
  2. 2. Department of Neurosurgery, University of Maryland Medical System, Baltimore, MD, United States
  3. 3. Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
  4. 4. University of California San Francisco, San Francisco, CA, United States
  5. 5. Department of Surgery, University of Calgary, Calgary, AB, Canada
  6. 6. University Health Network, Toronto, ON, Canada
  7. 7. Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
  8. 8. Thomas Jefferson University, Philadelphia, NJ, United States
  9. 9. Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, United States
  10. 10. Yonsei University, Seodaemun-gu, South Korea
  11. 11. Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
  12. 12. University of Washington, Seattle, WA, United States
  13. 13. Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong
  14. 14. Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, United States
  15. 15. Houston Methodist Orthopedics & Sports Medicine Texas Medical Center, Houston, TX, United States
  16. 16. Department of Neurological Surgery, University of California Davis, Sacramento, CA, United States
  17. 17. Department of Orthopaedics, Keio University School of Medicine Graduate School of Medicine, Tokyo, Japan
  18. 18. Department of Neurosurgery, Hopitaux Universitaires de Geneve, Geneve, Switzerland
  19. 19. Tehran University of Medical Sciences, Tehran, Iran
  20. 20. Department of Orthopaedics, Centro Hospitalar Universitario do Porto EPE, Porto, Portugal
  21. 21. Department of Neurosurgery, Amsterdam UMC VUMC Site, Amsterdam, Netherlands
  22. 22. New York University Medical Center, New York, NY, United States
  23. 23. Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
  24. 24. Department of Surgery, St Michael's Hospital, Toronto, ON, Canada

Source: Global Spine Journal Published: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. © The Author(s) 2022.
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