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Acute Central Cord Injury in the Elderly: When to Operate - - PowerPoint PPT Presentation
Acute Central Cord Injury in the Elderly: When to Operate - - PowerPoint PPT Presentation
Acute Central Cord Injury in the Elderly: When to Operate Orthopaedic Summit 2017 Las Vegas Michael W. Groff, MD Director of Spinal Neurosurgery Vice-Chairman Neurosurgery Brigham and Womans Hospital Harvard Medical School Disc losur e
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Central Cord Syndrome
Corticospinal tract
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Clinical Presentation
68 year old man body surfing in Hawaii 2 wks ago Minimal UE & hand weakness Burning dysesthetic pain Cervical stenosis, not unstable Won’t be able to ride his road bike
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Facts
Most common spinal cord injury (10%) Earlier decompression is better Early decompression is safe
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Facts
Most common spinal cord injury (10%) Earlier decompression is better Early decompression is safe Natural History is for improvement ”Early” not well defined Retrospective data is biased to more severe
Very controversial Lot’s of room for individual variation
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Literature: optimal timing
Not enough evidence to recommend early surgery (<24 H) Should operate in < 2 wks, first admission
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Failure of EBM?
Sacket: Integrating best external evidence
and individual clinical experience
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EBM evidence parachute
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EBM evidence parachute
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Cut the Gordian Knot
Operate too much or too little Catch 22 CCS is a continuum How much myelopathy before? Manage expectations – goals of surgery Recognize that surgery has a role both early and later
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