Fehlings Michael G, Kwon Brian K, Tetreault Lindsay A
Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
Global Spine J. 2017 Sep;7(3 Suppl):6S-7S. doi: 10.1177/2192568217701714. Epub 2017 Sep 5.
Introduction to a guidelines project.
The objective of this focus issue is to present guidelines that outline how to best manage patients with degenerative cervical myelopathy (DCM) and spinal cord injury (SCI). Topics addressed in this focus issue include: 1) management strategies for patients with mild, moderate and severe DCM; and 2a) timing of surgical decompression; b) the use of methylprednisolone sodium succinate; c) the type and timing of anticoagulation strategies; d) the role of magnetic resonance imaging in clinical decision making and outcome prediction; and e) the type and timing of rehabilitation in patients with SCI.
Systematic reviews were conducted to address key clinical questions and to synthesize the current body of evidence. A multidisciplinary guideline development group used the results of these reviews, along with their clinical expertise, to develop clinical practice guidelines, in a process that adhered to methodology proposed by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group.
The multidisciplinary guideline development group combined the systematic review findings with their clinical expertise and opinions to formulate recommendations on how to manage patients with DCM and SCI.
These guidelines will serve as tools to assist clinicians in their decision making by offering a perspective that combines the available evidence, expertise from a variety of clinicians, and patient values.
一项指南项目的介绍。
本焦点问题的目的是呈现指南，概述如何最佳管理退行性颈椎脊髓病（DCM）和脊髓损伤（SCI）患者。本焦点问题涉及的主题包括：1）轻度、中度和重度DCM患者的管理策略；以及2a）手术减压的时机；b）琥珀酸钠甲泼尼龙的使用；c）抗凝策略的类型和时机；d）磁共振成像在临床决策和结果预测中的作用；以及e）SCI患者康复的类型和时机。
进行系统评价以解决关键临床问题并综合当前证据。一个多学科指南制定小组利用这些评价的结果以及他们的临床专业知识，按照推荐分级、评估、制定与评价（GRADE）工作组提出的方法制定临床实践指南。
多学科指南制定小组将系统评价结果与他们的临床专业知识和意见相结合，就如何管理DCM和SCI患者制定建议。
这些指南将作为工具，通过提供结合现有证据、来自各种临床医生的专业知识以及患者价值观的观点，协助临床医生进行决策。
