Sánchez José Antonio Soriano, Sharif Salman, Costa Francesco, Rangel Jose Alberto Israel Romero, Anania Carla Daniela, Zileli Mehmet
Spine Clinic of the Neurological Center, American British-Cowdray Medical Center IAP, Mexico City, Mexico.
Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan.
Neurospine. 2020 Dec;17(4):759-784. doi: 10.14245/ns.2040366.183. Epub 2020 Dec 31.
Scientific knowledge today is being generated more rapidly than we can assimilate thus requiring continuous review of gold-standards for diagnosis and treatment of specific pathologies. The aim of this paper is to provide an update on the best early management of spinal cord injury (SCI), in order to produce acceptable worldwide recommendations to standardize clinical practice as much as possible.The WFNS Spine Committee voted recommendations regarding management of SCI based on literature review of the last 10 years. The committee stated 9 recommendations on 3 main topics: (1) clinical assessment and classification of SCI; (2) emergency care and early management; (3) cardiopulmonary management. American Spinal Injury Association impairment scale, Spinal Cord Independence Measure, and International Spinal Cord Injury Basic Pain Data Set are considered the most useful and feasible in emergency evaluation and follow-up in case of SCI. Magnetic resonance imaging is the most indicated examination to evaluate patients with symptomatic SCI. In early phase, correction of hypotension (systolic blood pressure < 90 mmHg), and bradycardia are strongly recommended. Surgical decompression should be performed as soon as possible with the ideal surgical time being within 8 hours for both complete and incomplete lesions.
如今，科学知识的产生速度超过了我们的吸收速度，因此需要不断审视特定病症诊断和治疗的金标准。本文旨在提供脊髓损伤（SCI）最佳早期管理的最新情况，以便尽可能制定出全球可接受的建议，使临床实践标准化。世界神经外科联合会脊柱委员会根据对过去10年文献的回顾，对SCI的管理进行了投票表决。委员会就3个主要主题提出了9项建议：（1）SCI的临床评估和分类；（2）急救和早期管理；（3）心肺管理。美国脊髓损伤协会损伤量表、脊髓独立测量量表和国际脊髓损伤基本疼痛数据集被认为在SCI的急诊评估和随访中最有用且可行。磁共振成像（MRI）是评估有症状SCI患者最适合的检查。在早期，强烈建议纠正低血压（收缩压<90mmHg）和心动过缓。对于完全性和不完全性损伤，应尽快进行手术减压，理想的手术时间为8小时内。
