Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Jefferson Orthopaedic Surgeons Leading International Study of Timing of Spinal Surgery

06.10.2006
When it comes to a devastating spinal injury, says spine surgeon Alexander Vaccaro, M.D., timing might be nearly everything. It’s also a topic of great debate and discussion among orthopaedic surgeons.

Dr. Vaccaro, professor of orthopaedic surgery and neurological surgery at Jefferson Medical College of Thomas Jefferson University in Philadelphia and the Rothman Institute at Thomas Jefferson University Hospital and his colleagues are trying to answer a very difficult and controversial question:

Should surgeons operate immediately, within hours of the severe spinal injury, to try to limit the damage to the spinal cord and surrounding tissues, as many surgeons believe? Or won’t it make a difference in how a patient ultimately fares, as others, citing their experiences, say?

Dr. Vaccaro, in conjunction with Michael G. Fehlings, M.D., at Toronto Western Hospital, is spearheading a multicenter trial called STASCIS, which looks at timing of surgery, the timing of spinal reduction and a prospective evaluation of how patients do.

STASCIS is an acronym for the Surgical Treatment of Acute Spinal Cord Injury Study. Begun in 2003, STASCIS is both an observational and prospective randomized study aimed at determining if patients with spinal cord injury will benefit from early treatment to reduce pressure on the spinal cord.

Two types of injuries occur when the spinal cord is damaged, says Dr. Vaccaro, co-director of the Delaware Valley Regional Spinal Cord Injury Center at Jefferson. The primary injury is the actual physical insult to the spinal cord, including bruising, bleeding and any kind of disruption to the cord and its functioning. But a secondary injury also occurs, usually between the first day after the initial damage to as many as three to five days later. Cell and tissue death begins – including apoptosis, or programmed cell death – as electrolytes like calcium and sodium become out of balance.

This secondary cascade of spinal cord injury, he says, can be reduced. “There’s not much we can do about the initial injury that’s already occurred,” he says. “But how we handle the secondary injury may determine whether or not a person will walk again. If we intervene early, with appropriate medical treatment such as steroids, for example, or physically taking off the pressure from the spinal cord compression, which can cause further cell death, we can affect the secondary cascade of injury.”

According to Dr. Vaccaro, animal studies on spinal cord injuries show that the sooner pressure is removed from a compressed spinal cord, the better the recovery of function. “We believe that compression causes electrolyte changes, cell death and apoptosis,” he says. “From an experimental standpoint, the data is unequivocal: operate early. But we’ve never been able to translate that into the clinical setting.”

In the study, patients at Jefferson who have a cervical spinal cord injury may be randomized to an early or late treatment group, depending on when they actually undergo surgery. If the patient has a cervical dislocation, the surgeon attempts to correct the dislocation as soon as medically possible. Patients who arrive after the study’s window of treatment time are placed in an observational treatment group.

He notes that at other participating hospitals which tend to see fewer patients with spinal cord injuries, surgeons treat each patient however they think is best in terms of the timing of surgery to reduce the pressure on the spinal cord. Because of the lack of clear guidelines for such surgeries, some doctors assume that timing doesn’t really affect long-term results. Perhaps it’s better to simply stabilize the injured patient, attend to any additional injuries, allow the inflammatory reactions to run their courses and put a little more planning into the surgery.

But others, including Dr. Vaccaro, see the timing as critical. Immediate treatment to reduce the pressure on the spinal cord might keep the secondary injury to a minimum, potentially sparing additional neurological problems. And possibly even allow for some of the initial damage to be reversed.

“My intuitive belief is that operating earlier is better,” Dr. Vaccaro says. “I have many anecdotal cases where operating earlier resulted in improved results.” Results from the participating centers will be pooled. The goal is to enroll a minimum of 450 patients at 20 centers. The outcomes from the patients who were treated early, in the first 12 to 24 hours after injury, will be compared to those who had treatment more than 24 hours subsequent to the initial damage. To participate, individuals must be betweenthe ages of 16 and 70, and have had a traumatic cervical fracture or dislocation with the accompanying neurological complications. At present, the study continues to enroll participants and is about 25 percent complete.

Dr. Vaccaro expects that that study’s results will change the standard of care for severe spinal cord injuries. Next, he says, he plans to focus on the genetic and medical factors that might play roles in recovery.

For more information on this trial, please call 267-339-3612 or 1-800-JEFF-NOW.

Steve Benowitz | EurekAlert!
Further information:
http://www.jefferson.edu

More articles from Studies and Analyses:

nachricht Drone vs. truck deliveries: Which create less carbon pollution?
31.05.2017 | University of Washington

nachricht New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Can we see monkeys from space? Emerging technologies to map biodiversity

An international team of scientists has proposed a new multi-disciplinary approach in which an array of new technologies will allow us to map biodiversity and the risks that wildlife is facing at the scale of whole landscapes. The findings are published in Nature Ecology and Evolution. This international research is led by the Kunming Institute of Zoology from China, University of East Anglia, University of Leicester and the Leibniz Institute for Zoo and Wildlife Research.

Using a combination of satellite and ground data, the team proposes that it is now possible to map biodiversity with an accuracy that has not been previously...

Im Focus: Climate satellite: Tracking methane with robust laser technology

Heatwaves in the Arctic, longer periods of vegetation in Europe, severe floods in West Africa – starting in 2021, scientists want to explore the emissions of the greenhouse gas methane with the German-French satellite MERLIN. This is made possible by a new robust laser system of the Fraunhofer Institute for Laser Technology ILT in Aachen, which achieves unprecedented measurement accuracy.

Methane is primarily the result of the decomposition of organic matter. The gas has a 25 times greater warming potential than carbon dioxide, but is not as...

Im Focus: How protons move through a fuel cell

Hydrogen is regarded as the energy source of the future: It is produced with solar power and can be used to generate heat and electricity in fuel cells. Empa researchers have now succeeded in decoding the movement of hydrogen ions in crystals – a key step towards more efficient energy conversion in the hydrogen industry of tomorrow.

As charge carriers, electrons and ions play the leading role in electrochemical energy storage devices and converters such as batteries and fuel cells. Proton...

Im Focus: A unique data centre for cosmological simulations

Scientists from the Excellence Cluster Universe at the Ludwig-Maximilians-Universität Munich have establised "Cosmowebportal", a unique data centre for cosmological simulations located at the Leibniz Supercomputing Centre (LRZ) of the Bavarian Academy of Sciences. The complete results of a series of large hydrodynamical cosmological simulations are available, with data volumes typically exceeding several hundred terabytes. Scientists worldwide can interactively explore these complex simulations via a web interface and directly access the results.

With current telescopes, scientists can observe our Universe’s galaxies and galaxy clusters and their distribution along an invisible cosmic web. From the...

Im Focus: Scientists develop molecular thermometer for contactless measurement using infrared light

Temperature measurements possible even on the smallest scale / Molecular ruby for use in material sciences, biology, and medicine

Chemists at Johannes Gutenberg University Mainz (JGU) in cooperation with researchers of the German Federal Institute for Materials Research and Testing (BAM)...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Plants are networkers

19.06.2017 | Event News

Digital Survival Training for Executives

13.06.2017 | Event News

Global Learning Council Summit 2017

13.06.2017 | Event News

 
Latest News

Quantum thermometer or optical refrigerator?

23.06.2017 | Physics and Astronomy

A 100-year-old physics problem has been solved at EPFL

23.06.2017 | Physics and Astronomy

Equipping form with function

23.06.2017 | Information Technology

VideoLinks
B2B-VideoLinks
More VideoLinks >>>