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 Amputees can learn to control a robotic arm with their minds
28.11.2017 | University of Chicago Medical Center

nachricht The importance of biodiversity in forests could increase due to climate change
17.11.2017 | Deutsches Zentrum für integrative Biodiversitätsforschung (iDiv) Halle-Jena-Leipzig

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: Long-lived storage of a photonic qubit for worldwide teleportation

MPQ scientists achieve long storage times for photonic quantum bits which break the lower bound for direct teleportation in a global quantum network.

Concerning the development of quantum memories for the realization of global quantum networks, scientists of the Quantum Dynamics Division led by Professor...

Im Focus: Electromagnetic water cloak eliminates drag and wake

Detailed calculations show water cloaks are feasible with today's technology

Researchers have developed a water cloaking concept based on electromagnetic forces that could eliminate an object's wake, greatly reducing its drag while...

Im Focus: Scientists channel graphene to understand filtration and ion transport into cells

Tiny pores at a cell's entryway act as miniature bouncers, letting in some electrically charged atoms--ions--but blocking others. Operating as exquisitely sensitive filters, these "ion channels" play a critical role in biological functions such as muscle contraction and the firing of brain cells.

To rapidly transport the right ions through the cell membrane, the tiny channels rely on a complex interplay between the ions and surrounding molecules,...

Im Focus: Towards data storage at the single molecule level

The miniaturization of the current technology of storage media is hindered by fundamental limits of quantum mechanics. A new approach consists in using so-called spin-crossover molecules as the smallest possible storage unit. Similar to normal hard drives, these special molecules can save information via their magnetic state. A research team from Kiel University has now managed to successfully place a new class of spin-crossover molecules onto a surface and to improve the molecule’s storage capacity. The storage density of conventional hard drives could therefore theoretically be increased by more than one hundred fold. The study has been published in the scientific journal Nano Letters.

Over the past few years, the building blocks of storage media have gotten ever smaller. But further miniaturization of the current technology is hindered by...

Im Focus: Successful Mechanical Testing of Nanowires

With innovative experiments, researchers at the Helmholtz-Zentrums Geesthacht and the Technical University Hamburg unravel why tiny metallic structures are extremely strong

Light-weight and simultaneously strong – porous metallic nanomaterials promise interesting applications as, for instance, for future aeroplanes with enhanced...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

AKL’18: The opportunities and challenges of digitalization in the laser industry

07.12.2017 | Event News

 
Latest News

Long-lived storage of a photonic qubit for worldwide teleportation

12.12.2017 | Physics and Astronomy

Multi-year submarine-canyon study challenges textbook theories about turbidity currents

12.12.2017 | Earth Sciences

Electromagnetic water cloak eliminates drag and wake

12.12.2017 | Power and Electrical Engineering

VideoLinks
B2B-VideoLinks
More VideoLinks >>>