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 Woman’s Hospital Harvard Medical School

Disc losur e s De puy Spine Co nsulting Gra nt suppo rt Bio me t Spine Co nsulting Gra nt suppo rt

Central Cord Syndrome Corticospinal tract

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

Facts Most common spinal cord injury (10%) Earlier decompression is better Early decompression is safe

Facts Most common spinal cord Natural History is for injury (10%) improvement Earlier decompression is ”Early” not well defined better Retrospective data is Early decompression is biased to more severe safe Very controversial Lot’s of room for individual variation

Literature: optimal timing Not enough evidence to recommend early surgery (<24 H) Should operate in < 2 wks, first admission

Failure of EBM? Sacket: Integrating best external evidence and individual clinical experience

EBM evidence parachute 10

EBM evidence parachute 11

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

T ha nk Yo u!