Neurological recovery after traumatic spinal cord injury:what is meaningful? A patients' and physicians' perspective

Study design: Cross-sectional survey. Objectives: Most studies on neurological recovery after traumatic spinal cord injury (tSCI) assess treatment effects using the American Spinal Injury Association Impairment Scale (AIS grade) or motor points recovery. To what extent neurological recovery is considered clinically meaningful is unknown. This study investigated the perceived clinical benefit of various degrees of neurological recovery one year after C5 AIS-A tSCI. Setting: The Netherlands. Methods: By means of a web-based survey SCI patients and physicians evaluated the benefit of various scenarios of neurological recovery on a scale from 0 to 100% (0% no benefit to 100% major benefit). Recovery to AIS-C and D, was split into C/C+ and D/D+, which was defined by the lower and upper limit of recovery for each grade. Results: A total of 79 patients and 77 physicians participated in the survey. Each AIS grade improvement from AIS-A was considered significant benefit (all p < 0.05), ranging from 47.8% (SD 26.1) for AIS-B to 86.8% (SD 24.3) for AIS-D+. Motor level lowering was also considered significant benefit (p < 0.05), ranging from 66.1% (SD 22.3) for C6 to 81.7% (SD 26.0) for C8. Conclusions: Meaningful recovery can be achieved without improving in AIS grade, since the recovery of functional motor levels appears to be as important as improving in AIS grade by both patients and physicians. Moreover, minor neurological improvements within AIS-C and D are also considered clinically meaningful. Future studies should incorporate more detailed neurological outcomes to prevent potential underestimation of neurological recovery by only using the AIS grade

Radiation exposure and avoidance in minimally invasive spine surgery

© Springer Nature Switzerland AG 2019. The advent of minimally invasive spine surgery (MIS or MISS) heralds an important milestone in the surgical management of spinal disorders. MIS provides the modern spine surgeon the ability to treat spine pathology in a precise, less morbid manner when compared to open procedures. The benefits of MIS over open procedures include, but are not limited to, decreased blood loss, decreased infection rates, and decreased hospital length of stay. These benefits of MIS coexist with the burden of an increased reliance on radiographic imaging in the operating theater. Radiography in MIS can produce significant amounts of radiation, placing both the surgeon and patient at risk. Efforts to limit radiation exposure in MIS stem from a basic understanding of the physical nature of ionizing radiation and its effects on living tissue. Although the quantity of radiation produced in various MIS procedures varies in the literature, a surgeon’s hands and thyroid gland may represent structures consistently at risk. Techniques to limit radiation exposure include preoperative considerations, such as prudently planning when imaging is necessary during a case, and intraoperative adjustments such as appropriately positioning the radiation source in relation to the patient and surgeon. Knowledge of these techniques allows spine surgeons to effectively perform MIS while simultaneously reducing radiation exposure