Michael George Fehlings

Objective. —To compare the efficacy of methylprednisolone administered for 24 hours with methyprednisolone administered for 48 hours or tirilazad mesylate administered for 48 hours in patients with acute spinal cord injury.Design. —Double-blind, randomized clinical trial.Setting. —Sixteen acute spinal cord injury centers in North America.Patients. —A total of 499 patients with acute spinal cord injury diagnosed in National Acute Spinal Cord Injury Study (NASCIS) centers within 8 hours of ...

The International Campaign for Cures of Spinal Cord Injury Paralysis (ICCP) supported an international panel tasked with reviewing the methodology for clinical trials in spinal cord injury (SCI), and making recommendations on the conduct of future trials. This is the first of four papers. Here, we examine the spontaneous rate of recovery after SCI and resulting consequences for achieving statistically significant results in clinical trials. We have reanalysed data from the Sygen trial to ...

BACKGROUND: Although there is a strong biological rationale for early decompression of the injured spinal cord, the influence of the timing of surgical decompression for acute spinal cord injury (SCI) remains debated, with substantial variability in clinical practice. We aimed to objectively evaluate the effect of timing of decompressive surgery for acute SCI on long-term neurological outcomes.

METHODS: We did a pooled analysis of individual patient data derived from four independent, ...

BACKGROUND: Surgery for symptomatic spinal metastases aims to improve quality of life, pain, function, and stability. Complications in the postoperative period are not uncommon; therefore, it is important to select appropriate patients who are likely to benefit the greatest from surgery. Previous studies have focused on predicting survival rather than quality of life after surgery.

OBJECTIVE: To determine preoperative patient characteristics that predict postoperative quality of life and ...

BACKGROUND: There is convincing preclinical evidence that early decompression in the setting of spinal cord injury (SCI) improves neurologic outcomes. However, the effect of early surgical decompression in patients with acute SCI remains uncertain. Our objective was to evaluate the relative effectiveness of early (<24 hours after injury) versus late (≥ 24 hours after injury) decompressive surgery after traumatic cervical SCI.

METHODS: We performed a multicenter, international, ...

STUDY DESIGN: Systematic review and survey.

OBJECTIVE: To perform an evidence synthesis of the literature and obtain information from the global spine care community assessing the frequency, timing, and predictors of symptom development in patients with radiographical evidence of cervical spinal cord compression, spinal canal narrowing, and/or ossification of posterior longitudinal ligament (OPLL) but no symptoms of myelopathy.

SUMMARY OF BACKGROUND DATA: Evidence for a marker to predict ...

Spinal cord injury leads to many forms of autonomic dysfunction including autonomic dysreflexia, a condition involving recurrent episodes of paroxysmal hypertension and associated bradycardia. This hypertension may reach intensities that are life-threatening. We investigated autonomic dysreflexia and the sprouting of central processes of primary afferent neurons (a potential mechanism for autonomic dysreflexia) in a clinically-relevant calibrated clip-compression model of spinal cord ...

To characterize the changes in axonal function in the motor and somatosensory tracts of the cord after spinal cord injury (SCI) and to correlate these changes with spinal cord blood flow (SCBF), the relationships among the severity of SCI, motor and somatosensory evoked potentials (MEPs and SSEPs) and SCBF were examined. Fifteen rats received a 1.5 g (n = 5), 20 g (n = 5) or 56 g (n = 5) clip compression injury of the cord at C8. SCBF at the injury site was measured by the hydrogen ...

OBJECT: Rates of complications associated with the surgical treatment of cervical spondylotic myelopathy (CSM) are not clear. Appreciating these risks is important for patient counseling and quality improvement. The authors sought to assess the rates of and risk factors associated with perioperative and delayed complications associated with the surgical treatment of CSM.

METHODS: Data from the AOSpine North America Cervical Spondylotic Myelopathy Study, a prospective, multicenter study, ...

BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in older individuals. Controversy remains in terms of the optimal timing and indications for surgical intervention. In this context, it would be of benefit to define clinical and magnetic resonance imaging (MRI) predictors of outcome after intervention for CSM.

OBJECTIVE: We studied subjects with clinically documented cervical myelopathy to evaluate the relationship among preoperative ...

STUDY DESIGN: Prospective, blinded validation study of an objective, quantitative measure to assess maximum canal compromise (MCC) and maximum spinal cord compression (MSCC) in individuals with acute cervical spinal cord injury (SCI).

OBJECTIVE: To examine the intraobserver and interobserver reliability of MCC and MSCC in individuals with acute traumatic cervical SCI.

SUMMARY OF BACKGROUND DATA: To date, few quantitative reliable radiologic methods for assessing the extent of spinal cord ...

The transplantation of neural stem/progenitor cells (NPCs) is a promising therapeutic strategy for spinal cord injury (SCI). However, to date NPC transplantation has exhibited only limited success in the treatment of chronic SCI. Here, we show that chondroitin sulfate proteoglycans (CSPGs) in the glial scar around the site of chronic SCI negatively influence the long-term survival and integration of transplanted NPCs and their therapeutic potential for promoting functional repair and ...

PURPOSE: Vertebral compression fractures (VCFs) are increasingly observed after spine stereotactic body radiation therapy (SBRT). The aim of this study was to determine the risk of VCF after spine SBRT and identify clinical and dosimetric factors predictive for VCF. The analysis incorporated the recently described Spinal Instability Neoplastic Score (SINS) criteria.

METHODS AND MATERIALS: The primary endpoint of this study was the development of a de novo VCF (ie, new endplate fracture ...

BACKGROUND: Despite decades of research, there are no national estimates of the incidence or prevalence of spinal cord injury (SCI) in Canada. Our objective was to utilize the best available data to estimate the incidence and prevalence of traumatic SCI (TSCI) and non-traumatic SCI (NTSCI) in Canada for 2010.

METHODS: Initial incidence (number of TSCIs at injury scene) and discharge incidence (number discharged into the community) were calculated using published TSCI rates from Alberta ...