{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:03:10Z","timestamp":1792800190815,"version":"4.5.0"},"reference-count":61,"publisher":"SAGE Publications","issue":"3_suppl","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"AO Foundation through the AO Spine Knowledge Forum Spinal Cord Injury","id":[{"id":"https:\/\/ror.org\/02z64pq54","id-type":"ROR","asserted-by":"crossref"}]},{"name":"AO Foundation and Praxis Spinal Cord Institute","id":[{"id":"https:\/\/ror.org\/03p2f7q52","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Systematic review update.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Interventions that aim to optimize spinal cord perfusion are thought to play an important role in minimizing secondary ischemic damage and improving outcomes in patients with acute traumatic spinal cord injuries (SCIs). However, exactly how to optimize spinal cord perfusion and enhance neurologic recovery remains controversial. We performed an update of a recent systematic review (Evaniew et al, J. Neurotrauma 2020) to evaluate the effects of Mean Arterial Pressure (MAP) support or Spinal Cord Perfusion Pressure (SCPP) support on neurological recovery and rates of adverse events among patients with acute traumatic SCI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched PubMed\/MEDLINE, EMBASE and ClinicalTrials.gov for new published reports. Two reviewers independently screened articles, extracted data, and evaluated risk of bias. We implemented the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach to rate confidence in the quality of the evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 569 potentially relevant new citations since 2019, we identified 9 new studies for inclusion, which were combined with 19 studies from a prior review to give a total of 28 studies. According to low or very low quality evidence, the effect of MAP support on neurological recovery is uncertain, and increased SCPP may be associated with improved neurological recovery. Both approaches may involve risks for specific adverse events, but the importance of these adverse events to patients remains unclear. Very low quality evidence failed to yield reliable guidance about particular monitoring techniques, perfusion ranges, pharmacological agents, or durations of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This update provides an evidence base to support the development of a new clinical practice guideline for the hemodynamic management of patients with acute traumatic SCI. While avoidance of hypotension and maintenance of spinal cord perfusion are important principles in the management of an acute SCI, the literature does not provide high quality evidence in support of a particular protocol. Further prospective, controlled research studies with objective validated outcome assessments are required to examine interventions to optimize spinal cord perfusion in this setting.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682231218737","type":"journal-article","created":{"date-parts":[[2024,3,25]],"date-time":"2024-03-25T12:31:56Z","timestamp":1711369916000},"page":"58S-79S","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":34,"title":["Interventions to Optimize Spinal Cord Perfusion in Patients With Acute Traumatic Spinal Cord Injury: An Updated Systematic Review"],"prefix":"10.1177","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-5224","authenticated-orcid":false,"given":"Nathan","family":"Evaniew","sequence":"first","affiliation":[{"name":"McCaig Institute for Bone and Joint Health, Department of Surgery, Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0591-5069","authenticated-orcid":false,"given":"Benjamin","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cambridge University, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4435-9034","authenticated-orcid":false,"given":"Farzin","family":"Farahbakhsh","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5722-6364","authenticated-orcid":false,"given":"Michael G.","family":"Fehlings","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada"},{"name":"Division of Neurosurgery, Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, ON, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Ganau","sequence":"additional","affiliation":[{"name":"Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"},{"name":"Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Graves","sequence":"additional","affiliation":[{"name":"College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Guest","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radha","family":"Korupolu","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, TX, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan R.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, Davis, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2030-8988","authenticated-orcid":false,"given":"Stephen L.","family":"McKenna","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A.","family":"Tetreault","sequence":"additional","affiliation":[{"name":"Department of Neurology, NYU Langone Medical Center, New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditya","family":"Vedantam","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika D.","family":"Brodt","sequence":"additional","affiliation":[{"name":"Aggregate Analytics, Inc, Fircrest, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea C.","family":"Skelly","sequence":"additional","affiliation":[{"name":"Aggregate Analytics, Inc, Fircrest, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian K.","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada"},{"name":"International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,3,25]]},"reference":[{"key":"bibr1-21925682231218737","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2019.6844"},{"key":"bibr2-21925682231218737","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1991.75.1.0015"},{"key":"bibr3-21925682231218737","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.18"},{"key":"bibr4-21925682231218737","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e318276ee16"},{"key":"bibr5-21925682231218737","doi-asserted-by":"publisher","DOI":"10.3171\/2017.8.FOCUS17428"},{"key":"bibr6-21925682231218737","doi-asserted-by":"publisher","DOI":"10.1177\/0885066616672643"},{"key":"bibr7-21925682231218737","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.05.138"},{"key":"bibr8-21925682231218737","first-page":"1","volume":"1","author":"Weber-Levine C","year":"2022","journal-title":"J Neurosurg 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