{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T03:21:53Z","timestamp":1777519313912,"version":"3.51.4"},"reference-count":13,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nGuidelines are needed to manage spinal cord infarctions. Here, we evaluated the incidence of noniatrogenic spinal ischemia, focusing on the spinal levels involved, and the relative efficacy of different management strategies.<\/jats:p>\n<\/jats:sec>\n\nMethods: <\/jats:title>\nWe performed a meta-analysis of 147 patients who sustained noniatrogenic spinal cord ischemia within the past 10 years. The most common causes of injury were idiopathic (i.e., 47% medical\/surgery-related) followed by systemic\/chronic conditions (23.6%) and aortic vascular pathology (20%). Postdiagnostic treatment options included rehabilitation in 53.7% of patients, while steroids (35.37%), antiplatelets aggregates (30.61%), and anticoagulation (18.37%) were also used.<\/jats:p>\n<\/jats:sec>\n\nResults: <\/jats:title>\nTraumatic causes of spinal cord ischemia were associated with worse outcomes, while those without a clear diagnosis despite extensive work-up had better results. At discharge, patients managed with cerebrospinal fluid (CSF) drainage had significant improvement (P<\/jats:italic> = 0.04), while other therapies were not effective. Notably, ischemia mostly occurring between the T4 and T7 levels and was associated with the worst outcomes. In this thoracic \u201cwatershed\u201d region, thoracic cord ischemia was most likely attributed to an increased susceptibility toto cord under-perfusion in this region (P<\/jats:italic> < 0.05).<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nThis meta-analysis revealed a variety of etiologies for noniatrogenic typically T4-T7 spinal cord ischemia. Several different treatment strategies may be utilized in this patient population, including CSF drainage, blood pressure elevation, corticosteroids, antiplatelets\/anticoagulants\/thrombolytics, mannitol, naloxone, surgical revascularization, hyperbaric oxygen, and systemic hypothermia.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_1252_2021","type":"journal-article","created":{"date-parts":[[2022,6,3]],"date-time":"2022-06-03T09:28:34Z","timestamp":1654248514000},"page":"228","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Noniatrogenic spinal cord ischemia: A patient level meta-analysis of 125 case reports and series"],"prefix":"10.25259","volume":"13","author":[{"given":"Anant","family":"Naik","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha L.","family":"Houser","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina M.","family":"Moawad","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravishankar K.","family":"Iyer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, Champaign,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul M.","family":"Arnold","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Carle Illinois College of Medicine, Urbana, Illinois, United States."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2022,6,3]]},"reference":[{"key":"10.25259\/SNI_1252_2021\/ref-1","doi-asserted-by":"crossref","first-page":"E336","DOI":"10.1532\/hsf.3681","article-title":"10-year trends in aortic dissection: Mortality and weekend effect within the US nationwide emergency department sample (NEDS)","volume":"24","author":"Brown","year":"2021","journal-title":"Heart Surg Forum"},{"key":"10.25259\/SNI_1252_2021\/ref-2","doi-asserted-by":"crossref","first-page":"275","DOI":"10.21037\/acs.2016.05.05","article-title":"Evolution of surgical therapy for Stanford acute Type A aortic dissection","volume":"5","author":"Chiu","year":"2016","journal-title":"Ann Cardiothorac Surg"},{"key":"10.25259\/SNI_1252_2021\/ref-3","doi-asserted-by":"crossref","first-page":"608","DOI":"10.3171\/jns.1986.65.5.0608","article-title":"Traumatic infarction of the spinal cord in 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