Current Practice in the Timing of Surgical Intervention in Spinal Cord Injury
Why this work is in the frame
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Bibliographic record
Abstract
STUDY DESIGN: Systematic review of the literature and prospective survey study. OBJECTIVE: To characterize expert opinion regarding the timing of surgery for decompression of the injured spinal cord and critically summarize the evidence for early surgical intervention for acute spinal cord injury (SCI). SUMMARY OF BACKGROUND DATA: The optimal timing of decompressive surgery for acute SCI is controversial, resulting in considerable variability in clinical practice. Moreover, the current opinion of spine surgeons regarding the optimal timing of surgery after SCI is unknown. METHODS: We undertook a systematic review of the applied preclinical and clinical published data regarding the timing of decompression following SCI. A 20-question survey was sent to orthopedic and neurosurgical spine surgeons across the world. Response frequencies were compiled for respondent demographics and preference for timing of surgical decompression in 6 distinct clinical scenarios. χ2 statistics were used to compare response frequencies based on specialty and fellowship training. RESULTS: A total of 971 spine surgeons responded to the survey. In almost every clinical scenario, with the exception of central cord syndrome, the majority of respondents (≥ 80%) preferred to decompress the spinal cord within 24 hours. A complete cervical SCI would preferably be decompressed within 6 hours by 46.2% of respondents, but 72.9% would operate within 6 hours for an incomplete SCI in an otherwise identical clinical scenario. CONCLUSION: The majority of spine surgeons prefer to decompress the acutely injured spinal cord within 24 hours. The majority of spine surgeons prefer to decompress the cervical spine for patients with complete or incomplete cervical SCI within 24 hours. Early decompression (within 24 hours) should be considered as part of the therapeutic management of any patient with SCI, particularly those with cervical SCI. Very early decompression (within 12 hours) should be considered for a patient with an incomplete cervical SCI (with the possible exception of central cord syndrome).
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.003 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it