‘Time is Spine’: new evidence supports decompression within 24 h for acute spinal cord injury
Bibliographic record
Abstract
Fehlings MG, Tetreault LA, Wilson JR, Aarabi B, Anderson P, Arnold PM, et al. A clinical practice guideline for the management of patients with acute spinal cord injury and central cord syndrome: recommendations on the timing (</=24 h versus >24 h) of decompressive surgery. Glob Spine J. 2017;7:195S–202S. Article Google Scholar Wilson JR, Forgione N, Fehlings MG. Emerging therapies for acute traumatic spinal cord injury. CMAJ. 2013;185:485–92. Article Google Scholar Ahuja CS, Wilson JR, Nori S, Kotter MRN, Druschel C, Curt A, et al. Traumatic spinal cord injury. Nat Rev Dis Prim. 2017;3:17018. Article Google Scholar Aarabi B, Simard JM, Sansur C, Schwartzbauer G, Chryssikos T. Response to Burke et al.: efficacy of ultra-early (<12 h), early (12–24 h), and late (>24–138.5 h) surgery with magnetic resonance imaging-confirmed decompression in American Spinal Injury Association impairment scale grades A, B, and C cervical spinal cord injury. J Neurotrauma. 2020;37:2343–4. https://doi.org/10.1089/neu.2020.7034 . Article PubMed Google Scholar Badhiwala JH, Wilson JR, Witiw CD, Harrop JS, Vaccaro AR, Aarabi B, et al. The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol. 2021;20:117–26. Article CAS Google Scholar Wilson JR, Witiw CD, Badhiwala J, Kwon BK, Fehlings MG, Harrop JS. Early surgery for traumatic spinal cord injury: where are we now? Glob Spine J. 2020;10:84S–91S. Article Google Scholar Grossman RG, Toups EG, Frankowski RF, Burau KD, Howley S. North American Clinical Trials Network for the Treatment of Spinal Cord Injury: goals and progress. J Neurosurg Spine. 2012;17:6–10. Article Google Scholar Fehlings MG, Vaccaro A, Wilson JR, Singh A, D WC, Harrop JS, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7:e32037. Article CAS Google Scholar Geisler FH, Coleman WP, Grieco G, Poonian D, Sygen Study G. The Sygen multicenter acute spinal cord injury study. Spine. 2001;26:S87–98. Article CAS Google Scholar Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Administration of methylprednisolone for 24 or 48 h or tirilazad mesylate for 48 h in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA. 1997;277:1597–604. Article CAS Google Scholar Glennie RA, Bailey CS, Tsai EC, Noonan VK, Rivers CS, Fourney DR, et al. An analysis of ideal and actual time to surgery after traumatic spinal cord injury in Canada. Spinal Cord. 2017;55:618–23. Article CAS Google Scholar Grassner L, Wutte C, Klein B, Mach O, Riesner S, Panzer S, et al. Early decompression (<8 h) after traumatic cervical spinal cord injury improves functional outcome as assessed by spinal cord independence measure after one year. J Neurotrauma. 2016;33:1658–66. Article Google Scholar Burke JF, Yue JK, Ngwenya LB, Winkler EA, Talbott JF, Pan JZ, et al. Ultra-early (<12 h) surgery correlates with higher rate of American Spinal Injury Association impairment scale conversion after cervical spinal cord injury. Neurosurgery. 2019;85:199–203. Article Google Scholar Aarabi B, Olexa J, Chryssikos T, Galvagno SM, Hersh DS, Wessell A, et al. Extent of spinal cord decompression in motor complete (American Spinal Injury Association impairment scale grades A and B) traumatic spinal cord injury patients: post-operative magnetic resonance imaging analysis of standard operative approaches. J Neurotrauma. 2019;36:862–76. Article Google Scholar Saadoun S, Papadopoulos MC. Targeted perfusion therapy in spinal cord trauma. Neurotherapeutics. 2020;17:511–21. Article Google Scholar Download references
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.003 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".