SPINAL CORD INJURIES SERVICES

Effectiveness and cost-effectiveness of acute hospital-based spinal cord injuries (SCI) services

Background

The review aimed to examine four areas (i) the effectiveness and cost-effectiveness of spinal fixation surgery (ii) immediate versus delayed referral to a spinal injuries unit (SIU) (iii) how many people with a new spinal cord injury (SCI) are discharged from hospital without ever being transferred to an SIU and (iv) the effectiveness and cost-effectiveness of steroids for people with SCI.

Findings

Although there was evidence to suggest some benefits of fixation surgery and also a benefit of immediate referral to SIUs compared with delayed or no referral, owing to the limitations of the data these should be interpreted with caution.

Data on effectiveness of spinal fixation surgery is high in quantity but low in quality. Spinal fixation does not appear to offer advantages in terms of neurological improvement, length of hospital stay or urinary status. Spinal fixation patients experienced less mortality, spinal instability or psychological problems. They were more likely to be mobile in a shorter time and independent in activities of daily living than non-fixation groups. They were more likely to experience wound infection, device failure and loss of spine flexibility. Not enough data were found to assess whether surgery is most beneficial when carried out in SIUs.

Patients undergoing immediate referral to SIUs may experience better outcomes than patients whose referral is delayed, or who are treated elsewhere. Owing to the questionable comparability of groups in the majority of studies, the evidence to support this conclusion is weak. Well-designed prospective observational studies with appropriately matched controls are needed.

High-dose methylprednisolone steroid therapy may be effective in promoting some degree of neurological recovery if given within eight hours of injury.

Conducted by: A-M Bagnall1, L Jones1, G Richardson1, S Duffy1, R Riemsma1

1. NHS Centre for Reviews and Dissemination; 2. Centre for Health Economics, University of York

Further details

Project page on HTA Programme website

Publications

Bagnall AM, Jones L, Richardson G, Duffy S, Riemsma R. Effectiveness and cost-effectiveness of acute hospital-based spinal cord injuries services: systematic review. Health Technol Assess. 2003;7(19):1-288

Funding

Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process