title: Systemic hypothermia in acute cervical spinal cord injury: a case-controlled study.
abstract: BACKGROUND
  Systemic hypothermia remains a promising neuroprotective strategy. There has been recent interest in its use in patients with spinal cord injury (SCI). In this article, we describe our extended single center experience using intravascular hypothermia for the treatment of cervical SCI.
  
  
  METHODS
  Thirty-five acute cervical SCI patients received modest (33 °C) intravascular hypothermia for 48 h. Neurological outcome was assessed by the International Standards for Neurological Classification of Spinal Cord Injury scale (ISNCSCI) developed by the American Spinal Injury Association. Local and systemic complications were recorded.
  
  
  RESULTS
  All patients were complete ISNCSCI A on admission, but four converted to ISNCSCI B in <24 h post injury. Hypothermia was delivered in 5.76 (±0.45) hours from injury if we exclude four cases with delayed admission (>18 h). Fifteen of total 35 patients (43%) improved at least one ISNCSCI grade at latest follow up 10.07 (±1.03) months. Even excluding those patients who converted from ISNCSCI A within 24 h, 35.5% (11 out of 31) improved at least one ISNCSCI grade. Both retrospective (n=14) and prospective (n=21) groups revealed similar number of respiratory complications. The overall risk of any thromboembolic complication was 14.2%.
  
  
  CONCLUSIONS
  The results are promising in terms of safety and improvement in neurological outcome. To date, the study represents the largest study cohort of cervical SCI patients treated by modest hypothermia. A multi-center, randomized study is needed to determine if systemic hypothermia should be a part of SCI patients' treatment for whom few options exist.
authors.affiliation: Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL 33136, USA.
authors.forename: M
authors.initials: M
authors.lastname: Dididze
authors.forename: B A
authors.initials: BA
authors.lastname: Green
authors.forename: W Dalton
authors.initials: WD
authors.lastname: Dietrich
authors.forename: S
authors.initials: S
authors.lastname: Vanni
authors.forename: M Y
authors.initials: MY
authors.lastname: Wang
authors.forename: A D
authors.initials: AD
authors.lastname: Levi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002574:Cervical Vertebrae; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult