Emerging Approaches to the Surgical Management of Acute Traumatic Spinal Cord Injury

Abstract

Summary: Traumatic, spinal cord injury (SCI) is a potentially catastrophic event causing major impact at both a personal and societal level. To date, virtually all therapies that have shown promise at the preclinical stage of study have failed to translate into clinically effective treatments. Surgery is performed in the setting of SCI, with the goals of decompressing the spinal cord and restoring spinal stability. Although a consensus regarding the optimal timing of surgical decompression for SCI has not been reached, much of the preclinical and clinical evidence, as well as a recent international survey of spine surgeons, support performing early surgery (<24 hours). Results of the multicenter, Surgical Trial in Acute Spinal Cord Injury Study (STASCIS), expected later this year, should further clarify this important management issue. The overall goal of this review is to provide an update regarding the current status of surgical therapy for traumatic SCI by reviewing relevant pathophysiology, laboratory, and clinical evidence, as well as to introduce radiologic and clinical tools that aid in the surgical decision-making process.

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

“…The only way we can explain this discrepancy with the literature is the fact that the results of the timing of spinal cord decompression and their effect on AIS grade conversion need more prospective studies. 40,49,61,74,95,96,104,107,108,110–117 …”

The Incomplete Picture of Incomplete Spinal Cord Injury

“…Reviews on the subject of early versus late surgical intervention have been problematic as some studies appear to have been inappropriately grouped together for comparison by considering stabilization surgery the same as decompressive surgery [2]. For example, early versus late surgery in the study by Merza et al addressed early stabilization procedures, noting that decompression of the cord was accomplished in all cases by closed reduction prior to surgery [3].…”

An analysis of ideal and actual time to surgery after traumatic spinal cord injury in Canada

“…[1][2][3][4][5] A growing body of evidence suggests that timely surgical decompression and stabilization may improve neurological recovery by reducing secondary damage. [6][7][8][9][10] When one of the only interventions to potentially improve neurological outcomes in acute tSCI is early treatment, ensuring this knowledge is accepted and then translated into action is known as knowledge translation. The stages of knowledge translation have been described by many, but generally represent identification and research, analysis of context and barriers, knowledge transfer interventions, and finally utilization of the knowledge.…”