Controversies in the Surgical Management of Spinal Cord Injuries

Neurology Research International, 2012 · DOI: 10.1155/2012/417834 · Published: March 7, 2012

Simple Explanation

Traumatic spinal cord injury (SCI) aﬀects over 200,000 people in the USA and is a major source of morbidity, mortality, and societal cost. Management of SCI includes several components. Acute management includes medical agents and surgical treatment that usually includes either all or a combination of reduction, decompression, and stabilization. Surgical treatment is an essential tool in management of SCI patients and the controversy surrounding the timing of surgery remains unresolved.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review Article

Key Findings

1
Presurgical reduction is considered safe and essential in the management of SCI with loss of alignment, at least as an initial step in the overall care of a SCI patient.
2
The review group’s ﬁnal conclusion was that closed reduction of fracture-dislocation injuries of the cervical spine by traction-reduction was safe and eﬀective for the re-duction of spinal deformity in awake patients.
3
Recent consensus is that there is no standard recommendation regarding the role and timing of surgery in acute SCI.

Research Summary

Traumatic SCI is a major source of morbidity, mortality, and imposed cost on society as a whole. Surgical treatment remains an essential tool in management and the controversy regarding the timing of surgery needs to be resolved. Presurgical reduction is considered safe and essential in the management of SCI with loss of alignment, at least as an initial step in the overall care of a SCI patient.

Practical Implications

Reduction Safety

Presurgical reduction is generally safe and important for SCI with alignment loss.

Timing of Surgery

The ideal surgical timing for SCI remains controversial and requires further research.

Surgical Approach

Surgical approach should be tailored to the individual patient's injury and goals.

Study Limitations

1
Heterogeneity of human SCI makes conclusions difficult.
2
Limited number of human spinal surgical studies with prospective, randomized, or controlled methodologies.
3
Lack of consensus on optimum timing of surgical treatment.

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