Impact of surgery on the outcome after spinal cord injury – current concepts and an outlook into the future

Neural Regeneration Research, 2016 · DOI: 10.4103/1673-5374.197132 · Published: December 1, 2016

Simple Explanation

Traumatic spinal cord injury (SCI) remains a devastating neurological disorder leading to severe consequences for the affected individual and their families. Early surgical intervention is recommended nowadays for spinal cord injuries, but the timing and precise role of surgery remain controversial among clinicians. Maintaining mean arterial pressure (MAP) above 85–90 mmHg is recommended – especially for patients with cervical injuries.

Study Duration

1 year follow-up period

Participants

More than 300 patients

Evidence Level

Prospective cohort study

Key Findings

1
Early decompression (within 24 hours) positively influences neurological outcome compared to later intervention without increasing complication rates.
2
“ultra-early” decompression within the first 8 hours might be even more beneficial. Neurologic recovery was superior if surgical intervention occurred within the first 8 hours versus 8–24 hours
3
Rapid intervention might lead to a significant gain of segmental medullary function as indicated by more caudal neurological and motor levels in the early decompressed group.

Research Summary

Early surgical management seems to be justified in most SCI patients. In recent years, the current practice changed towards “ultra-early decompression” and we have seen a paradigm shift, where clinical complete patients are considered as a neurologic emergency. In the future, advanced neuromonitoring will probably deliver important new insights and will allow an optimized and individualized acute care of SCI patients.

Practical Implications

Surgical Timing

Early surgical intervention, particularly within 24 hours or even within 8 hours, can significantly improve neurological outcomes for SCI patients.

Clinical Assessment

Rapid surgical management seems justified in most patients, regardless of their initial clinical presentation. Clinical complete syndromes don't necessarily equate to anatomical completeness.

Neuromonitoring

Advanced neuromonitoring techniques, such as measuring intraspinal pressure, can provide valuable insights for optimizing acute care and individualizing treatment strategies.

Study Limitations

1
Not all patients profit from early surgery, especially those with central cord syndromes and multiple comorbidities.
2
Surgery may need to be delayed due to polytrauma or concomitant traumatic brain injury.
3
Lack of level-1 evidence recommending early surgical intervention has been criticized.

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