Thoracolumbar spinal cord injury: management, techniques, timing

Acute traumatic spinal cord injury (tSCI) is a complex injury where several factors influence neurologic outcome. These factors include the level of injury, injury severity, duration and degree of spinal cord compression, and blood pressure management. Early surgical decompression may lead to a superior neurologic outcome, especially in patients with incomplete tSCI, suggesting surgical decompression to be performed as soon as possible. Circulatory stabilization must be achieved before surgical intervention, and minimally invasive procedures should be preferred. Invasive blood pressure monitoring should be started on admission.

• 1
  Early surgical decompression may lead to a superior neurologic outcome, especially in patients with incomplete tSCI.
• 2
  Patients with complete thoracic tSCI have a reduced potential for neurologic recovery compared to patients with complete cervical tSCI.
• 3
  Posterior reduction, decompression and fixation of thoracic and thoracolumbar spinal injuries is suggested to be performed as damage control surgery aimed to enhance spinal cord perfusion as soon as possible after injury, and should not be postponed for nonmedical reasons, especially in patients with incomplete injuries.