Time is spine: critical updates for the intensivist

The principle of ‘time is spine’ suggests that early surgical intervention after a spinal cord injury is crucial to improve patient outcomes. This is similar to the idea of ‘time is brain’ in stroke management. Intensivists play a vital role in the initial assessment and management of SCI patients, focusing on stabilizing the spine, monitoring neurological function, managing hemodynamics, and coordinating multidisciplinary care. While early decompression may be beneficial, the timing of surgery should be tailored to the individual patient, considering factors like injury severity, comorbidities, and available resources. Recent studies question the benefits of ultra-early decompression.

• 1
  Early decompression (within 24 hours) may improve neurological outcomes, but the evidence is not definitive and may be influenced by study methodology and patient heterogeneity.
• 2
  Ultra-early decompression (within 12 hours) did not show statistically significant or clinically meaningful neurological improvements at 12 months in a recent study.
• 3
  The decision regarding surgical timing must consider the specific characteristics of the injury and patient-specific factors that may influence outcomes.