This article deals with the main issues of surgical management of acute spinal cord injury patients – discussing the importance of timing of surgery with physiologic stability of the cord, and indications for surgery – absolute and relative. The importance of the type of injury to the spinal column, besides the cord injury, is also discussed. A brief review of relevant literature has been performed to try and answer the question whether early or late surgical treatment for acute spinal cord injury is better than conservative management, reflecting the ethos of treatment for these problems in RJ&AH Orthopaedic Hospital in Oswestry.
JaffrayDCEisensteinSMBalainBet al.Early mobilisation of thoracolumbar burst fractures without neurology – a natural history observation. Bone Joint J2016; 98-B: 97–101.
VaccaroARDaughertyRJSheehanTPet al.Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine1997; 22: 2609–2613.
4.
FehlingsMGArvinB. The timing of surgery in patients with central spinal cord injury. J Neurosurg Spine2009; 10: 1–2.
5.
FehlingsMGVaccaroAWilsonJRet al.Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One2012; 7: e32037–e32037.
6.
Kawanoet al.Outcome of decompression surgery for cervical spinal cord injury without bone and disc injury in patients with spinal cord compression. Spinal Cord2010; 48: 548–553.
7.
StevensEAMarshRWilsonJAet al.A review of surgical intervention in the setting of traumatic central cord syndrome. Spine J2010; 10: 874–880.
8.
Andersonet al.Optimal timing of surgical decompression for acute traumatic central cord syndrome: a systematic review of the literature. Neurosurgery2015; 77(Suppl 4): S15–S32.
9.
LenehanBFisherCGVaccaroAet al.The urgency of surgical decompression in acute central cord injuries with spondylosis and without instability. Spine2010; 35(21 Suppl): S180–S186.
10.
McKinleyWMeadeMAKirshblumSet al.Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch Phys Med Rehabil2004; 85: 1818–1825.
11.
Dvoraket al.The influence of time from injury to surgery on motor recovery and length of hospital stay in acute traumatic spinal cord injury: an observational Canadian cohort study. J Neurotrauma2015; 32: 645–654.
12.
KatohSel MasryWSJaffrayDet al.Neurologic outcome in conservatively treated patients with incomplete closed traumatic cervical spinal cord injuries. Spine1996; 21: 2345–2351.
