Emerging approaches to the surgical management of acute traumatic spinal cord injury

Abstract

Traumatic, spinal cord injury (SCI) is a potentially catastrophic event causing major impact at both a personal and societal level. To date, virtually all therapies that have shown promise at the preclinical stage of study have failed to translate into clinically effective treatments. Surgery is performed in the setting of SCI, with the goals of decompressing the spinal cord and restoring spinal stability. Although a consensus regarding the optimal timing of surgical decompression for SCI has not been reached, much of the preclinical and clinical evidence, as well as a recent international survey of spine surgeons, support performing early surgery (<24 hours). Results of the multicenter, Surgical Trial in Acute Spinal Cord Injury Study (STASCIS), expected later this year, should further clarify this important management issue. The overall goal of this review is to provide an update regarding the current status of surgical therapy for traumatic SCI by reviewing relevant pathophysiology, laboratory, and clinical evidence, as well as to introduce radiologic and clinical tools that aid in the surgical decision-making process.

FIG. 1

Preoperative T2-weighted cervical spinal magnetic resonance image demonstrating spinal cord compression at level C6-C7 with concomitant hyperintense signal changes within the cord. Based on the formula from Table 1, the degree of spinal cord compression is (1 - [0.4/(0.8 + 0.7)/2]) × 100% = 53%.

FIG. 2

Postoperative T2-weighted cervical spinal magnetic resonance image at 1-year postinjury demonstrating complete decompression of the spinal cord and restoration of normal cervical spinal alignment.