What is the role of surgery in the treatment of spinal cord injury (SCI)?

Updated: Nov 01, 2018
  • Author: Lawrence S Chin, MD, FACS, FAANS; Chief Editor: Brian H Kopell, MD  more...
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Spine service consultants should determine the need for and timing of any surgical intervention. Currently, there are no defined standards existing regarding the timing of decompression and stabilization in spinal cord injury. The role of immediate surgical intervention is limited. Emergent decompression of the spinal cord is suggested in the setting of acute spinal cord injury with progressive neurologic deterioration, facet dislocation, or bilateral locked facets. Emergent decompression is also suggested in the setting of spinal nerve impingement with progressive radiculopathy and in those select patients with extradural lesions such as epidural hematomas or abscesses or in the setting of the cauda equina syndrome.

A prospective surgical trial, the Surgical Treatment for Acute Spinal Cord Injury Study (STASCIS) conducted by the Spine Trauma Study Group, is ongoing. Preliminary data from this study are showing that 24% of patients who receive decompressive surgery within 24 hours of their injury experience a 2-grade or better improvement on the ASIA scale, compared with 4% of those in the delayed-treatment group. Furthermore, the study found that cardiopulmonary and urinary tract complications were found to be 37% in the early surgery group compared with the delayed group rate of 48.6%. The hope is that the final data from STASCIS will better define the benefits and timing of early surgical decompression and stabilization.

A review article of spinal fixation surgery for acute traumatic spinal cord injury concluded that, in the absence of any randomized controlled studies, no recommendations regarding risks or benefits could be made. [53]

Previous studies from the 1960s and 1970s showed that the patients experienced no improvement with emergent surgical decompression, although 2 studies in the late 1990s appeared to show improved neurologic outcomes with early stabilization. Gaebler et al reported that early decompression and stabilization procedures within 8 hours of injury allowed for a higher rate of neurologic recovery. [54] Mirza et al reported that stabilization within 72 hours of injury in cervical spinal cord injury improved neurologic outcomes. [55]

Unfortunately, both the above studies and others were not prospectively controlled or randomized. In the only prospective, randomized, controlled study to determine whether functional outcome is improved in patients with cervical spinal cord injury, Vaccaro et al reported no significant difference between early (< 3 d, mean 1.8 d) or late (>5 d, mean 16.8 d) surgery. [56]

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