Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004

TLDR

The timing of surgical intervention after destabilizing cervical or thoracic spine trauma is controversial, with clinical studies failing to show a clear neurological benefit, although basic science indicates the early postinjury period may offer a unique therapeutic window. Early surgical stabilization of the spine yields significant nonneurological benefits—such as faster mobilization, fewer pulmonary and pressure sore complications, shorter ICU and hospital stays, and lower costs—and, despite limited neurological recovery, animal and recent clinical studies support its use—particularly for unstable thoracic injuries—leading the authors to recommend timely stabilization whenever feasible.

Abstract

U Appropriate timing for surgical intervention following destabilizing cervical or thoracic spine trauma remains controversial. Clinical investigators have failed to provide convincing evidence that the timing of surgery significantly affects neurological outcome in most situations. Nevertheless, early surgical stabilization of the injured spine has been shown to provide significant nonneurological benefits such as more rapid patient mobilization, facilitation of treating associated injuries, reduction in rates of pulmonary and pressure sore complications, reduction in duration of intensive care unit and hospital stays, and a decrease in overall medical costs. The findings of basic science studies have improved our understanding of the molecular and cellular events surrounding initial and secondary spinal cord injury (SCI), and analysis of these findings suggests that the early postinjury period may present a unique opportunity for meaningful intervention. This possibility has been supported by results obtained in animal studies that demonstrate the potential for improving functional outcome when surgical intervention is performed within a few hours following experimental SCI. Despite the absence of significant neurological recovery in most clinical studies, the results of most recent clinical studies strongly support the overall clinical benefits of early surgical intervention, particularly in the setting of unstable thoracic spinal column injury with associated SCI. Based on the best available scientific and clinical evidence, the authors report that it is therefore recommended that surgical stabilization be performed in as timely a fashion as possible, particularly for unstable thoracic spine trauma, within the constraints of the patient’s overall medical condition and availability of appropriate resources.