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Early surgical intervention for acute spinal cord injury: time is spine

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Abstract

Acute traumatic spinal cord injury (tSCI) is a devastating occurrence that significantly contributes to global morbidity and mortality. Surgical decompression with stabilization is the most effective way to minimize the damaging sequelae that follow acute tSCI. In recent years, strong evidence has emerged that supports the rationale that early surgical intervention, within 24 h following the initial injury, is associated with a better prognosis and functional outcomes. In this review, we have summarized the evidence and elaborated on the nuances of this concept. Additionally, we have reviewed further concepts that stem from “time is spine,” including earlier cutoffs less than 24 h and the challenging entity of central cord syndrome, as well as the emerging concept of adequate surgical decompression. Lastly, we identify barriers to early surgical care for acute tSCI, a key aspect of spine care that needs to be globally addressed via research and policy on an urgent basis.

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Acknowledgements

N. H. is supported by the Research Fund of the University of Basel for Excellent Junior Researchers. M. G. F. is supported by the Robert Campeau Family Foundation/Dr. C. H. Tator Chair in Brain and Spinal Cord Research at UHN.

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Authors and Affiliations

  1. Institute of Medical Science, University of Toronto, Toronto, ON, Canada

    Ayesha Quddusi, Karlo M. Pedro & Michael G. Fehlings

  2. Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada

    Karlo M. Pedro, Mohammed Ali Alvi, Nader Hejrati & Michael G. Fehlings

  3. Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada

    Nader Hejrati & Michael G. Fehlings

  4. Toronto Western Hospital, 399 Bathurst Street, Suite 4WW-449, Toronto, ON, M5T 2S8, Canada

    Michael G. Fehlings

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Quddusi, A., Pedro, K.M., Alvi, M.A. et al. Early surgical intervention for acute spinal cord injury: time is spine. Acta Neurochir 165, 2665–2674 (2023). https://doi.org/10.1007/s00701-023-05698-0

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