Abstract
BackgroundThere is no clear evidence that early decompression following spinal cord injury (SCI) improves neurologic outcome. Such information must be obtained from randomized controlled trials (RCTs). To date no large scale RCT has been performed evaluating the timing of surgical decompression in the setting of thoracolumbar spinal cord injury. A concern for many is the ethical dilemma that a delay in surgery may adversely effect neurologic recovery although this has never been conclusively proven. The purpose of this study is to compare the efficacy of early (before 24 hours) verse late (24–72 hours) surgical decompression in terms of neurological improvement in the setting of traumatic thoracolumbar spinal cord injury in a randomized format by independent, trained and blinded examiners.MethodsIn this prospective, randomized clinical trial, 328 selected spinal cord injury patients with traumatic thoracolumbar spinal cord injury are to be randomly assigned to: 1) early surgery (before 24 hours); or 2) late surgery (24–72 hours). A rapid response team and set up is prepared to assist the early treatment for the early decompressive group. Supportive care, i.e. pressure support, immobilization, will be provided on admission to the late decompression group. Patients will be followed for at least 12 months posttrauma.DiscussionThis study will hopefully assist in contributing to the question of the efficacy of the timing of surgery in traumatic thoracolumbar SCI.Trial RegistrationRCT registration number: ISRCTN61263382
Highlights
There is no clear evidence that early decompression following spinal cord injury (SCI) improves neurologic outcome
The role and timing of surgical decompression after an acute spinal cord injury (SCI) remains one of the most controversial topics pertaining to spinal surgery [1]
The primary mechanism, usually caused by rapid spinal cord compression caused by bone displacement from a fracture-dislocation or burst fracture, is irreversible
Summary
There is no clear evidence that early decompression following spinal cord injury (SCI) improves neurologic outcome. Such information must be obtained from randomized controlled trials (RCTs). The role and timing of surgical decompression after an acute spinal cord injury (SCI) remains one of the most controversial topics pertaining to spinal surgery [1]. The primary mechanism, usually caused by rapid spinal cord compression caused by bone displacement from a fracture-dislocation or burst fracture, is irreversible. It initiates a cascade of secondary injury mechanisms, including ischemia, electrolyte derangements, and lipid peroxidation. Secondary injury is preventable and may be reversible [3]
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