A review of spinal cord injury decompression in experimental animals and human studies

Background: Traumatic spinal cord injury (SCI) is major permanent sequelae of trauma with high burden and low frequency. In the setting of SCI is there any correlation between the timing of surgical  decompression and sensory-motor improvement.

Material and Methods: A literature review was performed using PUBMED from 1966 to 25^th January 2010. Cross referencing of discovered articles was also reviewed.

Results: The results of animal studies have shown that aside from the kind of procedure and species, when compression is less severe and of shorter duration, the neurological and histopathological recovery is significantly good. One meta-analysis, nine prospective studies, and one randomized clinical trial were identified.

Conclusion: There are presently no standards regarding the role and timing of decompression in acute SCI. As a practice guideline, early surgery in less than 24 hours can be done safely in patients with acute SCI and urgent decompression is a reasonable practice option. Traction is the most practical method of achieving urgent decompression after cervical SCI. There are class III data to support a recommendation for urgent decompression in any patient with incomplete SCI with or without neurologic deterioration, with or without bilateral irreducible facet dislocations. There is emerging evidence that surgery within 24 hours may reduce both the length of intensive care unit stay and incidence of medical complications.