AO Spine Clinical Practice Recommendations for the Surgical Management of Acute Traumatic Spinal Cord Injury: Contemporary Concepts

Study Design: Review of the literature with critical appraisal and clinical recommendations. Objective: To highlight contemporary concepts relating to surgical care for acute traumatic spinal cord injury (SCI) based on recent evidence that may be integrated into clinical practice. Methods: Three recent articles relating to the surgical management of acute traumatic SCI were selected and critically appraised. Clinical practice recommendations were developed and graded as strong or conditional. Results: Article 1: Early vs late surgical decompression for central cord syndrome. Strong recommendation to consider early surgery (<24 hours) as an option in patients with ASIA Impairment Scale (AIS) grade C central cord syndrome. Article 2: Extent of decompression in motor complete SCI. Conditional recommendation to consider laminectomy, with or without anterior surgery, to achieve circumferential decompression of the spinal cord. Article 3: Use of intra-operative ultrasound. Conditional recommendation to use ultrasound intra-operatively to confirm the adequacy of surgical decompression. Conclusions: Timely and adequate decompression of the spinal cord are critical priorities in the management of acute traumatic SCI. The importance of timeliness extends to central cord syndrome. Careful consideration and use of operative techniques (e.g., addition of laminectomy) and adjuncts (e.g., intra-operative ultrasound) help achieve safe and adequate decompression of the spinal cord.