%0 Journal Article
%T Controversies in the Surgical Management of Spinal Cord Injuries
%A Ahmed M. Raslan
%A Andrew N. Nemecek
%J Neurology Research International
%D 2012
%I Hindawi Publishing Corporation
%R 10.1155/2012/417834
%X Traumatic spinal cord injury (SCI) affects over 200,000 people in the USA and is a major source of morbidity, mortality, and societal cost. Management of SCI includes several components. Acute management includes medical agents and surgical treatment that usually includes either all or a combination of reduction, decompression, and stabilization. Physical therapy and rehabilitation and late onset SCI problems also play a role. A review of the literature in regard to surgical management of SCI patients in the acute setting was undertaken. The controversy surrounding whether reduction is safe, or not, and whether prereduction magnetic resonance (MR) imaging to rule out traumatic disc herniation is essential is discussed. The controversial role of timing of surgical intervention and the choice of surgical approach in acute, incomplete, and acute traumatic SCI patients are reviewed. Surgical treatment is an essential tool in management of SCI patients and the controversy surrounding the timing of surgery remains unresolved. Presurgical reduction is considered safe and essential in the management of SCI with loss of alignment, at least as an initial step in the overall care of a SCI patient. Future prospective collection of outcome data that would suffice as evidence-based is recommended and necessary. 1. Introduction Traumatic spinal cord injury (SCI) affects over 200,000 people in the USA, with nearly 10,000 new injuries reported annually [1¨C3]. People affected by SCI are usually young (average age 32 years) and life expectancy is marginally lower when compared with a non-SCI population. Hence, the ramifications of the injury itself as well as the medical decisions made can result in enormous economic burden and social cost [4]. Long-term outcome after SCI comprises a combination of the initial extent of the injury, natural recovery from injury, medical interventions, rehabilitation, and social/community reintegration. Several components play a role in management of SCI. Initially, acute management includes medical agents administered with the goal of reducing secondary injury cascade, and an initial surgical treatment that usually includes either all or a combination of reduction, decompression, and stabilization. Physical therapy and rehabilitation, which can lead to a significant impact on overall recovery is an additional component. Finally, late onset SCI problems, such as bowel and bladder dysfunction, pain, spasticity, and problems with automatic breathing, play a role. This paper focuses on the surgical management of SCI in the acute setting. Later
%U http://www.hindawi.com/journals/nri/2012/417834/