Session III - Spine

Emergent Spinal Cord Decompression and Stabilization

Rush Fisher, MD; Daxes Banit, MD; Greg Grau, BA; University of Kentucky, Lexington, KY

Study Design: Prospective study of consecutive trauma patients with spine trauma and neurologic deficit.

Objective: To determine the feasibility of emergent spinal decompression and stabilization in the trauma patient.

Summary of Background Data: Earlier reports in the literature advocates delayed surgical intervention for the spine injured patient. However, advances in trauma triage, critical care, early orthopaedic stabilization principles and in vivo studies in dogs indicating a viscoelastic property to the spinal cord and neural structures, challenge the prudence of delayed surgery.

Materials and Methods: Seventeen consecutive patients with spine trauma and neurologic deficit were treated by a single surgeon over a 7-month period. All patients had their spines decompressed and stabilized within 12 hours. Seven of these patients were decompressed within 8 hours. All patients were evaluated for pre- and postoperative neurologic function, length of surgery, blood loss, perioperative complications and length of stay in the intensive care unit (ICU) and hospital.

Results: Of the seventeen patients, 11 improved at least one ASIA grade postoperatively. Two patients made dramatic improvement from complete SCI to ASIA E. One patient experienced a decline in neurologic function consistent with a very dense anterior cord syndrome and injury to the anterior spinal artery. One patient experienced unexplained near total blindness 18 hours after surgery and 26 hours after trauma. Though subjective, the critical care service looked very favorably upon early spine stabilization in their management of the severe polytrauma patient.

Conclusion: In this short trial period and small study group, the benefits appeared to outweigh the risks of emergent spinal cord decompression and stabilization. In the ICU setting, there also appears to be a window, similar to other orthopaedic management of the polytrauma patient, in which the spine can be stabilized before the patient's health deteriorates as a result of other organ injury. With appropriate surgical planning and streamlining of the trauma evaluation, emergent spinal cord decompression and stabilization is feasible and favorable to the management of the spinal trauma patient. A larger study is need to fully evaluate and standardize outcomes.