Spine Surgery After Spinal Cord Injury: Why Timing Matters

Two goals of spine surgery after spinal cord injury that can benefit a patient’s long-term functional and sensory outcomes.

Spine surgery plays an essential role in the traumatic spinal cord injury (SCI) treatment plan. Undergoing surgery shortly after the injury may have meaningful benefit for people with SCI, as studies link early surgical intervention to better long-term outcomes.

Two Goals of Spine Surgery After Spinal Cord Injury
If you’ve been through a traumatic event, your spinal column and spinal cord may have sustained significant damage. A particular region or level of your spine could be unstable, and different anatomical structures (eg, vertebral bone, disc, ligament) may be compressing on your spinal cord.

Spine surgery may be used to resolve these issues by:

  1. Decompressing the spinal cord
  2. Re-stabilizing the spine

Cross section through the spinal column showing fractured vertebrae and damage to the spinal cord.Vertebral fractures have destabilized a section of the spinal column and compressed the spinal cord.Spinal Decompression Surgery and Fusion
The goal of decompression surgery is to relieve the pressure on the spinal cord and/or spinal nerves. This can be accomplished by removing damaged structures (eg, herniated disc, bone fracture) or soft tissues pressing on the cord and nerves—thereby creating space around these neural elements.

Different types of decompression procedures exist (such as laminotomy and laminectomy), and your spine surgeon will choose the best procedure or combination of techniques based on many factors (eg, spinal level involved), including your injury.

Sometimes a spinal decompression surgery is all that is needed. However, if your spine is unstable, spinal stabilization surgery, often with spinal fusion is performed following decompression. Your spine may be unstable from the traumatic event, or the decompression procedure may create spinal instability, as it may have involved removing bone, disc or soft supporting tissue.

Spinal stabilization surgery often includes instrumentation and fusion. Instrumentation refers to different types of implantable devices, such as rods, screws, plates, or interbody cages. While instrumentation provides an element of immediate spinal stabilization, fusion is the glue. Fusion involves autograft (your own bone) or allograft (donor bone) that is packed into and around the instrumentation to stimulate bony ingrowth and healing. There are different types of bone graft products. Over several months the fusion heals the spine into a solid mass.

Decompression, spinal instrumentation and fusion are surgical procedures that may help preserve your quality of life after SCI by helping to prevent spinal deformity, pain and progression of nerve-related damage (eg, weakness, tingling, and bowel and bladder problems).

However, the longer you have untreated nerve damage, the more likely it may become permanent. That’s why it’s important to undergo spine surgery as soon as it’s safe after your injury.

Why Spine Surgery Shortly After Trauma Is Important
One of the benefits of having spine surgery shortly after suffering a SCI is it helps preserve healthy blood flow to your spinal cord.

Inadequate blood flow caused by prolonged spinal cord compression promotes the secondary injury cascade (which you can read more about in Traumatic Spinal Cord Injury Triggers a Cascade of Biological Events). If the secondary injuries after the initial SCI are minimized, you may have better long-term outcomes.

There aren’t many quality studies examining the effectiveness of early spine surgery on long-term SCI outcomes, but the available evidence supports the idea that delaying surgery is connected to poorer outcomes.

Several studies showed that decompression surgery is a safe and effective procedure after traumatic spine injury. In fact, one study showed that patients who sustained a cervical SCI and had spine surgery within 24 hours of their injury had greater odds of receiving at least a 2-grade improvement in the ASIA Impairment Scale compared to those who had surgery more than 24 hours after their injury (you can learn more about how the ASIA Impairment Scale grades SCI severity in Spinal Cord Injury Classification and Syndromes).

Research has also connected early spinal decompression surgery to greater improvements in functional recovery, and reduced hospital stays, complication rates, and health care costs.

While the available evidence supports early surgical intervention after traumatic spinal cord injury, there’s no standard clinical guideline about the optimal timing of decompression spine surgery. Your spine surgeon will take your specific injury into account when determining the best time for you to undergo surgery.

Suggested Additional Reading
A special issue of the Global Spine Journal set forth guidelines for the Management of Degenerative Myelopathy and Acute Spinal Cord Injury, which is summarized on SpineUniverse in Summary of the Clinical Practice Guidelines for the Management of Degenerative Cervical Myelopathy and Traumatic Spinal Cord Injury.

Updated on: 01/10/18
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