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Surgery for Traumatic SCI

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Surgical treatment of traumatic SCI has several proposed benefits. First, after the primary insult has occurred, relief of any ongoing spinal cord compression is theorized to minimize any secondary neurologic injury that might occur via ischemia, inflammation, etc. In a similar manner, surgical decompression is thought to minimize the risk any further cord injury at the injured level. Mechanical stabilization of the injured spinal segment is thought to reduce the risk of future instability and reduce pain at the injured segment. Surgical stabilization often also obviates the need for activity limitations or a cervical collar, thereby facilitating nursing care, and allowing earlier mobilization and ongoing rehabilitation. The purported benefits must be weighed against the risks of surgical treatment. These include the physiological stress of a potentially long, time-intensive, and morbid procedure in a population of individuals who are often critically ill at the time of surgery. Several aspects of surgical treatment of SCI will be reviewed here, including surgical timing, anterior-vs-posterior approaches, prognosis, and comparisons with other treatment methods.