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Surgical Stabilization

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After traumatic SCI, surgical stabilization serves multiple purposes. Apart from the primary goal of decompression of neural structures, the restoration of mechanical stability can reduce pain, eliminate the need for a cervical collar or other activity restrictions, and facilitate nursing and other rehabilitation. The precise method of mechanical stabilization can be variable but consists of non-surgical rigid orthosis, versus open stabilization through a variety of anterior, posterior or circumferential instrumentation and fusion maneuvers.

Table 5 Surgical Stabilization after SCI

Discussion

Non-operative methods of spine stabilization are sometimes used, especially for cervical spine injuries. Halo vest immobilization is most commonly indicated for injuries of the atlantoaxial joint or high cervical spine. To specifically assess individuals with sub-axial cervical spine injuries, Bucci et al. (1988) published a retrospective review of immobilization plus surgery versus immobilization with halo vest alone. Many of the nonsurgical individuals eventually required crossover to receive surgical treatment, and some experienced neurological worsening during halo vest application. As such, for this type of sub-axial cervical spine injuries, surgery is generally preferred to halo vest immobilization in sufficiently unstable injuries.

Rimoldi et al. (1992) assessed the effect of stabilization method on rehabilitation time in thoracolumbar SCI. Although the surgical constructs used are outdated and no longer in use, the finding that individuals judged to have a more mechanically stable construct, and whom were able to avoid orthosis use, may be generalizable.

Among individuals receiving surgical stabilization of the cervical spine, a common management dilemma is whether to provide stabilization from an anterior approach, a posterior approach, or both. Capen et al. (1985) published a retrospective analysis suggesting small proportions of neurologic worsening in each group; however, this study is of limited use today as the fixation techniques are no longer in use.

Conclusion

There is conflicting level 4 evidence (based on three case series;(Bucci et al., 1988; Capen et al., 1985; Rimoldi et al., 1992)on the effectiveness of surgical and non-surgical mechanical stabilization methods post SCI; methods described in the literature are quite dated and no longer used clinically.

  • Method of mechanical stabilization can be variable and consist of non-surgical rigid orthosis or open stabilization (e.g., anterior, posterior or circumferential instrumentation and fusion manoeuvres); however, the methods described in the literature are no longer used in clinical practice today.