Surgical decompression in acute spinal cord injury: earlier is better

• Published in: Lancet neurology Vol. 20; no. 2; pp. 84 - 86
• Main Authors: Maas, Andrew I R, Peul, Wilco, Thomé, Claudius
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2021; Elsevier Limited
• Subjects: Clinical medicine; Compression; Decompression; Decompression, Surgical; Humans; Open data; Patients; R&D; Research & development; Spinal cord injuries; Spinal Cord Injuries - surgery; Subarachnoid hemorrhage; Surgery; Thorax; Traumatic brain injury
• ISSN: 1474-4422; 1474-4465
• DOI: 10.1016/S1474-4422(20)30478-6

Productive examples in neurology include the IMPACT studies on traumatic brain injury,2 the establishment of Federal Interagency Traumatic Brain Injury Research (FITBIR), and the Subarachnoid Haemorrhage International Trialists' (SAHIT) repository.3 In the field of SCI, an Open Data Commons for SCI (ODC-SCI) has been established with support from the National Institutes of Health, the Craig H Neilsen Foundation, Wings for Life, the International Spinal Research Trust, and the Rick Hansen Institute.4 However, this Open Data Commons has a primary focus on preclinical research, and there is no platform for accessing pooled clinical studies on SCI for meta-analyses. Results should be put in perspective with the current evidence and persisting dogmas in clinical care; current guidelines5 provide only weak recommendations for surgical decompression within 24 h, regardless of indication criteria, and complete and thoracic SCI are still commonly addressed in a non-urgent fashion without providing recommendations on the timing of surgery.6 As a consequence, considerable variation exists in practice: in several regions many SCI patients with spinal cord compression either do not receive surgery or surgery is delayed. Developing more individualised surgical indications and determining optimal surgical approaches will require large patient numbers, which can perhaps best be facilitated by establishing a data repository for SCI studies or the creation of large-scale registry data which includes sufficient clinical detail.