Surgical stabilisation of the spine

It is important to assess spinal injuries, both in terms of cord damage and column damage, shortly after the trauma has occurred. A decision should then be made concerning the eventual stability of the bony vertebral column. If a lesion is unlikely to heal soundly by bone or if one is unable to obtain a reduction by conservative measures, one should consider surgical stabilisation of the damaged spine in the subacute phase. At the same time as one stabilISES THe spine with metallic fixation, bone grafts should be added for ultimate stability. If an unstable spine is encountered in the later stages of treatment, surgical stabilisation is again indicated. Metallic fixation can greatly aid in stabilising the spine until bone grafts can mature. Osteotomies of the spine through a combined transthoracic and posterior approach can be extremely valuable in correcting deformity. While there is no role for decompressive surgery after spinal cord injury, there is still a definite role for surgery in balancing and stabilising the vertebral column.