Surgery for spinal injury with neurologic deficit: a matter of opinion?

The establishment of a new technology into the mainstream of treatment, such as spinal surgery for traumatic spinal cord injury, only rarely happens after being scrutinized in trials. Usually, a new technology is widely adopted when it offers an easily identifiable advantage over other treatment choices. In the case of spinal fixation, this advantage is the omission of a prolonged immobilization. However, this does not automatically preclude that the final outcome of the treatment is better. It does not imply that associated assumptions, such as the benefit of early decompression toward neurological improvement, are true as well. They need to be established with careful studies.