Outcomes of Spinal Cord Injury: WFNS Spine Committee Recommendations

Area of Science:

• Neurosurgery
• Orthopedics
• Spinal Cord Injury Research

Background:

• Cervical spinal cord injury (CSCI) management outcomes are influenced by multiple factors.
• Definitive statements on prognostic indicators and treatment efficacy are needed.

Purpose of the Study:

• To establish consensus-based statements on factors influencing CSCI management outcomes.
• To provide recommendations for clinical practice and future research.

Main Methods:

• Comprehensive literature review of studies from the last decade.
• Consensus building using the Delphi method among WFNS Spine Committee members and experts.
• Re-evaluation of statements in subsequent expert meetings.

Main Results:

• Traumatic spinal cord syndromes generally have a good prognosis, with exceptions for the elderly or those with severe initial deficits.
• Early decompressive surgery (within 24 hours) yields better results than delayed management.
• Magnetic resonance imaging (MRI) T2 imaging, along with other radiological parameters (e.g., BASIC score), are crucial prognostic indicators.
• Diffusion tensor imaging (DTI) shows promise as a future predictive tool.

Conclusions:

• Clinical presentation, radiological findings, and timely surgical decompression significantly impact CSCI outcomes.
• Conservative management can be satisfactory, but surgery improves outcomes in cases of instability or progressive compression.
• Locked facet joints in spinal cord injury indicate a poor prognosis.