Time is spine: critical updates for the intensivist

The concept of 'time is spine' emphasizes early or ultra-early surgical decompression within 24 or 12 h, respectively, after spinal cord injury (SCI) to maximize recovery. This review updates the latest findings on the timing of surgical decompression and hemodynamic management in acute SCI, focusing on neurological outcomes and complications.

While early decompression may improve neurological outcomes, factors like injury severity, comorbidities, and system resources affect surgical timing. Recent studies question the benefits of ultra-early decompression, finding no significant improvement at 12 months, suggesting earlier analyses may have overstated its benefits. Current recommendations include tailoring decompression timing to individual cases, considering patient-specific and systemic factors. New techniques like spinal cord pressure monitoring, intraoperative ultrasound, and advanced imaging are advancing targeted intervention and hemodynamic management in SCI.

The timing of spinal decompression and hemodynamic management may impact neurological function, however, because of the deficiencies of current studies, individualized, patient-tailored decision-making is critical. A multidisciplinary approach that considers injury severity and patient characteristics is essential for optimal management. Further research is required to refine the timing of surgical intervention and explore additional factors influencing recovery.