Operative and nonoperative management of spinal cord injury. A review

Technological developments over the last two centuries have advanced the spinal surgeon's capability to service the needs of the spinal cord injured person. While the role that surgery can play in shortening hospitalization for tetraplegics has yet to be proven, it does play a much needed role in the correction of instability and prevention of deformity when the possibility of these conditions exist. Surgical intervention for purposes of neural decompression has yet to be proven as justifiable in view of the risks involved. All surgical procedures must be undertaken only after due consideration of the patients' general medical condition, including coexisting trauma, the potential for and actual instability and deformity of the spine, and the neurological level and degree of incompleteness of the patient. In general, the greater the remaining neurological function, the more there is to be gained by early mobilization. Yet, in the face of progressive improvement in neurological function, caution is advised since there will be much to lose if anything goes wrong with the operation.