Spine and Bone Heath Department, Bragborough Hall Health Centre, Daventry, UK.
Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China.
Bone Joint J. 2023 Mar 15;105-B(4):347-355. doi: 10.1302/0301-620X.105B4.BJJ-2023-0111.
Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial. However, there has never been a properly conducted trial of surgery versus active conservative care. As a result, it is still not known whether early surgery or active physiological management of the unstable injured spinal cord offers the better chance for recovery. Surgeons who care for patients with traumatic spinal cord injuries in the acute setting should be aware of the arguments on all sides of the debate, a summary of which this annotation presents.
2023 年，创伤性脊髓损伤的初始治疗仍然存在争议，就像 19 世纪阿斯特利·库珀爵士和查尔斯·贝尔爵士争论手术缓解脊髓压迫的优缺点一样。尽管早期手术缺乏高质量的证据，但迅速干预已成为手术规范。在过去十年中，这种证据不足的情况逐渐得到解决，更多的现代统计方法被用于澄清一些问题，这一点在 SCI-POEM 试验的结果中得到了体现。然而，从来没有进行过手术与积极保守治疗的对照试验。因此，目前仍不清楚早期手术还是对不稳定的损伤脊髓进行积极的生理管理，哪种方法能提供更好的恢复机会。在急性环境中照顾创伤性脊髓损伤患者的外科医生应该了解辩论各方的观点，本注释对此进行了总结。
