Timing of operative care in cervical spinal cord injury.

The emphasis of this review has been on bone pathology and not on neurologic syndromes. We have not discussed those rare conditions in which the neurologic deficit progresses after injury and past authors have recommended decompressive procedures. When neurologic deficits do increase, we think this is more often an indication for further diagnostic studies to see if the alignment is proper, to rule out further compression, or increase medical support if the cardiovascular status has deteriorated. When there has been a dramatic and sudden worsening of the neurologic deficit, as occurs in 3% of patients after the initial injury, the most common etiologic factor has been vascular insufficiency and further infarction of an already damaged cord. This has been substantiated by repeated diagnostic studies without compressive pathology and two pathologic specimens to support our opinion. Strict attention to the guidelines of care for spinal cord injury (1. immobilization; 2. general medical support; 3. alignment; 4. diagnostic procedures; 5. decompression only when necessary; 6. stabilization only when required) should achieve the best possible results when appropriately individualized for particular patients.