Early surgery: boon for spinal injuries?

A new scientific study suggests that early surgery may benefit people suffering from spinal cord injuries. The finding may help resolve a continuing controversy about when to treat such patients.

Physicians at some medical centers believe that early surgery can exacerbate or cause neurological damage in patients with spinal cord damage. They advocate leaving the patient in traction for about a week until the swelling goes down. Others say there's no harm in performing surgery within days of the injury.

A study led by Walter F. Krengel III of the University of Washington in Seattle now provides data favoring early surgery. The researchers studied 38 people who had suffered a spinal cord injury in the neck area. Most of the injuries were caused by a diving accident, a fall or an automobile accident. Twelve patients received surgical treatment within 72 hours, and 26 went to surgery three days or more after their injury.

The early surgery group developed fewer complications compared with those who got later surgery. The early surgery group also spent less time in the intensive care unit and less time on ventilators, Krengel says.

In addition, the team discovered that, compared to the late surgery group, early surgery patients performed better on one test of neurological functioning. However, two other neurological and motor function tests showed no difference between the two groups of patients.

Rather than exacerbate neurological injury, early surgery may actually improve the outlook for spinal-cord-injury patients, Krengel says.

Does the study put an end to the controversy? Probably not, comments Alan M. Levine, an orthopedic surgeon at the University of Maryland in Baltimore. Krengel's study included only a small number of patients. A larger study is needed to definitively answer the question about when to treat spinal cord injuries, Levine says.

Still, the finding that early surgery seems to cause no harm is important, especially for spinal-cord-injury patients with multiple fractures, Levine says. Such patients need spinal cord surgery before physicians can fix their other injuries. This study suggests that an early trip to the operating room will do no damage--and will let doctors fix the patient's remaining problems as soon as possible, he adds.