Time is spine: What's over the horizon.

The overarching theme in the early treatment of acute spinal cord injury (SCI) is to reduce the extent of secondary damage to facilitate early neurological and functional recovery. Although multiple studies have brought us innovative and potential new therapies to treat SCI, ameliorating neural damage remains a formidable challenge. Knowledge translation of clinical and basic research studies has shown that surgical intervention is a valuable treatment modality; however, the role, timing and optimal technique in surgery remains a topic of great controversy. While evidence to support the concept of ultra-early surgery for acute SCI continues to emerge, current protocols and international guidelines that encourage reducing time from trauma to surgery support the concept of "Time is Spine". The present article provides a critical narrative review of the current best practice, with a particular focus on the timing of surgical intervention, which shapes our understanding of how time is of the essence in the management of acute SCI.

Early Decompressive Surgery for Compressive Neuropathy by Hematoma after Posterior Spinal Decompressive Surgery / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis was performed to identify the diagnostic and therapeutic factors related to postoperative compressive neuropathy by hematoma after posterior spinal decompressive surgery. OBJECTIVES: To document by analysis the clinical course of postoperative compressive neuropathy by hematoma, the efficacy of early surgical decompression, and to recommend methods of prevention. SUMMARY OF LITERATURE REVIEW: Various diagnostic and treatment modalities have been applied to postoperative compressive neuropathy after spinal surgery. However, the timing of surgical decompression remains controversial. MATERIALS AND METHODS: Five cases of postoperative compressive neuropathy after posterior spinal decompressive surgery, which occurred from May 1996 to May 2000, were investigated in terms of causes, clinical courses, and management profiles after early surgical decompression, and final outcome. RESULTS: Five cases (2.14%) among 234 patients were managed by re-decompression including the evacuation of hematoma. Four cases, which had been managed by earlier surgical decompression showed neurologic improvement after 2 postoperative weeks, and achieved favorable clinical results without grave neurologic sequelae. However, in one case, in which surgical decompression had been delayed, weakness of the peroneii remained. CONCLUSION: Early evacuation of hematoma achieved a more favorable result than a delayed operation. Early diagnosis and prompt surgical decompression is recommended to reduce neurologic sequelae.