Every year, nearly 12,000 individuals in the United States and Canada, mostly young adults, sustain a spinal cord injury (SCI). According to the Centers for Diseases Control and Prevention (CDC), SCI costs an estimated $9.7 billion each year in the United States alone.
Although there are some surgical interventions, such as decompression, which neurosurgeons administer to SCI patients after injury, these procedures have not dramatically improved overall recovery and outcome. "This is an area of medicine that has not seen tremendous scientific advances, so there remains an urgent need to improve upon current interventions to help restore neurological function in patients with acute SCI," said Michael Fehlings, MD, PhD, FRCSC, FACS, head of the Krembil Neuroscience Center at the University Health Network in Toronto and professor of Neurosurgery at the University of Toronto.
Surgical decompression of the spinal cord is often done after an injury occurs, although the timing of this intervention varies widely. Surgery involves the removal of various tissue or bone fragments that are compressing and comprising the spinal cord. Depending on the unique circumstances of the injury, decompression is accomplished through a variety of surgical approaches, including, for example, approaching the compressed cord from either the front (anterior) or back (posterior).
The role and timing of decompression in patients with SCI is controversial. Despite a strong biological rationale, the clinical data to support early decompression are unconvincing. Accordingly, researchers conducted a prospective multicenter study to evaluate the role and timing of decompressive surgery in a consecutive series of patients with cervical SCI. The Surgical Treatment of Acute Spinal Cord Injury Study (STASCIS) has enrolled 170 patients to date.
The findings of this study, A Prospective Multicenter Trial to Evaluate the Role and Timing of Decompression in Patients with Cervical Spinal Cord Injury: Initial One-Year Results of the STASCIS Study, will be presented by Dr. Fehlings, 10:25 to 10:39 a.m. on Monday, April 28, 2008, during the 76th Annual Meeting of the American Association of Neurological Surgeons in Chicago. Co-authors are Bizhan Aarabi, MD, Marcel Dvorak, MD, FRCSC, Charles G. Fisher, MD, FRCSC, James Harrop, MD, Stephen Lewis, MD, Eric M. Massicotte, MD, FRCSC, Y. Raja Rampersaud, MD, Christopher Shaffrey, MD, and Alexander Vaccaro, MD; FRCSC.
Patients with cervical SCI (American Spinal Injury Association (ASIA) grades A-D) and evidence on computed tomography (CT)/magnetic resonance imaging (MRI) of canal/cord compression were entered into the prospective multicenter nonrandomized case-control study. ASIA grade 'A' designates complete SCI, and Grades 'B' through 'D' designate decreasing levels of neurological involvement. Decompression was achieved by traction and/or surgery. Additional patient demographics were as follows: