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Early decompression an option for some patients with severe central cord injuries

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BOSTON — A debate held at the Congress of Neurological Surgeons Annual Meeting here highlighted why decisions about the timing of surgical decompression of central cord injuries require a balanced approach.

According to the debaters, Michael G. Fehlings, MD, PhD, FRCSC, FACS, and Paul M. Arnold, MD, FACS, such decisions should take into account the patient’s biology, the severity of the injury and other factors.

However, surgeons should be aware that much of the literature does not support early intervention in these cases, Arnold said.

“I operate on everybody ... Not all in 24 hours, but I operate on them a lot earlier than I used to,” Fehlings said during his argument for early decompression.

He urged spine surgeons to avoid “old thinking” when it comes to managing these patients and said he recently took his own advice. Today, Fehlings operates on patients who have severe central syndrome early, within 24 hours, which represents a shift from his former practices.

Arnold, who argued against decompression in severe central cord injury cases, said many questions are still unanswered about this treatment. Some of the advantages of delaying surgery are that patients may get better and can perhaps avoid the complications known to be associated with early surgery, according to Arnold.

“Early decompression, for me, should only be considered an option,” he said.

However, Arnold agreed with Fehlings in the belief that the timing of decompression should be individualized, not universal. — by Susan M. Rapp

Reference:

Arnold PM. Against. Controversy: Early decompression for central cord injury — A question of balance?  Presented at: Congress of Neurological Surgeons Annual Meeting; Oct. 18-22, 2014; Boston.

Fehlings MG. For. Controversy: Early decompression for central cord injury — A question of balance?  Presented at: Congress of Neurological Surgeons Annual Meeting; Oct. 18-22, 2014; Boston.

Disclosures: Arnold has no relevant financial disclosures. Fehlings receives support from AOSpine.