An Update of a Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role and Timing of Decompressive Surgery

This clinical practice guideline (CPG) aims to update recommendations from 2017 regarding the best timing for surgery to relieve pressure on the spinal cord after an acute injury. The guideline development group (GDG) consisted of spine surgeons, neurologists, critical care specialists, emergency medicine doctors, physical medicine and rehabilitation professionals, as well as individuals living with SCI. The group looked at evidence for both 'early' surgery (within 24 hours of injury) and 'ultra-early' surgery (especially within 12 hours) to see how they affected recovery.

• 1
  The guideline recommends that early surgery (within 24 hours of injury) should be considered for adult patients with acute spinal cord injury, no matter the severity or location of the injury.
• 2
  Patients who had surgery within 24 hours were about twice as likely to show significant improvement (≥2 ASIA Impairment Scale grades) at both 6 and 12 months after the injury.
• 3
  The group could not make a recommendation for ultra-early surgery (less than 12 hours) because the evidence was limited and inconsistent.