Traumatic spinal injury and spinal cord injury: point for active physiological conservative management as compared to surgical management

Spinal Cord Series and Cases, 2018 · DOI: https://doi.org/10.1038/s41394-018-0045-z · Published: January 16, 2018

Simple Explanation

The paper discusses the historical debate between surgical and conservative treatment for spinal cord injuries, highlighting that early approaches favored conservative methods. Active Physiologic Conservative Management (APCM) involves simultaneous attention to the injured spine and all affected systems, requiring recumbence for 4–6 weeks followed by bracing. APCM aims to protect the spinal cord, maximize neurological recovery, minimize pain, and enable patients to live fulfilling lives in the community at a low cost.

Study Duration

Not specified

Participants

815 consecutive patients (PTS study) or 'Not specified'

Evidence Level

Perspective

Key Findings

1
APCM yields excellent neurological outcomes, with 20–30% of patients with complete SCI improving 1–2 Frankel grades or more.
2
Motor recovery returns in myotomes corresponding to the dermatomes with spino-thalamic sensory sparing (STSS) in patients with both complete and incomplete cord injury.
3
There is no credible evidence that surgical realignment, stabilization, or decompression achieves equality or superiority of outcomes compared to APCM.

Research Summary

The paper advocates for Active Physiologic Conservative Management (APCM) over surgical intervention for traumatic spinal cord injuries, citing historical evidence and physiological rationale. APCM involves a comprehensive approach that addresses both the biomechanical instability of the spine and the systemic effects of spinal cord injury, emphasizing recumbence, bracing, and intensive supportive care. The author concludes that APCM offers comparable or superior neurological outcomes, lower complication rates, and reduced costs compared to surgical management, while also allowing for future advanced imaging and interventions.

Practical Implications

Informed Decision-Making

Patients with spinal cord injuries should be given an informed, evidence-based choice about whether or not to undergo surgery.

Resource Allocation

Healthcare resources should be directed towards centers with expertise in APCM, ensuring comprehensive and appropriate care for SCI patients.

Future Research

Further research should focus on advanced imaging techniques to visualize cord regeneration and evaluate new interventions that may be beneficial in conjunction with APCM.

Study Limitations

1
The paper is a perspective, which inherently carries the author's bias and may not represent a comprehensive review of all available evidence.
2
Lack of specific study details (duration, participant characteristics) limits the ability to fully assess the evidence supporting APCM.
3
The author acknowledges the need for well-designed trials with independent assessment of pre-intervention neurological status and outcomes.

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