decompression

[gpbullock]

Dr. Young, When a person is injured with SCI, what are the pros/cons of decompression. I had a burst fracture at t12, and part of the bone was compressed into the spinal cord. I received steroids immediately, but was left with a broken vertibrae and no decompression for 5 days, waiting for an orthopedic surgeon who never arrived. The neurosurgeon who finally did the decompression told me that because they thought I was "incomplete",(I had some sensation on and around my groin area) that they wouldn't proceed with the decompression at the time of injury. In one of your posts, it sounded like you felt decompression was important within hours of the injury. Is this right

[Wise Young]

This is the first time that I have heard the claim that they did not decompress because a person was "incomplete". Usually, it is the other way around. For many years, neurosurgeons and orthopedic surgeons believed that a "complete" spinal cord injury means that the spinal cord has been "physiologically transected" and therefore decompression would do nothing to restore any function. Therefore, they can wait until it is convenient and possibly safer to do an elective decompression. On the other hand, most surgeons would try to do an emergency decompression if it is in a patient who is "incomplete".

Currently, about 50% (this is a very rough impression) of surgeons will do rapid decompression of the spinal cord (within 24 hours after injury). In my opinion, even 24 hours is too long, particularly in cases of cervical spinal cord injury. Delay of decompression of the thoracic spinal cord is more understandable because the procedure frequently requires the surgeon to open the chest cavity in order to gain access to the front of the spinal column. Cracking open the chest requires a team of surgeons, including a thoracic surgeon or a general surgeon. It takes time to get the team together to do that surgery. However, depending on the hospital, they frequently pull together teams to do emergency surgery for thoracic aortic aneurysms which is a common problem in automobile accidents and I think that it is possible to do it for spinal cord injury.

The following is a rant and rave issue that I have frequently brought up with my neurosurgical and orthopedic colleagues. There is no place else in the central nervous system that they would not do emergency surgery to decompress. They only do this in the spinal cord. For example, if somebody came into the hospital with a depressed skull fracture with a bone fragment pressing on the brain, they would never wait 5 days to do the decompression surgery. Likewise, if something were pressing on your brainstem, your eyeball, even your peripheral nerves, they would do emergency surgery to decompress.

Yes, I believe that the spinal cord should be decompressed, the earlier the better.

Wise.

[gpbullock]

Dr. Young, is it normal to go through the back for T12, because that is where they went through. I am a little angry that I was told I was "incomplete," and then had to wait too long for decompression. I know hindsight is always 20/20 but I have to feel I might be further along in my recovery if the Dr. had done emergency decompression sooner.

[Wise Young]

Even though the injury is to the last thoracic vertebrae, if they put rods in to stabilize, they will need to have access to the ribs and the front of the vertebral column above T12. Wise.