Surgery to treat spinal cord injury (SCI) may be performed immediately after the injury, or at a later time. Urgent surgical intervention is more common in patients with incomplete SCI. Urgent surgical intervention is also done if neurologic dysfunction worsens. The decision to operate depends on many circumstances, such as the cause and extent of injury and spinal stability issues.

The type of surgical procedure and when it should be performed is the surgeon's decision. That decision is based on what is best, in the surgeon's opinion, for the patient. Basically, spine surgery to treat SCI involves:

• Decompressing the spine (ie, spinal cord)
• Stabilizing the spine

Decompression
Many things can compress the spinal cord: herniated disc, a collection of blood (hematoma) or fluid around the spinal cord, vertebral fracture, infection, or tumor. Obviously, each of these conditions requires careful pre-operative assessment to determine:

• Timing (when it is best to perform surgery)
• Approach, such as from the front (anterior) or back (posterior)
• Traditional open or minimally invasive spine surgery
• Type of procedure (eg, discectomy, laminotomy)
• Need to re-align and stabilize the spine

Spinal Stabilization If the spine needs to be re-aligned or stabilized, instrumentation and fusion is necessary. Instrumentation involves using implantable devices such as rods, screws, and cages. Bone graft is added to promote fusion. A gone graft is usually taken from your own body, but it is possible to use donor bone. The surgeon may choose to use a biologic substance that will stimulate bone growth.

New bone should grow around the instrumentation and between the affected vertebrae. The fusion should join them and make them solid and stable.

Outcome
Surgery may not reverse spinal cord damage. However, decompression and spinal stabilization are important to prevent pain, deformity, and progression of neurologic deficit (eg,weakness, tingling, bowel/bladder problems).