STUDY DESIGN:
Evidence-based literature review.

OBJECTIVE:
To provide updated evidence-based recommendations regarding spinal cord decompression in patients with acute spinal cord injury (SCI).

SUMMARY OF BACKGROUND DATA:
It is controversial whether early decompression following SCI conveys a benefit in neurologic outcome.

METHODS:
MEDLINE search of experimental and clinical studies showing the effect of decompression on neurologic outcome following SCI. We focused on articles published within the last 10 years, with a particular emphasis on research conducted within the past 5 years.

RESULTS:
A total of 66 articles were retrieved. Animal studies consistently show that neurologic recovery is enhanced by early decompression. There was 1 randomized controlled trial that showed no benefit to early (< 72 hours) decompression. Several recent prospective series suggest that early decompression (< 72 hours) can be performed safely and may improve neurologic outcomes. A recent systematic review showed that early decompression (< 24 hours) resulted in statistically better outcomes compared to both delayed decompression and conservative treatment.

CONCLUSIONS:
There are currently no standards regarding the role and timing of decompression in acute SCI. We recommend urgent decompression of bilateral locked facets in a patient with incomplete tetraplegia or in a patient with SCI with neurologic deterioration. Urgent decompression in acute cervical SCI remains a reasonable practice option and can be performed safely. There is emerging evidence that surgery within 24 hours may reduce length of intensive care unit stay and reduce post-injury medical complications.