Surgical decompression in acute spinal cord injury: A review of clinical evidence, animal model studies, and potential future directions of investigation

Abstract

The goal for treatment in acute spinal cord injury (SCI) is to reduce the extent of secondary damage and facilitate neurologic regeneration and functional recovery. Although multiple studies have investigated potential new therapies for the treatment of acute SCI, outcomes and management protocols aimed at ameliorating neurologic injury in patients remain ineffective. More recent clinical and basic science research have shown surgical interventions to be a potentially valuable modality for treatment; however, the role and timing of surgical decompression, in addition to the optimal surgical intervention, remain one of the most controversial topics pertaining to surgical treatment of acute SCI. As an increasing number of potential treatment modalities emerge, animal models are pivotal for investigating its clinical application and translation into human trials. This review critically appraises the available literature for both clinical and basic science studies to highlight the extent of investigation that has occurred, specific therapies considered, and potential areas for future research.

Keywords

acute spinal cord injury / surgical decompression / durotomy / animal models

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Acknowledgements

This work was supported by National Institutes of Health (NIH/NINDS R01 NS059622, R01 NS050243, R01 NS073636 to XMX, and F31NS 071863 to CLW), the Indiana Clinical and Translational Sciences Institute (CTSI) Collaboration in Biomedical/Translational Research (CBR/CTR) Pilot Program Grants (Grant #RR025761) from the NIH, the Indiana Spinal Cord and Brain Injury Research Funds, the Mari Hulman George Endowment Funds. We also appreciate the use of the Core facility of the Spinal Cord and Brain Injury Research Group/Stark Neurosciences Research Institute at Indiana University School of Medicine, and collaboration with Norton Healthcare, Louisville, KY.

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