Surgical controversies in the management of spinal cord injury

The Edwin Smith papyrus, a surgical treatise drafted nearly 4000 years ago, recounted the devastation attendant to cervical spine injuries with quadriplegia and categorized them as “ailments not to be treated.” The nihilism implied by this proscription has remained the prevailing sentiment over the succeeding millennia. Recent advances in the emergency, diagnostic, medical, and surgical management of patients with spinal cord injury (SCI), however, have infused a sense of optimism to an area that, even to this day, remains a debacle relative to the triumphs achieved in other areas of modern medicine. The acute management of the SCI patient begins at the scene of an accident the moment that such an insult is suspected, and progresses until the time of discharge to a rehabilitation facility. At each stage along this continuum, the goals of treatment remain identical: