Personalized Management Strategies in Traumatic Spinal Cord Injury: From Resuscitation to Definitive Surgical Care

Personalized management of traumatic spinal cord injury (TSCI) is an emerging approach in modern spine and trauma care. Unlike traditional protocol-driven approaches that apply uniform resuscitation, imaging, and surgical strategies across heterogeneous injury patterns, individualized care pathways that account for biological, physiological, and injury-specific variability may improve neurological outcomes and resource utilization. This review summarizes contemporary concepts in personalized TSCI management spanning prehospital and initial hospital care, resuscitation, imaging, and definitive surgical decision-making. The proposed framework is informed by evidence from clinical trials, observational studies, and emerging consensus statements, emphasizing stratified approaches based on neurological status, injury mechanism, physiological reserve, and imaging biomarkers. Selective spinal motion restriction, hemodynamic support within guideline ranges, and early decompression are supported by current guidelines, albeit based largely on low-quality evidence, whereas individualized hemodynamic targets, advanced neuroimaging, blood-based biomarkers, and artificial intelligence-based risk stratification remain emerging strategies that require prospective validation before routine clinical use. In conclusion, personalized management across the continuum of TSCI care provides a rational framework with potential clinical applications, although its effect on patient outcomes remains to be demonstrated.