Controversies in cervical spine trauma: The role of timing of surgical decompression and the use of methylprednisolone sodium succinate in spinal cord injury. A narrative and updated systematic review

Abstract

Traumatic spinal cord injuries (SCIs) have devastating physical, social, and financial consequences for both patients and their families. SCIs most frequently occur at the cervical spine level, and these injuries are particularly prone to causing debilitating functional impairments. Unfortunately, no effective neuroregenerative therapeutic approaches capable of reversing lost neurologic and functional impairments exist, resulting in a large number of patients living with the persistent disability caused by a chronic cervical SCI. Over the past decades, a multitude of nonpharmacologic and pharmacologic neuroprotective strategies have been intensely investigated, including the timing of surgical decompression and the role of methylprednisolone sodium succinate (MPSS) in patients with acute SCI. These strategies have been the source of vibrant debate surrounding their potential risks and benefits. Our aim in this combined narrative and updated systematic review is to provide an assessment on the timing of surgical decompression as well as the role of high-dose MPSS treatment in patients with traumatic SCIs, with a special emphasis on the cervically injured subpopulation. Based on the current literature, there is strong evidence to support early surgical decompression within 24 h of injury to promote enhanced neurologic recovery. Meanwhile, moderate evidence supports the early initiation of a 24-h high-dose MPSS treatment within 8 h of injury, particularly in patients with a cervical SCI.