Early Decompressive Surgery in Traumatic Thoraco-Lumbar Spine: When and Why?

Spinal trauma is a very common disease, associated with spinal cord injury in 15-30% of cases [1]. The treatment is affected both from non-modifiable variables (fracture’s morphology and biomechanics of the trauma, fracture site, neurological status, primary or secondary comorbidities) both from modifiable variables (first aid and hospital transportation, supportive therapy, surgical timing etc.). The role of the surgical timing after acute thoraco-lumbar spinal cord injury is still one of the most controversial points actually debated in literature. Surgical treatment is conditioned both by the general conditions of the patient both by the extent of the neurological deficit. In literature are described three possible windows for surgical timing: early surgery , performed in the first 48 hours; intermediate surgery, performed between 48 hours 7 days; late surgery, performed after 7 days from the injury. In the light of the debatment actually under discussion in literature, the real question is: The implementations of the early surgery have effectively a role in the management of thoraco-lumbar spine injury and, if so, when is mandatory? Actually, based on the literature evidence, is extremely difficult to find a clear indication.