THE DAMAGE DONE: Doctors say two types of injuries happen when someone suffers a spinal cord injury. First, there is damage done when the injury happens -- this is the initial impact and includes bruising, bleeding and disruption to the spinal cord and how it functions. However, there is another kind of injury that happens after the initial impact. It's called secondary injury and it includes cell, nerve and tissue death occurring between the first days and, possibly, weeks after the injury happens. Neurosurgeon Michael Fehlings, M.D., from Toronto Western Hospital, says: "This involves the death of nerve cells that might otherwise be initially potentially alive or salvageable after the initial injury. This occurs to persisting pressure on the damaged spinal cord [and] disruption of the blood supply to the spinal cord ... Inflammation can occur, which might provoke more swelling in the spinal cord, and all of these factors together culminate in a dramatic increase in the amount of damage to the injured spinal cord."

OPERATE EARLIER, DECREASE THE HARM: Doctors are now conducting a study to determine just how much the timing of surgery matters after a spinal cord injury. Dr. Fehlings says most patients will undergo surgery after an injury to fix the spine and relieve the pressure on it. However, there is no consensus among surgeons on when to do the surgery. A 1999 study shows about 70 percent of people with spinal cord injuries do undergo surgery, and the most common time to have that surgery is five days or more after the injury occurred. However, preliminary results from Dr. Fehlings' new research shows: earlier is better. Dr. Fehlings and many of his colleagues say they believe operating sooner means less harm done to the patient. He says, "The majority of patients should undergo surgery earlier ... It turns out that the critical time window is probably the first 24 hours after injury." He adds, "We know it's safe. We know it's feasible to do in the majority of patients."

WHAT IT MEANS FOR PATIENTS: Dr. Fehlings says operating early could, in some cases, mean the difference between walking and not walking. He says, "The stakes are potentially very high. We are seeing that some people are walking away from injuries where they would normally not be able to walk away. Twenty years ago, I never saw this kind of recovery." Dr. Fehlings does emphasize patients need to be stabilized before surgery is considered but says, in most cases, stabilization should be possible within the first 24 hours.

FOR MORE INFORMATION, PLEASE CONTACT:

Robert Thompson
Senior Public Health Affairs Adviso
r University Health Network
Toronto, ON, Canada
Robert.thompson@uhn.on.ca