Spine2d time
This was a multi-center, nonrandomized, prospective cohort study that enrolled 313 adults (18–80 years) with cervical SCI from six North American centers. The results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) were published in 2012. The bulk of clinical evidence favors a 24-h threshold in defining “early” surgical decompression. To this point, there is robust basic science data from rodent models of SCI to indicate that the degree of histological tissue destruction is mitigated, and neurobehavioral outcomes improved, when the duration of compression is minimized. Surgical decompression aims to interrupt this progression by relieving pressure within the cord parenchyma to partially restore microvascular blood flow, reduce ischemia, and remove mechanical stretch/compression of neuroglial cell membranes.
As the injury evolves over hours, increasing edema and ongoing compression of the cord cyclically add to neuroglial cell death.
This is compounded by the compromised microvasculature which can create a lesional and perilesional region of ischemia.
#SPINE2D TIME FREE#
As phagocytes clear debris, they generate free radicals which can generate additional cellular injury. DNA, ATP, neurotransmitters), initiates proapoptotic signaling in nearby cells. This, combined with significant ionic dysregulation and the release of byproducts of cellular necrosis (e.g. interleukin-1β, tumor necrosis factor-α, etc.) to the site of injury. polymorphonuclear leukocytes and macrophages) and cytokines (e.g. Within minutes, hemorrhage and blood-spinal-cord barrier disruption allow a rapid influx of peripheral inflammatory cells (e.g. This initiates a secondary injury cascade from the moment of injury which causes additional damage and neurologic dysfunction. Traumatic injury to the spinal cord results in mechanical damage to neuroglial cell membranes, the extracellular matrix architecture, and the sensitive microvasculature.