Abstract
BACKGROUND: Acute traumatic spinal cord injury (tSCI) is among the more complex challenges in modern medicine and has far-reaching implications for the affected patients' quality of life. A practical summary for treating physicians of the currently recommended clinical measures for the acute care of patients with tSCI is needed as an evidence-based guide to treatment. METHODS: This narrative review is based on pertinent publications (1984-2024) retrieved by a search in the PubMed, Cochrane, and EMBASE databases, with particular attention to the updated clinical practice guideline on acute spinal cord trauma issued by AO Spine in 2024. The abstracts were examined for relevance, and the full text of selected articles was studied. RESULTS: The evidence base for the management of tSCI includes only a small number of randomized controlled trials. As a result, the evidence underlying many of the recommendations is on a moderate or low level. Early surgical decompression (within 24 hours) is associated with a significantly better neurological outcome: it more than doubles the likelihood of an improvement of ≥ 2 points on the ASIA Impairment Scale (AIS) (RR: 2.76, 95% confidence interval [1,60; 4,98]; moderate evidence level). Maintaining an adequate mean arterial blood pressure is considered to be essential, despite the absence of robust evidence for any specific protocol (very low evidence level). The use of corticosteroids remains controversial because of conflicting evidence. CONCLUSION: The treatment of tSCI requires a multidisciplinary, evidence-based approach including early surgery and patient-oriented hemodynamic management.