I am facing a difficult decision by myself. My husband was injured in an automobile accident and is in a coma. There is evidence of a spinal cord injury but he also has multiple other injuries to the head, lungs, and pelvis. There is a chance he could recover on his own. But early surgery to stabilize the spine and spinal cord might make a difference in the long-term results. Should I approve the decision to do the surgery or wait and see what happens? I don’t know what to do.

Every year, trauma takes the lives of 1000s of North Americans between the ages of five and 44. For those who are not killed but survive, spinal cord injury is a major problem. If the accident victim is lucky, there will be a trauma center nearby to address any spinal cord trauma and other injuries that occur at the same time. Even better is the presence of a spine trauma unit.

New studies addressing the optimal time for surgery are just coming out. Timing for surgery after spinal trauma is a very important topic as every hour can make a difference in the final outcomes.

From studies done so far, the current recommendations are for early surgery for patients with severe neurologic injury. For those who have mild neurologic symptoms, a wait-and-see approach is advised to give patients time to heal and recover on their own.

Early stabilization of the spine and decompression of the spinal cord has been shown to reduce hospital costs by decreasing length of hospital stay and fewer days on mechanical ventilation (machines keeping the patient alive by breathing for them).

There is more evidence than ever to show support for early rather than late stabilization and decompression. Some surgeons advocate surgical intervention even earlier — within 12 hours rather than the 24 hours previously debated.

The final decision depends on whether or not the patient is stable enough to even have surgery. Family members may give the nod to go ahead or wait but you won’t have to do this without the expertise and counsel of the trauma team.