My husband and I sat on pins and needles while a team of surgeons tried to decide if our 18-year-old son should have surgery right away for a spinal cord injury. After three hours, they finally went ahead and scheduled the operation for this afternoon. We are in the waiting room searching the Internet for any information we can find on this. Why wouldn’t surgery be done immediately?

Much has changed in our knowledge and understanding of spinal cord injuries and the best way to treat them. New technologies and improved surgical techniques have changed the way these injuries are handled. Understanding the role of antiinflammatories and steroid medications has improved results by limiting pressure on the cord. Patients experience less permanent neurologic damage when swelling around the cord can be minimized.

But for all the knowledge we have gained, there are still some big holes in evidence to guide management of these injuries. In particular, the best time to do surgery is a key area of debate. According to a recent survey completed by 77 neurosurgeons, there really isn’t agreement about the optimal management of acute spinal cord trauma.

There isn’t just one factor to consider when determining whether surgery should be done immediately (within 24 hours) or later after stabilizing the patient. There are safety issues for the patient, staffing issues (is a properly trained neurosurgeon available?), cost analysis, possible complications to consider, and considerations centered on patient quality of life. And the level of the injury can make a difference, too.

There is some evidence that the longer the spinal cord is compressed (crushed, pinched, pressed by the damaged vertebrae), the worse the results. It makes sense to get the pressure off the cord as soon as possible.

But there can be other life-threatening issues that must be taken care of first. And there’s some question about what to do when surgery could make matters worse or even prevent the patient from recovering naturally. In cases where the cord is severed all the way across, the value of immediate surgery is less well-known.

You can be sure that the team of medical personnel who are working with your son are making every effort to determine the best course of action. This is obvious since they haven’t just launched into surgery without much discussion and consideration. It’s likely there are other variables at play in the decision-making process.