Grant: Operating Grant

Spinal cord injuries (SCIs) are caused primarily by high-speed injury to the body where severe forces are exerted on the human neck, which result in various patterns of bony injury to the neck. Further, recent research by our group has shown that these different patterns of bony injury also cause different patterns, or mechanisms, of cellular damage to the spinal cord. Despite this, SCIs are treated without regard for these different patterns of cord injury. The overriding hypothesis of this research is that this mechanism of cord injury is an important factor that should be incorporated into clinical decision- making. After SCI, the spinal cord is often compressed by fragments of bone or other neck tissue. A very controversial topic over the past 30 years has been how quickly surgery should be performed on these patients to decompress the cord. Some recent clinical data suggest that early surgical decompression after SCI may enhance the functional improvement of patients. However, the differences observed between early and late decompression in this trial were small and roughly 50% of patients in the study did not show any improvement. This suggests that there are predisposing factors as to why only some people improve after decompression. This five-year research project addresses the timing of surgical decompression after acute SCI from the two most common injury mechanisms - contusion and shear dislocation. Our objective in this project is to determine the importance of two primary cord injury mechanisms and the effect of injury velocity; particularly as they relate to the timing of surgical decompression after SCI. Our overall hypothesis is that early decompression is most effective for the low velocity, contusion injury mechanism, given that there remains more intact tissue in this scenario immediately after impact. The results of this project will provide guidance for clinicians regarding which SCIs are most likely to benefit from early decompression.