COPYRIGHT © 2003 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED SUSTAINED SPINAL

T he extent of the initial damage to the spinal cord produced by a spinal cord injury depends on factors such as the mechanism of injury, force of the impact, cord displacement, acceleration, and kinetic energy of compres sion':'. The primary injury is followed by secondary injury mechanisms that are associated with physiological,biochemi cal, immunological, and cellular changes in the injured cord'. Spinal cord compression and displacement from bone frag ments, ligaments, or hematoma within the spinal canal may contribute to the initial damage by stimulating this secondary injury cascade. Mitigation of this secondary injury process by spinal cord decompression may be an important factor in the preservation of neurological function. Retrospective studies have demonstrated that surgical decompression increases neurological recovery". However, de spite this increasing evidence supporting spinal cord decom pression, there is currently no consensus regarding the mos