Surgery for SCI has been aimed at stabilizing the spine in an attempt to prevent further injury or to prevent future pain and deformity. Spinal instrumentation involves using rods, bars, wires and screws to provide permanent stability to the spine to correct and solidify the level where a spinal injury has occurred. Instrumentation may be combined with fusion, or bone grafting, to permanently join two vertebrae together.

The use of steroids to treat spinal cord injury has been controversial for many years. There is evidence that the use of steroids helps to decrease the swelling that occurs as a result of SCI. Steroids must be given as soon as possible after the initial injury in order to have the desired effect, usually within eight hours, and are given for up to 48 hours after injury. Steroids may help to prevent further injury, but will not return the patient to their previous functioning. The most widely studied steroid for the treatment of SCI is Methylprednisolone.

There is some new evidence that early surgical intervention to decompress the spinal cord may significantly improve patient outcomes and reduce the risk of complications. A recent STASCIS (Surgical Treatment of Acute Spinal Cord Injury Study) study has found that 24% of patients who received decompressive surgery within 24 hours of injury showed a significant improvement in ASIA scores. Additionally, patients studied who received early surgical decompression suffered 20% less complications than those patients who had delayed surgical intervention.

Recommendations from the Spine Study Trauma Group, a group composed of 40 of the world’s top spine surgeons, are that patients with SCI who have no other major injuries should undergo spinal decompression within 24 hours of injury, and that SCI should be treated as a medical emergency, much like strokes and heart attacks, where treatment must be instituted as soon as possible to achieve the best patient outcome possible.