What is the prognosis for a patient with spinal cord compresion dependent on the onset of paralysis symptoms?

The Bottom Line: There is no data available to when paralysis becomes irreversible, and therefore surgery not advisable.

Helweg Larsen, S. Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients. European journal of cancer 1994 vol:30A iss:3 pg:396 -398

For patients without gait function, the median time from motor weakness onset until the loss of the ability to walk was 38 days. Those patients who progressed into paralysis did in a median time of 12 days after losing ability to walk (p. 397).

From Spinal cord injury – Acute management. In: DynaMed:
“consider early surgical canal decompression in setting of deteriorating spinal cord injury (may improve neurologic recovery, however, no supporting evidence ) (CSCM Level II/III/IV, Grade B, Strength 5).”

This directs to the following guideline:
Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. The journal of spinal cord medicine 2008 vol:31 iss:4 pg:403 -479

Which includes this statement: “Surgical intervention is commonly used to manage patients with an acute cervical spinal cord injury. This often involves reducing or realigning the spinal elements, decompressing compromised neural tissue, and stabilizing the spine. Basic science and animal experimental evidence suggests that early decompression of a compressed and injured spine may result in improved neurological recovery; however, the timing of surgical intervention has been a subject of much debate as there are no well designed and well-executed level I studies that have determined if early (< 12 hours) versus late decompression is beneficial to spinal cord recovery.” (p. 445)

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