***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Study Design . A prospect i ve analysis evaluating neurologic outcome after early versus late surgery for cervical spinal cord trauma . Objectives . The study was conducted to determine whether neurologic and functional outcome is improved in traumatic cervical spinal cord‐injured patients ( C3‐T1 , American Spinal Injury Association grade s A‐D ) who had early surgery ( < 72 hours after spinal cord injury ) compared with those patients who had late surgery ( > 5 days after spinal cord injury ) . Summary of Background Data . There is considerable controversy as to the appropriate timing of surgical decompression and stabilization for cervical spinal cord trauma . There have been numerous retrospective studies , but no prospect i ve studies , to determine whether neurologic outcome is best after early versus late surgical treatment for cervical spinal cord injury . Methods . Patients meeting appropriate inclusion criteria were r and omized to an early ( < 72 hours after spinal cord injury ) or late ( > 5 days after spinal cord injury ) surgical treatment protocol .  The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow‐up . Results . Comparison of the two groups showed no significant difference in length of acute postoperative intensive care stay , length of inpatient rehabilitation , or improvement in American Spinal Injury Association grade or motor score between early ( mean , 1.8 days ) versus late ( mena , 16.8 days ) surgery . Conclusions . The results of this study reveal no significant neurologic benefit when cervical spinal cord decompression after trauma is performed less than 72 hours after injury ( mean , 1.8 days ) as opposed to waiting longer than 5 days ( mean , 16.8 days ) OBJECT A multicenter retrospective study was performed in 36 North American centers to examine the use and timing of surgery in patients who have sustained acute spinal cord injury ( SCI ) . The study was performed to obtain information required for the planning of a r and omized controlled trial in which early and late decompressive surgery are compared . METHODS The records of all patients aged 16 to 75 years with acute SCI admitted to 36 centers within 24 hours of injury over a 9-month period in 1994 and 1995 were examined to obtain data on admission variables , methods of diagnosis , use of traction  , and  surgical variables including type and timing of surgery .  A total of 585 patients with acute SCI or cauda equina injury were admitted to participating centers , although approximately half were ultimately excluded because they did not meet inclusion criteria . Common causes for exclusion were late admission , age , gunshot wound , and absence of signs of compression on imaging studies . Thus , only approximately 50 % of patients with acute SCI would be eligible for inclusion in a study of acute decompressive surgery . Although all patients underwent computerized tomography ( CT ) scanning , only 54 % underwent magnetic resonance imaging , and CT myelography was performed in only 6 % . Complete neurological injuries ( American Spinal Injury Association Grade A ) were present in 57.8 % . Traction was applied in only 47 % of patients who sustained cervical injury , in whom decompressive traction was successful in only 42 % of cases . Neurological deterioration occurred in 8.1 % of cases after traction .  Surgery was performed in 65.4 % of patients . The timing of surgery varied widely : less than 24 hours postinjury in 23.5 % , between 25 and 48 hours postinjury in 15.8 % , between 48 and 96 hours in 19 % , and more than 5 days postinjury in 41.7 % of patients . CONCLUSIONS These data indicate that although surgery is commonly performed in patients with acute SCI , one third of cases are managed nonoperatively , and there is very little agreement on the optimum timing of surgical treatment . The results of this study confirm the need for a r and omized controlled trial to assess the optimum timing of decompressive surgery in SCI Study Design . Experimental dog model of acute spinal cord injury . Objective . To compare the relative value of methylprednisolone , surgical decompression , or both for the treatment of traumatic spinal cord injury . Summary of Background Data . Acute spinal cord injury results from both primary damage to the spinal cord at the time of the initial injury as well as a deleterious secondary cascade of events , which leads to further damage . Surgical decompression is known to improve clinical outcomes , but the timing of surgical decompression remains controversial . Methods . A nylon tie was used to constrict the spinal cord in 18 adult male beagle dogs . The animals were then prospect ively r and omized to 3 groups : 1 ) surgical decompression at 6 hours and intravenous methylprednisolone ; 2 ) surgical decompression at 6 hours and intravenous saline ; and 3 ) intravenous methylprednisolone without surgical decompression . Each animal was evaluated by somatosensory-evoked potentials , daily neurologic assessment , and histologic examination at 2 weeks following injury . Results . Immediately following spinal cord constriction , all animals were paraplegic , incontinent , and the somatosensory-evoked potentials were abolished . Surgical decompression 6 hours after injury , with or without methylprednisolone , led to significantly better neurologic function at 2 weeks than methylprednisolone alone . Conclusion . In the setting of acute and persistent spinal cord compression in beagle dogs , surgical decompression 6 hours after injury , with or without methylprednisolone , is more effective for improving neurologic recovery than methylprednisolone alone The optimal management of acute spinal cord injuries remains to be defined . The authors prospect ively applied resuscitation principles of volume expansion and blood pressure maintenance to 77 patients who presented with acute neurological deficits as a result of spinal cord injuries occurring from C-1 through T-12 in an effort to maintain spinal cord blood flow and prevent secondary injury . According to the Intensive Care Unit protocol , all patients were managed by using Swan-Ganz and arterial blood pressure catheters and were treated with immobilization and fracture reduction as indicated . Intravenous fluids , colloid , and vasopressors were administered as necessary to maintain mean arterial blood pressure above 85 mm Hg . Surgery was performed for decompression and stabilization , and fusion in selected cases . Sixty-four patients have been followed at least 12 months postinjury by means of detailed neurological assessment s and functional ability evaluations . Sixty percent of patients with complete cervical spinal cord injuries improved at least one Frankel or American Spinal Injury Association ( ASIA ) grade at the last follow-up review . Thirty percent regained the ability to walk and 20 % had return of bladder function 1 year postinjury . Thirty-three percent of the patients with complete thoracic spinal cord injuries improved at least one Frankel or ASIA grade . Approximately 10 % of the patients regained the ability to walk and had return of bladder function . As of the 12-month follow-up review , 92 % of patients demonstrated clinical improvement after sustaining incomplete cervical spinal cord injuries compared to their initial neurological status . Ninety-two percent regained the ability to walk and 88 % regained bladder function . Eighty-eight percent of patients with incomplete thoracic spinal cord injuries demonstrated significant improvements in neurological function 1 year postinjury . Eighty-eight percent were able to walk and 63 % had return of bladder function . The authors conclude that the enhanced neurological outcome that was observed in patients after spinal cord injury in this study was in addition to , and /or distinct from , any potential benefit provided by surgery . Early and aggressive medical management ( volume resuscitation and blood pressure augmentation ) of patients with acute spinal cord injuries optimizes the potential for neurological recovery after sustaining trauma Acute spinal cord injury ( SCI ) is a major public health problem for which there is still only limited treatment available . The National Acute Spinal Cord Injury Study -2 ( NASCIS-2 ) and -3 clinical trials demonstrated that the use of acute pharmacotherapy with methylprednisolone can attenuate the secondary injury cascade if administered within 8 hours of acute SCI . However , no trial has been performed to examine whether acute surgical decompressive procedures within this critical 8-hour time window can improve patients ' neurological outcome . The purpose of the current prospect i ve Surgical Treatment for Acute Spinal Cord Injury Study ( STASCIS ) pilot study was to determine the feasibility of obtaining a radiological diagnosis of spinal canal compromise of 25 % or more and to perform spinal cord ( C3-T1 ) decompressive procedures by 8 hours postinjury . One of the following three decompressive methods was used : 1 ) traction alone ; 2 ) traction and surgery ; or 3 ) surgery alone .  Twenty-six patients from eight North American centers were entered into the study between 1996 and 1997 . Significant difficulties were encountered in many centers in performing immediate magnetic resonance imaging examination in patients with acute SCI . Fewer than 10 % of acute cervical SCI patients could be enrolled into this protocol mainly because the combination of the required time for rescue , resuscitation , transport , imaging study , and surgical preparation exceeded the 8-hour injury-to-decompressive surgery window . Eleven patients underwent decompressive procedures initially by being placed in traction at a mean time of 10.9 hours postinjury . Those patients not undergoing this procedure underwent  decompressive surgery  at a mean time of 40.1 hours . However , the surgical decompressive procedure was completed within 12 hours in seven patients . As a result of these findings , several major changes have been made to the STASCIS protocol for early decompressive therapy BACKGROUND The effect of immediate surgical spinal cord decompression on neurologic outcome after spinal cord injury is controversial . Experimental models strongly suggest a beneficial effect of early decompression but there is little supportive clinical evidence . This study is design ed to evaluate the feasibility and outcome of an immediate spinal cord decompression treatment protocol for cervical spinal cord injury in a tertiary treatment center . METHODS To address this issue , 91 consecutive patients with acute , traumatic cervical spinal cord injury ( 1990 - 1997 ) were prospect ively studied . Sixty-six patients ( protocol group ) underwent emergency magnetic resonance imaging ( MRI ) to determine the presence of persistent spinal cord compression followed , if indicated , by immediate operative decompression and stabilization .  Twenty-five patients were managed outside the treatment protocol because of contraindication to magnetic resonance imaging , need for other emergency surgical procedures , or admitting surgeon preference ( reference group ) . The protocol and reference groups had similar sex and age distributions , admitting Frankel grade s , levels of neurologic injury , and Injury Severity Scores . RESULTS Twenty-seven percent of patients seen were not enrolled in the treatment protocol because of the need for other emergent surgical treatment , contraindication to MRI , and specific surgeon bias regarding the " futility " of emergent treatment . The neurologic outcome for the patients in the reference group were similar to that in the previously reported literature . Fifty percent of protocol patients , compared with only 24 % of reference patients , improved from their admitting Frankel grade . Eight protocol patients ( 12 % ) , but no reference patients , improved from complete motor quadriplegia ( Frankel grade A or B ) to independent ambulation ( Frankel grade D or E ) . Protocol patients required shorter intensive care unit stays , and shorter total hospital stays than reference patients . In the treatment protocol group , spinal cord decompression , confirmed by MRI , was achieved with immediate spinal column alignment and skeletal traction in 32 patients ( 46 % ) . Thirty-four patients ( 54 % ) required emergent operative spinal cord decompression because of MRI-documented persistent spinal cord compression . CONCLUSION We conclude that immediate spinal column stabilization and spinal cord decompression , based on magnetic resonance imaging , may significantly improve neurologic outcome . The feasibility of such a treatment protocol in a tertiary treatment center is well demonstrated . Additional multicenter trials are necessary to achieve definitive conclusions regarding clinical efficacy 
    Output:
    
The majority of spine surgeons prefer to decompress the acutely injured spinal cord within 24 hours .
The majority of spine surgeons prefer to decompress the cervical spine for patients with complete or incomplete cervical SCI within 24 hours .