Dr. Khalid Kurtom on major trends in spinal cord injury surgery


Khalid Kurtom, MD, is a neurosurgeon at the University of Maryland Shore Medical Center at Easton and a clinical assistant professor of neurosurgery at the Baltimore-based University of Maryland School of Medicine. He recently spoke with Becker's Spine Review about trends in spinal cord injury surgery.

Note: Content has been lightly edited for style and clarity.

Question: What major trends do you see in spinal cord injury surgery?

Dr. Khalid Kurtom: Spinal cord injury, whether traumatic in origin or due to advanced degenerative spine disease, results in significant morbidity for our patients. While there is not a standard approach for managing the various pathologies resulting in SCI, most spine surgeons now agree that early surgical decompression of the spinal cord, with or without fusion, results in better outcomes and more rapid recovery.

In most cases, especially involving trauma, surgical intervention in the first 24 hours is now the standard. In addition, there are a number of research trials aimed at reducing secondary spinal cord injury with various medications, hypothermia, ICU management of blood pressure, etc. There are trials involving stem cell injections into the spinal cord and insertion of various conduits for nerves to regenerate. All these studies have promising results and will hopefully advance our management paradigm of SCI.

Q: Have you noticed a change in the population of patients undergoing surgery for SCI?

KK: There is a higher number of athletes and motor vehicle accident victims that suffer from SCI, which could be due to the more competitive nature of sports and the increasing number of high-speed motor vehicle crashes.

Nationally, the average age at injury has increased from 29 years during the 1970s to 42 years currently. There are 17,000 new SCI cases each year in the United States, and male patients account for approximately 80 percent of new SCI cases.

Q: Will biologics be a viable alternative to SCI surgery in the next decade? 

KK: There are a number of studies looking at various biologics to treat SCI patients. I am hopeful that in the next few years we will have more options, surgical and medical, of managing this debilitating injury.

Initial SCI research was mainly focused on immediate decompression and stabilization as well ICU management and prevention of secondary injury. Now most research is targeting novel ways to repair and remodel the damaged neurons. This involves insertion of new conduits and replacement of lost nerve cells with stem cells. Electrical stimulation to the damaged spinal cord as well as the use of antioxidants and anti-inflammatory agents are also being studied.

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