One of the most severe types of traumas is Traumatic spinal cord injury (TSCI), which regularly causes long-term neurological abnormalities, disability, economic and social effects [1]. It occurs due to an external physical force that damages the spinal cord, vertebral column, or surrounding structures. This damage leads to partial or complete loss of motor, sensory, and autonomic functions below the level of injury. TSCI acute management, long-term rehabilitation, and quality of life results are difficult, even with trauma treatment and surgical management [2].

The prevalence of TSCI varies between regions. It ranges from 10 to 83 cases per million population per year. Rapid urbanization, transportation safety issues, and trauma care shortages challenge low- and middle-income countries. TSCI is rising in many developing countries most economically engaged generation, notably young adults [3].

Road traffic accidents (RTAs), falls from heights, violent crimes, and sports injuries are the most common cause of Traumatic spinal cord injuries [4]. Motor vehicle collisions and other high-energy road occurrences cause most traffic fatalities in metropolitan and semi-urban places. Another issue is the increased incidence of falls due to an aging population, particularly among the elderly [5]. Sports and high-risk entertaining activities cause most injuries, gunshot and stabbing wounds are also more common in other regions.

In healthcare systems the burden of TSCI is substantial. Prolonged hospitalization, intensive rehabilitation, multiple surgical interventions, and long-term follow-up is required for patient [6]. Pressure ulcers, respiratory problems, urinary tract infections, and chronic pain complication can increase healthcare expenses [7]. TSCI significantly affects patients, family and caregivers from the psychologically and financially and this shows the importance of appropriate prevention and management strategies.

Traumatic spinal cord injury is characterized by complex primary and secondary damage processes [8]. The immediate mechanical damage continued at the time of trauma which is referred to as the primary injury. Contusion, compression, laceration, or transection of the spinal cord are included which often related with vertebral fractures, dislocations, or ligamentous disruptions [9]. The severity of the primary injury mainly depends on the magnitude and direction of the traumatic force and regulates the initial neurological deficit.

In the progression of neurological damage, a cascade of secondary injury processes ensues plays a vital role followed by the primary insult [10]. Ischemia due to compromised spinal cord blood flow, disruption of the blood spinal cord barrier, inflammatory responses, excitotoxicity, oxidative stress, and cellular apoptosis are included among secondary injury mechanisms [11]. Tissue compression and ischemic damage are further exacerbated by edema and hemorrhage within the spinal cord. After the initial injury these processes evolve over hours today, and if not promptly addressed might knowingly worsen neurological results [12].

A key contributor to secondary injury is Inflammation which is characterized by the infiltration of immune cells and release of pro-inflammatory cytokines, which strengthen neuronal and glial cell damage. Neuronal death and demyelination are caused by Ionic imbalance and glutamate-mediated excitotoxicity. Understanding these pathophysiological mechanisms has been fundamental in guiding therapeutic strategies aimed at minimizing secondary injury and preserving residual neurological function.

The treatment of traumatic spinal cord injury must be timely, co‐ordinated and multimodal focused in order to maximize neurological recovery and functional results. Early treatment is crucial since a delay in treatment or diagnosis enables the secondary injury mechanisms to develop. Initial treatment includes spinal immobilization, hemodynamic stabilization, and neurological evaluation to prevent further injury.

In patients with spinal instability, prolonged cord compression, or worsening neurological symptoms, surgery may be necessary. Early spinal decompression and stabilization surgery relieves cord pressure, realigns the spine, and allows movement. Early surgery may improve neurological outcomes and reduce complications. A conservative approach is still possible in some cases, particularly in the presence of stable injuries, limited neurological deficits and must be always adapted to each case.

Study Objectives

• To evaluate current surgical and non-surgical management strategies
• To analyze neurological and functional outcomes in 60 TSCI patients
• To compare outcomes between different management approaches

Study Design

The retrospective observational study was conducted in a tertiary hospital. Medical data of patients were analysed from July 2024 to July 2025. In a retrospective analysis, real-world management methods and clinical results were used to evaluate surgical and non-surgical therapies for traumatic spinal cord injury.

Study Population

For this study, a total of 60 patients were included. Both male and female patients are participated in this study.

Inclusion Criteria

• Patient with traumatic spinal cord injury based on clinical and radiological findings
• Age 18 years or older at the time of injury
• Patients managed surgically and/or conservatively

Exclusion Criteria

• Non-traumatic causes of spinal cord injury
• Congenital spinal abnormalities or degenerative spinal disorders
• Incomplete or inadequate medical records preventing proper data extraction
• Reliable neurological assessment was precluded by the associated severe head injury.

Initial Assessment Protocol

All patients were evaluated at the time of admission with a structured admission assessment before treatment was initiated. A complete neurological examination was done to determine the motor and sensory condition of the patient. The neurological function was evaluated with the American Spinal Injury Association (ASIA) impairment scale, a standardized examination system to assess severity of the spinal cord. X-rays were used to determine the alignment of the spine, as well as any obvious presence of fractures. CT was used to observe skeletal structure, and MRI was employed for degree of spinal cord compression, soft tissue injury, disc herniation and ligament lesion.

Management Strategies

The customized treatment of each individual with traumatic spinal cord injury was based on the nature of the injury, the neurologic status, and spinal stability as well as general health status.

Surgical Management

The interval from injury to operation was the factor deciding between early and delayed surgery. Decompression, internal fixation, and spinal fusion were performed to relieve the compression of spinal cord and maintain stability. Surgery was performed on the cervical, thoracic and lumbar segments according to site of injury.

Non-Surgical (Conservative) Management

Conservative therapy was recommended for stable spinal injuries, modest or non-progressive neurological deficits, or medically unfit patients. Conservative treatment included cervical collars, braces, or orthoses for spinal immobilization. Pharmacological therapy aimed to manage pain, prevent complications, and provide support. After medical stabilization, patients began early physiotherapy and rehabilitation to strengthen muscles and training mobility to prevent pressure sores and joint contractures.

Outcome Measures

Mortality and affected area by management tactics were evaluated. Neurologic improvement was defined as change in the ASIA Impairment Scale score between admission and follow-up. Serial neurological examinations demonstrated improvement in motor and sensory abilities. Results were assessed by mobility and functional independence. Other outcomes were side effects, hospitalization and death.

Follow-Up

Patients were followed up at scheduled intervals as part of institutional protocol. Follow-up comprised outpatients and inpatient visit or a neurological evaluation and functional reassessment, according to the clinical status of the patient. Recovery and long-term follow up were assessed using functional status and ASIA scores.

Statistical Analysis

Data were entered and analysed using SPSS. Demographic, injury, and management data were summarised using descriptive statistics. Comparative analysis examined surgical and conservative patient outcomes. Statistical significance was assessed by tests with a p-value of 0.05 or less.

Demographic Profile

The study included 60 catastrophic spinal cord injury victims. Since men are more likely to engage in harmful activities, they dominated the patient population. Most affected were 21–40-year-olds. Motor vehicle accidents caused the most injuries, followed by falls from considerable heights.

Table 1 Demographic Characteristics and Mechanism of Injury

Injury Characteristics

Most injuries involved the cervical, thoracic, and lower back. Most admitted patients exhibited moderate to severe neurological impairment, according to the ASIA Impairment Scale.

Table 2 Injury Characteristics at Presentation

Management Distribution

Out of 60 patients, 22 were conservatively treated and 38 were surgically treated. Most surgically handled patients had decompression and stabilisation.

Table 3 Management Distribution and Surgical Procedures

Table 4 Types of Surgical Procedures Performed

Neurological Outcomes

Use of ASIA grade changes during follow-up to assess neurological improvement. Conservatively treated patients improved neurological function more than surgical patients.

Table 5 ASIA Grade Improvement at Follow-Up

A statistically significant improvement in neurological outcomes was observed in the surgically managed group compared to the conservative group (p < 0.05).

Functional Outcomes

Functional outcomes included rehabilitation success, bladder/bowel function, and mobility. Surgery allowed patients to move more freely and independently.

Table 6 Functional Outcomes at Final Follow-Up

Complications

Both groups had post-treatment issues, but surgically managed patients had more. Pressure sores and UTIs plagued both groups.

Table 7 Complications Observed

Length of Hospital Stay and Mortality

Surgical patients needed extra hospital time for perioperative care and rehabilitation, which extended their stay. Low mortality rates were observed throughout the study.

Table 8 Hospital Stay and Mortality

The present study evaluated the current surgical and non-surgical management strategies for traumatic spinal cord injury in a cohort of 60 patients over a one-year period. The findings demonstrate that timely and appropriately selected management strategies can lead to meaningful neurological and functional recovery in patients with TSCI. Surgical intervention was associated with greater neurological improvement, better functional outcomes, and higher rates of independent ambulation when compared to conservative management. In selected cases with stable injuries even conservative treatment has been considered of vital importance and therapeutic value. These findings also underscore the necessity of creating a personalized treatment plan in relation to injury grade, spinal stability, and general patient condition.

Comparison with Existing Literature

Table 9 Comparison of Present Study with Previous Studies

Surgical vs Non-Surgical Outcomes

Neurological and functional outcomes differed between surgical and non-surgical treatments. Surgical patients improved more functionally and ASIA grade-wise than conservative patients.  Early surgical decompression is crucial for reduction of spinal cord compression, improving spine alignment, and accelerating neurological recovery by minimizing secondary injury mechanisms. While the optimal timing of surgery is subject to debate, early intervention is encouraged by a number of studies, particularly within 24-72 hours following injury.

Treatment that is more conservative may be effective in certain situations. This study was able to provide non-surgical care since the patients had stable spinal injuries, a small number of neurological abnormalities, and severe medical comorbidities. Patients are able to attain functional results that are acceptable when they are immobilised appropriately, receive pharmacological support, and begin rehabilitation as soon as possible. This demonstrates that conservative treatment can be helpful in certain situations and highlights the significance of selecting the appropriate people for treatment.

 Importance of Early Intervention and Multidisciplinary Care

The prognosis for traumatic spinal cord injury patients depends on quick medical treatment. The appropriate neurological evaluation, immobilisation, and imaging can avoid additional injury. Early operative decisions can determine recovery of neurology and functional independence. Initiating early therapy can help to prevent and recover from pressure ulcers, joint contractures, and respiratory infections.

TSCI requires a multidisciplinary approach from neurologists, physiotherapists, occupational therapists, nursing staff and psychologists. Rehabilitation increases mobility, bowel and bladder control, and quality of life. Patients with spinal cord injury have to receive psychiatric help because they suffer from severe emotional and psychological distress. The findings of this research indicate that trauma and rehabilitation programs should work together to optimize patient outcomes.

Limitations of the Study

Despite its limitations, this study had some promising results. Due to the 60-patient sample size, the results may not apply to a larger population. Due to its single-center design, study results may reflect institutional practices rather than larger populations. The short follow-up time may have prevented neurological recovery, late effects, and long-term functional benefits. Future multicenter trials should employ larger samples and longer follow-ups to confirm these findings and enhance traumatic spinal cord injury therapy.

The findings of this study demonstrate that Traumatic spinal cord injury with current management strategies are effective in improving neurological and functional outcomes when applied properly. Better neurological recovery and functional independence were related with surgical intervention, mainly in patients with spinal instability or significant neurological deficits. Conservative treatment was a valued option in selected cases with no significant deficits and stable lesions. These findings indicate the need for a tailored treatment method depending on injury pattern, neurologic condition and patient-related factors. Early diagnosis, timely determination of appropriate surgical management, and structured multidisciplinary rehabilitation have to be considered as the key points in treatment to maximize recovery as well as limiting complications and improving quality of life for traumatic SCI patients.

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