title: Can the standard treatment of acute spinal cord injury be improved? Perhaps the time has come.
abstract: OBJECTIVE
  To present additional surgical maneuvers that might lead to improved results in the treatment of acute spinal cord injuries (SCI).
  
  
  METHODS
  Techniques are presented that allow the dura mater to be widely opened over a traumatized spinal cord, thus limiting the opportunity for extrusion of edematous spinal cord material. Additionally, placement of an intact omental pedicle over a traumatized SCI allows absorption of spinal cord edematous fluid.
  
  
  RESULTS
  Widely opening the dura mater and placing an intact omental pedicle over an SCI site results in a dynamic equilibrium between the production of spinal cord injury edema fluid and its absorption by the omentum. This absorption of edema fluid allows for the associated absorption of fibrinogen. A decreased fibrinogen level lessens its activation to fibrin, thus resulting in the decreased production of scar tissue which is readily observed in patients with a chronic SCI.
  
  
  CONCLUSIONS
  A proposal is presented that may have the potential to improve the neurological results following the surgical treatment of an acute SCI.
authors.affiliation: Department of Surgery, University of Nevada School of Medicine, Reno, NV, USA. hlgldsmith@aol.com
authors.forename: Harry S
authors.initials: HS
authors.lastname: Goldsmith
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000818:Animals; D002415:Cats; D002921:Cicatrix / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery; D004121:Dimethyl Sulfoxide / Q000494:pharmacology / Q000627:therapeutic use; D004388:Dura Mater / Q000503:physiopathology / Q000601:surgery; D004487:Edema / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D006801:Humans; D018696:Neuroprotective Agents / Q000494:pharmacology / Q000627:therapeutic use; D019635:Neurosurgical Procedures / Q000379:methods*; D009852:Omentum / Q000502:physiology / Q000637:transplantation; D011785:Quality Assurance, Health Care; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000601:surgery*; D016378:Tissue Transplantation / Q000379:methods* / Q000592:standards / Q000639:trends; D016896:Treatment Outcome
chemical_list: D018696:Neuroprotective Agents; D004121:Dimethyl Sulfoxide