Traumatic Cervical Spinal Cord Injuries: Is There a Clinical Benefit of Added Duroplasty Alongside Bony Decompression?

Abstract

Traumatic cervical spinal cord injury (cSCI) is a devastating condition associated with significant morbidity and long-term disability. Surgical decompression remains the cornerstone of management; however, the potential role of duraplasty as an adjunctive procedure remains controversial. Proponents argue that duraplasty alleviates intraspinal pressure, enhances spinal cord perfusion, and reduces secondary ischemic injury by expanding the dural space and mitigating post-traumatic edema. Emerging clinical and preclinical data suggest that duraplasty may improve neurological outcomes by optimizing cerebrospinal fluid dynamics and reducing ischemia-induced neuronal apoptosis. However, critics highlight significant risks, including cerebrospinal fluid leakage, pseudomeningocele formation, infection, and intracranial hypotension, which may outweigh its theoretical benefits. This comparative article critically examines the pathophysiological rationale, existing evidence, and ongoing controversies in favour or against widespread adoption of duroplasty in cervical spinal cord trauma.