(PHILADELPHIA) -- When it comes to a devastating spinal injury, says spine surgeon Alexander Vaccaro, M.D., timing might be nearly everything. It's also a topic of great debate and discussion among orthopaedic surgeons.

Dr. Vaccaro, professor of orthopaedic surgery and neurological surgery at Jefferson Medical College of Thomas Jefferson University in Philadelphia and the Rothman Institute at Thomas Jefferson University Hospital and his colleagues are trying to answer a very difficult and controversial question: Should surgeons operate immediately, within hours of the severe spinal injury, to try to limit the damage to the spinal cord and surrounding tissues, as many surgeons believe? Or won't it make a difference in how a patient ultimately fares, as others, citing their experiences, say?

Dr. Vaccaro, in conjunction with Michael G. Fehlings, M.D., at Toronto Western Hospital, is spearheading a multicenter trial called STASCIS, which looks at timing of surgery, the timing of spinal reduction and a prospective evaluation of how patients do.

STASCIS is an acronym for the Surgical Treatment of Acute Spinal Cord Injury Study. Begun in 2003, STASCIS is both an observational and prospective randomized study aimed at determining if patients with spinal cord injury will benefit from early treatment to reduce pressure on the spinal cord.

Two types of injuries occur when the spinal cord is damaged, says Dr. Vaccaro, co-director of the Delaware Valley Regional Spinal Cord Injury Center at Jefferson. The primary injury is the actual physical insult to the spinal cord, including bruising, bleeding and any kind of disruption to the cord and its functioning. But a secondary injury also occurs, usually between the first day after the initial damage to as many as three to five days later. Cell and tissue death begins including apoptosis, or programmed cell death as electrolytes like calcium and sodium become out of balance.