Evidence-based guidelines for long-term care in spinal cord-related decompression illness

Introduction: The aim of this review was to synthesise current knowledge and propose structured evidence-based recommendations for long-term care of individuals with spinal cord decompression illness (scDCI) drawing on experience from French clinical settings and the international literature. Methods: We conducted a systematic search of international and French guidelines for decompression illness (DCI) and spinal cord injury (SCI), including systematic reviews and consensus statements. Additional literature searches were performed in PubMed® (1996-2025) to identify evidence relevant to long-term care. Key domains were predefined based on SCI guidelines: lower urinary tract and gastrointestinal function, thromboembolic, autonomic dysreflexia, pulmonary function, pain, and spasticity. Results: Our findings confirmed the absence of specific long-term follow-up protocols for scDCI. Evidence from SCI guidelines was therefore adapted to this population. We propose structured, evidence-based recommendations that include systematic neurological and urological screening even in apparently recovered patients and risk-adapted follow-up during the first two years. Conclusions: Long-term outcomes after scDCI remain poorly defined, but sequelae are frequent and may be underdiagnosed. Structured follow-up based on adapted SCI guidelines may improve prognosis, harmonise care, and generate robust data for future prospective studies.