**3.5. Definitive treatment**

Management of acute missile-penetrating SCI is multidisciplinary. The treatment is guided by many factors, but first and above all, the patient's respiratory and hemodynamic stability are defined by the ATLS guidelines. A hemodynamically unstable patient, whose primary resuscitation has failed, should be transferred immediately to angiography or surgery suite without further delay. In a stable patient, treatment should be guided by the presence of other factors such as neurological status, mechanical stability of the spine, CSF leak, risk for infection, and other systemic injuries.
