162 - Medical Management of Adult and Pediatric Spinal Cord Injury

Abstract

Acute traumatic spinal cord injury (SCI) is a life-altering neurological event that has devastating consequences for the physical, financial, and psychosocial wellbeing of patients. Injury results in significant motor and sensory deficits, or even complete paralysis. Effective therapies that abate further neurological compromise and facilitate functional recovery after SCI have not been established. Existing treatment options are limited, thus requiring the development of novel strategies to advance SCI treatment. A solid understanding of the pathophysiology underlying SCI is imperative, as it may hold promise in the development of future treatment modalities and prevention of further injury. The traumatic primary injury invokes an intense signaling cascade of neuronal damage and hypoxia that further induces neurological deterioration, which characterizes secondary injury. Prevention of secondary mechanisms that cause posttraumatic degeneration of the spinal tissue can provide the opportunity for neuroprotection and neuroregeneration, thereby impeding tissue destruction and preserving neurological function outcomes. The advancement of neuroprotective therapies to prevent secondary injury has been well documented in preclinical experimental models; however, the overall efficacy of these therapies in human subjects has been inconclusive. This chapter reviews the medical management of adult and pediatric SCI, including the pathophysiological mechanisms of SCI (both primary and secondary), the medical management of acute critical care needs, and emerging therapies for neuroprotection and neuroregeneration. The chapter concludes with a discussion of the medical management of subacute and chronic issues encountered by patients with SCI.