29 - Pathophysiology and Early Management of Spinal Cord Injury

Abstract

Traumatic spinal cord injury (SCI) is a devastating neurologic entity, and injury results in the development of substantial motor, sensory, and autonomic deficits or even permanent loss of neurologic function. Up to the present time, effective therapies for functional recovery from SCI have not been established. Existing treatment options are limited; therefore the development of novel strategies to treat SCI is warranted. Understanding the underlying pathophysiology is imperative because it may lead to the development of promising treatment modalities and the prevention of further injury. The primary insult leads to a signaling cascade of neuronal damage and hypoxic sequelae known as secondary injury that further induces neurologic deterioration due to ongoing tissue damage. Prevention of secondary mechanisms that cause posttraumatic degeneration of the spinal cord can provide the opportunity for neuroprotection and impede tissue destruction, thus promoting improved neurologic outcomes after initial spinal cord trauma. The advancement of neuroprotective therapies to prevent secondary injury has been well documented in preclinical experimental models. However, translation into human subjects and the overall efficacy of these therapies have been largely unsuccessful to date. In this chapter, we focus on the pathophysiology of SCI, including both primary and secondary injury, and highlight emerging therapies for neuroprotection. Additionally, we review early versus late surgical management of SCI and briefly review the literature regarding current SCI trials.