Acute Care in Cervical Spinal Cord Trauma with Long-Term Benefit: A Review

Abstract

Spinal cord injury involves three phases. In the first, trauma events deliver direct pressure to the cervical spine, which may compress, dislocate, or fracture the spine, and in turn compress, crush, or transect the spinal cord. In the process, local neurons are destroyed and sensory and motor pathways can be severed. In the second phase, acute tissue responses, bleeding, and inflammation rapidly and radically change the physical and chemical conditions at the wound site. Finally, days, weeks, and months after the initial trauma, chronic post-injury processes reform the wound site into a lasting scar that impedes regeneration of spinal cord pathways. A major goal of current spinal cord injury research should be rapid and lasting inhibition of acute and chronic tissue reactions in the spinal cord wound that lead to a growth-inhibiting environment and diverting these reactions toward conditions that favor regeneration of severed spinal pathways. Here, we consider experimental strategies that could form the basis for treatments that can be rapidly administered after trauma and provides lasting benefit to spinal cord regeneration and rehabilitation.