Acute traumatic spinal cord injury

Parveen Athar MD (Dr. Athar of the University of Texas Health Science Center has no relevant financial relationships to disclose.)
Courtney M Preston MD (Dr. Preston of the University of Texas Health Science Center has no relevant financial relationships to disclose.)
Osman Athar (Mr. Athar of the University of Texas Health Science Center has no relevant financial relationships to disclose.)
Randolph W Evans MD, editor. (Dr. Evans of Baylor College of Medicine received honorariums from Allergan and DepoMed for speaking engagements.)
Originally released June 7, 1999; last updated September 19, 2014; expires September 19, 2017

Overview

Spinal cord injury is a devastating condition often affecting healthy individuals around the world. Currently in the United States, motor vehicle accidents account for the largest percentage of new acute traumatic spinal cord injuries, followed by falls and violence. It is estimated that in the United States, there are approximately 260,000 people living with spinal cord injury and 12,000 new cases annually. Recent advances in both medical and surgical treatment of spinal cord injury have shown much promise in the past several years and may ultimately offer novel therapeutic strategies as regenerative and reparative approaches become translated to the clinic. The authors provide an updated overview of the disease, including presentation and modern diagnosis and management principles, both surgical and nonsurgical.

Key points

 

• Acute spinal cord injury is a devastating condition that affects mostly healthy individuals around the world, with motor vehicle accidents being the major cause.

 

• Several mechanisms may collectively contribute to spinal cord injury, including primary injury (ie, direct tissue destruction) or secondary injury (ie, biochemical derangement, hemodynamic alteration).

 

• Prevention of spinal cord injury remains the most effective method of managing this horrible condition.

 

• There are no medical treatments that effectively treat acute spinal cord injury, and the use of steroids (particularly methylprednisolone) is still controversial.

 

• Early surgical treatment, when indicated, may improve functional outcome.

Historical note and terminology

The earliest clinical account of spinal cord injury was given in the Edwin Smith Papyrus as "a disease that cannot be treated" (Elsberg 1931). Hippocrates advocated several methods of reducing chronic spinal deformities, whereas Galen was able to localize cervical spinal cord injury by performing extensive vivisections. The biomechanical principle of immobilization was strongly advocated by Herbert Burrell, who also emphasized the need for spinal reduction (Sanan and Rengachary 1996). A gloomy prognosis for patients with spinal cord injury prevailed until the end of World War II. In 1944 Sir Ludwig Guttman founded the Spinal Injury Center at Stoke Mandeville Hospital in Aylesbury, England, the first center of its kind to focus on global care for patients with spinal cord injury. Subsequently, in the United States, the Veteran Administration initiated spinal cord injury services. These centers emphasized patient education, education to health care providers, prevention, early diagnosis, treatment of the injury and its complications, and physical and occupational health with rehabilitation facilities.

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