Acute traumatic spinal cord injury

Marc-Alain Babi MD (Dr. Babi of the University of Florida has no relevant financial relationships to disclose.)
Katharina M Busl MD MS (Dr. Busl of University of Florida, Gainesville, has no relevant financial relationships to disclose.)
Randolph W Evans MD, editor. (

Dr. Evans of Baylor College of Medicine received honorariums from Allergan, Amgen, Avanir, DepoMed, Lilly, and Novartis for speaking engagements and honorariums from Alder and Promius for advisory board membership.

Originally released June 7, 1999; last updated December 1, 2017; expires December 1, 2020


Acute traumatic spinal cord injury (TSCI) is a global epidemic in modern society. Yearly, there are over 12,000 new cases of acute spinal cord injury in the United States of America alone, and over 260,000 people live with spinal cord injury. Motor vehicle accidents account for nearly half of all cases, followed by falls (16%), violence (including gunshot wounds) (12%), sports-related accidents (10%), and other causes (14%). Despite advances made in the understanding of the pathogenesis and improvements in the early recognition, and treatment of coexisting complications, TSCI remains a devastating event, often leading to permanent and severe disability. In this update, the authors provide an overview of the disease, including epidemiology, pathophysiology, clinical presentation, and management principles.

Key points


• Most traumatic spinal cord injuries occur in association with impact to the vertebral column, resulting in direct compression or disruption of the spinal cord. Secondary injuries may ensue, resulting from ischemic and inflammatory processes, disrupted homeostasis, and apoptosis.


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


There are no medical treatments that effectively treat or reverse acute spinal cord injury.


• There is conflicting evidence of potential benefit of steroids in traumatic spinal cord injury with lack of clear outcome improvement. Their use is no longer endorsed by major society guidelines.


• All traumatic spinal cord injuries require emergent neurosurgical (or orthopedic) consultation to evaluate the role of emergent surgical decompression.

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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