Current insights into the management of spinal cord injury

Journal of Orthopaedics, 2023 · DOI: https://doi.org/10.1016/j.jor.2023.05.007 · Published: May 16, 2023

Spinal Cord Injury Surgery Rehabilitation

Simple Explanation

Traumatic spinal cord injury (SCI) is a serious condition that impairs neurological function and reduces a patient's quality of life. SCI involves a primary and secondary phase that causes neurological injury. Current management focuses on early surgery, optimizing blood pressure, steroid therapy, and rehabilitation to reduce secondary injury mechanisms. Emerging therapies like cell-based, gene, pharmacological, and neuromodulation treatments aim to repair the spinal cord after the initial injury.

Study Duration

Not specified

Participants

Multiple studies analyzed, varying participant numbers

Evidence Level

Narrative Review

Key Findings

1
Early surgical decompression (within 24 hours of injury) is associated with improved sensorimotor recovery in SCI patients.
2
Maintaining a mean arterial pressure (MAP) above 85 mmHg for 7 days post-injury is recommended to prevent hypotension and secondary complications.
3
MRI can be used as a prognostic tool, with specific patterns (e.g., single-level edema, multilevel edema) predicting neurological outcomes after SCI.

Research Summary

This review explores the current clinical management of spinal cord injury (SCI), focusing on strategies to mitigate secondary injury mechanisms. The review highlights the importance of early decompressive surgery, blood pressure management, steroid therapy, and rehabilitation in improving patient outcomes. Emerging therapies, including cell-based, gene, and pharmacological approaches, hold promise for repairing the primary injury mechanism and further enhancing recovery.

Practical Implications

Surgical Timing

Early surgical intervention (within 24 hours) should be prioritized to improve neurological outcomes.

Blood Pressure Management

Maintaining adequate MAP through blood pressure augmentation is crucial in the acute phase of SCI.

Rehabilitation Strategies

Implementing targeted and intensive rehabilitation programs can maximize functional independence and community reintegration.

Study Limitations

1
The long-term functional recovery after SCI is still not optimal.
2
An effective regenerative therapy is currently not accessible in the clinic.
3
Efficacy of stem cell administration to the damaged spinal cord has not been proven yet.

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