Updates in the Early Management of Acute Spinal Cord Injury.
Mark J LambrechtsTariq Ziad IssaAlan S HilibrandPublished in: The Journal of the American Academy of Orthopaedic Surgeons (2023)
Spinal cord injury (SCI) is a leading cause of disability worldwide, and effective management is necessary to improve clinical outcomes. Many long-standing therapies including early reduction and spinal cord decompression, methylprednisolone administration, and optimization of spinal cord perfusion have been around for decades; however, their efficacy has remained controversial because of limited high-quality data. This review article highlights studies surrounding the role of early surgical decompression and its role in relieving mechanical pressure on the microvascular circulation thereby reducing intraspinal pressure. Furthermore, the article touches on the current role of methylprednisolone and identifies promising studies evaluating neuroprotective and neuroregenerative agents. Finally, this article outlines the expanding body of literature evaluating mean arterial pressure goals, cerebrospinal fluid drainage, and expansive duroplasty to further optimize vascularization to the spinal cord. Overall, this review aims to highlight evidence for SCI treatments and ongoing trials that may markedly affect SCI care in the near future.
Keyphrases
- spinal cord injury
- spinal cord
- neuropathic pain
- cerebrospinal fluid
- minimally invasive
- high dose
- healthcare
- systematic review
- multiple sclerosis
- genome wide
- case control
- electronic health record
- computed tomography
- magnetic resonance
- intensive care unit
- machine learning
- chronic pain
- ultrasound guided
- global health
- cerebral ischemia
- gene expression
- deep learning
- aortic dissection