Current Treatment Options in Neurology

, Volume 9, Issue 2, pp 115–125 | Cite as

Acute spinal cord injury

  • Ricardo Cortez
  • Allan D. Levi

Opinion statement

Acute spinal cord injury is a devastating disease with enormous repercussions, not only for the victims and their families but for society as a whole. Despite the advent of novel medical therapies for the treatment of these injuries, many patients with spinal cord injury remain severely incapacitated and dependent on their families and/or specialized nursing care. Much of the controversy in the treatment of these injuries stems from insufficient knowledge about the pathophysiology of the disease as well as the timing of certain treatments such as surgery. We discuss the diagnosis and management of these injuries as well as novel therapies on the horizon. The recent emphasis on evidence-based medicine has resulted in the creation of guidelines from the American Association of Neurological Surgeons and the Congress of Neurological Surgeons, which will hopefully result in some standardization of care. It is our opinion that early recognition of spinal cord injury and careful management in an intensive care setting can prevent many of the medical complications that are the major source of morbidity and mortality in these patients.


Spinal Cord Injury Mean Arterial Blood Pressure American Spinal Injury Association Acute Spinal Cord Injury Cervical Spinal Cord Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Fehlings MG, Perrin RG: The role and timing of early decompression for cervical spinal cord injury: update with a review of recent clinical evidence. Injury Int J Care Injured 2005, 36:S-B13–S-B26.Google Scholar
  2. 2.
    Levi AD: Approach to the patient and diagnostic evaluation. In Youmans Neurological Surgery. Edited by Winn HR. Philadelphia, PA: WB Saunders; 2003:4869–4884.Google Scholar
  3. 3.
    Prusmack C, Rochman AS, Levi AD: The effect of age on survival following traumatic spinal cord injury. J Spinal Cord Med 2006, 12:49–57.Google Scholar
  4. 4.
    Maynard FM Jr, Bracken MB, Creasy G, et al.: International standards for neurological and functional classification of spinal cord injury. Spinal Cord 1997, 35:266–274.PubMedCrossRefGoogle Scholar
  5. 5.
    AANS Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries. Cervical spine immobilization before admission to the hospital. Neurosurgery 2002, 50(Suppl):S7–S17.Google Scholar
  6. 6.
    Belanger E, Levi AD: The acute and chronic management of spinal cord injury. J Am Coll Surg 2000, 190:603–618.PubMedCrossRefGoogle Scholar
  7. 7.
    DeVivo MJ, Kartus PL, Stover SL, Fine PR: Benefits of early admission to an organized spinal cord injury care system. Paraplegia 1990, 28:545–555.PubMedGoogle Scholar
  8. 8.
    AANS Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries. Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery 2002, 50(Suppl):S36–S43.Google Scholar
  9. 9.
    AANS Guidelines. Radiographic assessment of the cervical spine in asymptomatic trauma patients. Neurosurgery 2002, 50(Suppl):S30–S35.Google Scholar
  10. 10.
    Bracken MB, Shepard MJ, Collins WF Jr, et al.: A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990, 322:1405–1411.PubMedCrossRefGoogle Scholar
  11. 11.
    Bracken MB, Shepard MJ, Holford TR, et al.: Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Study. JAMA 1997, 277:1597–1604.PubMedCrossRefGoogle Scholar
  12. 12.
    Fehlings MG, Baptiste DC: Current status of clinical trials for acute spinal cord injury. Injury Int J Care Injured 2005, 36:S-B113–S-B122.Google Scholar
  13. 13.
    Geisler FH, Dorsey FC, Coleman WP: Recovery of motor function after spinal-cord injury—a randomized, placebo-controlled trial with GM-1 ganglioside. N Engl J Med 1991, 324:1829–1838.PubMedCrossRefGoogle Scholar
  14. 14.
    Geisler FH, Coleman WP, Grieco G, et al.: The Sygen multicenter acute spinal cord injury study. Spine 2001, 26:S87–S98.PubMedCrossRefGoogle Scholar
  15. 15.
    Sekhon L Fehlings MG: Epidemiology, demographics and pathophysiology of acute spinal cord injury. Spine 2002, 26:S2–S12.CrossRefGoogle Scholar
  16. 16.
    DeVivo MJ, Kartus PL, Stover SL, et al.: Cause of death for patients with spinal cord injuries. Arch Intern Med 1989, 149:1761–1766.PubMedCrossRefGoogle Scholar
  17. 17.
    Harrop JS, Sharan AD, Scheid EH Jr, et al.: Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association grade A. J Neurosurg 2004, 100(Suppl):20–23.PubMedGoogle Scholar
  18. 18.
    Northrup BE, Vaccaro AR, Rosen JE, et al.: Occurrence of infection in anterior cervical fusion for spinal cord injury after tracheostomy. Spine 1995, 20:2449–2453.PubMedCrossRefGoogle Scholar
  19. 19.
    AANS Guidelines. Initial closed reduction of cervical spine fracture-dislocation injuries. Neurosurgery 2002, 50(Suppl):S44–S50.Google Scholar
  20. 20.
    Dimar JR, Glassman SD, Raque GE, et al.: The influence of spinal canal narrowing and timing of decompression on neurologic recovery after spinal cord contusion in a rat model. Spine 1999, 24:1623–1633.PubMedCrossRefGoogle Scholar
  21. 21.
    Waters RL, Adkins RH, Sie IH, et al.: Motor recovery following spinal cord injury associated with cervical spondylosis: a collaborative study. Spinal Cord 1996, 34:711–715.PubMedGoogle Scholar
  22. 22.
    Selden NR, Quint DJ, Patel N, et al.: Emergency magnetic resonance imaging of cervical spinal cord injuries: clinical correlation and prognosis. Neurosurgery 1999, 44:785–792.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Department of Neurological SurgeryThe University of Miami, Miller School of Medicine and The Miami Project to Cure Paralysis, Lois Pope Life CenterMiamiUSA

Personalised recommendations