Update on Traumatic Spinal Cord Injury

  • Carolina Rouanet
  • Gisele Sampaio Silva


Traumatic spinal cord injury (TSCI) is a devastating disease, with a global prevalence ranging between 236 and 1009 per million. The major goal in its management is to reduce primary and secondary injuries, which account for the final disease extent. Acute complications comprise motor and sensory disturbances but also cardiovascular, respiratory, thermoregulatory, urinary, gastrointestinal, and sexual disturbances, especially in injuries above sixth thoracic vertebra (Th6). Neurogenic shock is a well-recognized phenomenon caused by the interruption of sympathetic pathways and unopposed vagal tone, with hypotension and bradycardia. Hypotension contributes to secondary injury and should be avoided, with the use of vasopressors when needed. The best vasopressor is still a matter of debate and should be individualized. Surgical decompression should be performed early in order to relieve mechanical pressure on the microvascular circulation, reducing ongoing ischemia. Methylprednisolone is no longer recommended in guidelines. Neuroprotective and neuroregenerative therapies are under extensive investigations and seem to be promising. Cell-based therapies may be the future of regeneration.


  1. 1.
    Cripps RA, Lee BB, Wing P, et al. A global map for traumatic spinal cord injury epidemiology: towards a living data repository for injury prevention. Spinal Cord. 2011;49:493–501.CrossRefGoogle Scholar
  2. 2.
    Ahuja CS, Martin AR, Fehlings MG. Recent advances in managing spinal cord injury secondary to trauma. F1000 Res. 2016;5(F1000 Faculty Rev):1017.CrossRefGoogle Scholar
  3. 3.
    Rouanet C, Reges D, Rocha R, et al. Traumatic spinal cord injury: current concepts and treatment update. Arq Neuropsiquiatr. 2017;75(6):387–93.CrossRefGoogle Scholar
  4. 4.
    Wilson JR, Forgione N, Fehlings MG. Emerging therapies for acute traumatic spinal cord injury. CMAJ. 2013;185(6):485–92.CrossRefGoogle Scholar
  5. 5.
    Hagen EM. Acute complications of spinal cord injuries. World J Orthop. 2015;6(1):17–23.CrossRefGoogle Scholar
  6. 6.
    Stein DM, Sheth KN. Management of acute spinal cord injury. Continuum (Minneap Minn). 2015;21(1):159–87.Google Scholar
  7. 7.
    Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34(6):535–46.CrossRefGoogle Scholar
  8. 8.
    Le CT, Price M. Survival from spinal cord injury. J Chronic Dis. 1982;35(6):487–92.CrossRefGoogle Scholar
  9. 9.
    Hadley MN, Walters BC, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, et al. Update guidelines for the management of acute cervical spine and spinal cord injury. Neurosurgery. 2013;72(Suppl 3):1.Google Scholar
  10. 10.
    Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med. 2000;343(2):94–9.CrossRefGoogle Scholar
  11. 11.
    Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841–8.CrossRefGoogle Scholar
  12. 12.
    Krishna V, Andrews H, Varma A, Mintzer J, Kindy MS, et al. Spinal cord injury: how can we improve its classification and quantification of its severity and prognosis? J Neurotrauma. 2014;31:215–27.CrossRefGoogle Scholar
  13. 13.
    Casha S, Christie S. A systematic review of intensive cardiopulmonary management after spinal cord injury. J Neurotrauma. 2011;28(8):1479–95.CrossRefGoogle Scholar
  14. 14.
    Ploumis A, Yadlapalli N, Fehlings MG, Kwon BK, Vaccaro AR. A systematic review of the evidence supporting a role for vasopressor in acute SCI. Spinal Cord. 2010;48:356–62.CrossRefGoogle Scholar
  15. 15.
    Inoue T, Manley GT, Patel N, Whetstone WD. Medical and surgical management after spinal cord injury: vasopressor usage, early surgeries, and complications. J Neurotrama. 2014;31:284–91.CrossRefGoogle Scholar
  16. 16.
    Readdy WJ, Dhall SS. Vasopressor administration in spinal cord injury: should me apply a universal standard to all injury patterns? Neural Regen Res. 2016;11(3):420–1.CrossRefGoogle Scholar
  17. 17.
    Jacobs WB. Mean arterial blood pressure treatment for acute spinal cord injury (MAPS). Clinical Trialsgov. NCT 02232165.
  18. 18.
    Vazquez RG, Sedes PR, Farina MM, Marques AM, Velasco EF. Respiratory management in the patient with spinal cord injury. Biomed Res Int. 2013;2013:168757.Google Scholar
  19. 19.
    Choi HJ, Paeng SH, Kim ST, Lee KS, Kim MS, Jung YT. The effectiveness of early tracheostomy in cervical spinal cord injury patients. J Korean Neurosurg Soc. 2013;54:220–4.CrossRefGoogle Scholar
  20. 20.
    Fehlings MG, Vaccaro A, Wilson JR, Singh A, Cadotte D W, Harrop JS, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(1):e32037.CrossRefGoogle Scholar
  21. 21.
    Wilson JR, Singh A, Craven C, Verrier MC, Drew B, Ahn H, et al. Early versus late surgery for traumatic spinal cord injury: the results of a prospective Canadian cohort study. Spinal Cord. 2012;50(11):840–3.CrossRefGoogle Scholar
  22. 22.
    AOSpine Europe. Surgical treatment for spinal cord injury(SCI-POEM). Clinical NCT 01674764; 2012.
  23. 23.
    Anwar MA, Shehabi TSA, Eid AH. Inflammogenesis of secondary spinal cord injury. Front Cell Neurosci. 2016;10(98):1–24.Google Scholar
  24. 24.
    Bracken MB, Collins WF, Freeman DF, Shepard MJ, Wagner FW, Silten RM, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA. 1984;251(1):45–52.CrossRefGoogle Scholar
  25. 25.
    Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, 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(20):1405–11.CrossRefGoogle Scholar
  26. 26.
    Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Administration of methylprednisolone for 24 or 48hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury: results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. JAMA. 1997;277(20):1597–604.CrossRefGoogle Scholar
  27. 27.
    Evaniew N, Belley-Côté EP, Fallah N, Noonan VK, Rivers CS, Dvorak MF. Methylprednisolone for the treatment of patients with acute spinal cord injuries: a systematic review and meta-analysis. J Neurotrauma. 2016;33(5):468–81.CrossRefGoogle Scholar
  28. 28.
    Petitjean ME, Pointillart V, Dixmerias F, Wiart L, Sztark F, Lassié P, et al. [Medical treatment of spinal cord injury in the acute stage]. Ann Fr Anesth Reanim. 1998;17(2):115–22.Google Scholar
  29. 29.
    Geisler FH, Coleman WP, Grieco G, Poonian D. The Sygen multicenter acute spinal cord injury study. Spine. 2001;26(24 Suppl):87–98.CrossRefGoogle Scholar
  30. 30.
    AOSpine North America Research Network. Riluzole in spinal cord injury study (RISCIS). Clinical NCT 01597518.
  31. 31.
    Rick Hansen Institute. Minocycline in acute spinal cord injury(MASC). Clinical NCT 01828203.
  32. 32.
    Daiichi Sankyo Inc. Study to evaluate the efficacy, safety, and pharmacokinetics of SUN13837 injection in adult subjects with Acute Spinal Cord Injury (ASCI). Clinical NCT01502631.
  33. 33.
    Kamiya K, Koda M, Furuya T, Kato K, Takahashi H, Sakuma T, et al. Neuroprotective therapy with granulocyte colony-stimulating factor in acute spinal cord injury: a comparison with high-dose with methylprednisolone as a historical control. Eur Spine J. 2015;24(5):963–7.CrossRefGoogle Scholar
  34. 34.
    Takahashi H, Yamazaki M, Okawa A, Sakuma T, Kato K, Hashimoto M, et al. Neuroprotective therapy using granulocyte colony-stimulating factor for acute spinal cord injury: a phase I/IIa clinical trial. Eur Spine J. 2012;21(12):2580–7.CrossRefGoogle Scholar
  35. 35.
    Streijger F, Lee JH, Monouchehri N, Okon EB, Tigchelaar S, et al. The evaluation of magnesium chloride within a polyethylene glycol formulation in a porcine model of acute spinal cord injury. J Neurotrauma. 2016;33(24):2202–16.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Carolina Rouanet
    • 1
  • Gisele Sampaio Silva
    • 1
  1. 1.Neurology and Neurosurgery Department Federal University of São PauloSão PauloBrazil

Personalised recommendations