Diagnosis and Acute Management of Spinal Cord Injury: Current Best Practices and Emerging Therapies

Abstract

The diagnosis and management of spinal cord injury (SCI) have continuously evolved over decades of clinical experience. We now understand that the injured spinal cord is in a precarious state, experiencing a complex cascade of inflammatory events and hemodynamic compromise. Careful navigation is required at each stage, from emergency personnel to the spinal surgeon who reconstructs the damaged spine, to minimize secondary injury and optimize neurological outcome. Future advances in SCI diagnosis will likely utilize novel MRI techniques that characterize spinal cord microstructure and functional connectivity. The acute management of SCI is likely to undergo a radical transformation, with numerous potential treatments used in combination, such as neuroprotective and regenerative pharmaceuticals, cellular transplantation, and implantation of structural scaffolds. In this review, we summarize current best practices in diagnosis and acute management of SCI, highlight areas of controversy, and introduce emerging therapies that are candidates for translation to clinical use.