Update on Traumatic Spinal Cord Injury

Abstract

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.