Physiopathology of spinal cord injury

Abstract

Spinal cord injury (SCI) is a highly incapacitating nosologic entity. Often, patients affected by this disease suffer functional restrictions that impede their return to normal professional and leisure activities. Patients with spinal cord injury have a high rate of associated morbidities, as well as multiple and prolonged hospital internment, with a mortality rate, only in the period of the first internment, of 4.4% to 16.7%. Thus, it is necessary to promote suitable mechanisms to prevent the occurrence of spinal cord injury and more efficiently treat patients with the condition, which will be possible with the expansion of knowledge regarding its pathophysiology. The pathophysiology of traumatic spinal cord injury involves understanding two lesion mechanisms, or moments: the primary and the secondary. The primary lesion is the result of the initial mechanical trauma. It can be understood as a combination of the initial impact with a possible subsequent compression. There is a direct and immediate relationship with the trauma and, once it occurs, it is irreversible. Such trauma determines damage to the axons, glial cells and blood vessels to different degrees (partial or complete). The only way to avoid the primary lesion is to prevent the occurrence of the trauma, which can only be achieved with education and public awareness policies aimed at reducing the incidence of such lesions. The secondary lesion is that which follows the first and its pathophysiology involves multiple mechanisms. They all occur concomitantly, are interrelated, and potentialize one another, so that it is impossible to state which is the principal pathophysiological mechanism. They are: - Vascular mechanisms; - Ionic mechanisms; - Biochemical mechanisms; - Inflammatory mechanisms; - Cellular mechanisms; As it occurs post-trauma, the secondary damage is susceptible to therapy, and so is potentially reversible. The understanding of its pathophysiology will facilitate the treatment of spinal cord injury. Spinal Cord injury is an event that produces countless harmful consequences for the patient, his family and for society. The factors involved in its pathophysiology are multiple and the understanding of those factors and their interrelationship facilitate the emergence of therapeutic targets that certainly, one day will make it possible to treat the patient with SCI. Only then will we be able to change the neurological, psychological and social prognosis of the patient with spinal cord injury. © 2010 by Nova Science Publishers, Inc. All rights reserved.