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Review
. 2022;24(7):285-304.
doi: 10.1007/s11940-022-00720-9. Epub 2022 Jun 10.

Pharmacologic and Acute Management of Spinal Cord Injury in Adults and Children

Ajay X Thomas  1   2 , James J Riviello Jr  1 , Daniel Davila-Williams  1 , Sruthi P Thomas  3   4 , Jennifer C Erklauer  1   5 , David F Bauer  4 , Jon A Cokley  1   6
Affiliations
Review

Pharmacologic and Acute Management of Spinal Cord Injury in Adults and Children

Ajay X Thomas et al. Curr Treat Options Neurol. 2022.

Abstract

Purpose of review: This review provides guidance for acute spinal cord injury (SCI) management through an analytical assessment of the most recent evidence on therapies available for treating SCI, including newer therapies under investigation. We present an approach to the SCI patient starting at presentation to acute rehabilitation and prognostication, with additional emphasis on the pediatric population when evidence is available.

Recent findings: Further studies since the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) demonstrated a potential functional outcome benefit with ultra-early surgical intervention ≤ 8 h post-SCI. Subsequent analysis of the National Acute Spinal Cord Injury Study (NASCIS) II and NASCIS III trials have demonstrated potentially serious complications from intravenous methylprednisolone with limited benefit. Newer therapies actively being studied have demonstrated limited or no benefit in preclinical and clinical trials with insufficient evidence to support use in acute SCI treatment.

Summary: Care for SCI patients requires a multi-disciplinary team. Immediate evaluation and management are focused on preventing additional injury and restoring perfusion to the affected cord. Rapid assessment and intervention involve focused neurological examination, targeted imaging, and surgical intervention when indicated. There are currently no evidence-based recommendations for pathomechanistically targeted therapies.

Keywords: Autonomic dysreflexia; MAP management; Rehabilitation; Spinal cord injury; Spinal shock; Surgical management of vertebral fracture.

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Conflict of interest statement

Conflict of InterestThe authors did not receive support from any organization for the submitted work. The authors have no relevant financial or non-financial interests to disclose. Open access of this publication was supported by the Texas Children’s Hospital Young Investigator Endowment.

Figures

Fig. 1
Fig. 1
American Spinal Injury Association (ASIA) Form [84].
See this image and copyright information in PMC

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