MANAGEMENT OF ACUTE SPINAL CORD INJURY: FRACTURES AND LUXATIONS

摘要

Medical and surgical therapies should address both primary and secondary SCI.Nociception is a key prognosticator for outcome in SCI.Benefit of high dose corticosteroids is minimal and significant complications are possible.Surgery is indicated for paretic animals with intact nociception, animals with worsening neurologic status, or those with unstable fractures or spinal cord compression.Acute spinal cord injury causes damage through a variety of mechanisms. Broadly speaking, spinal cord injury can be defined as primary or secondary. Primary injury is a mechanical insult that can usually be classified as concussion, compression, shearing, laceration, or elongation. The spinal cord may be subject to multiple primary injuries subsequent to the initial hit, due to ongoing instability or persistent compression. The mechanical insult directly damages nervous tissue and induces a cascade of vascular and molecular events leading to secondary changes such as hemorrhage, ischemia, and edema. A cycle of secondary neuronal injury is induced and mediated via factors including free radicals, excitatory neurotransmitters, cytokines, inflammatory mediators, ionic dysregulation, and catecholamines. This secondary injury may be as damaging as the primary injury itself, and the severity of overall spinal cord damage is a reflection of both the primary and secondary injuries.