Reviews: Review Article

Updates in the Early Management of Acute Spinal Cord Injury

Lambrechts, Mark J. MD; Issa, Tariq Ziad BA; Hilibrand, Alan S. MD

From the Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA.

Conflicts of Interest: The authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. There are no relevant disclosures.

Journal of the American Academy of Orthopaedic Surgeons 31(17):p e619-e632, September 1, 2023. | DOI: 10.5435/JAAOS-D-23-00281

CME Test

Abstract

Spinal cord injury (SCI) is a leading cause of disability worldwide, and effective management is necessary to improve clinical outcomes. Many long-standing therapies including early reduction and spinal cord decompression, methylprednisolone administration, and optimization of spinal cord perfusion have been around for decades; however, their efficacy has remained controversial because of limited high-quality data. This review article highlights studies surrounding the role of early surgical decompression and its role in relieving mechanical pressure on the microvascular circulation thereby reducing intraspinal pressure. Furthermore, the article touches on the current role of methylprednisolone and identifies promising studies evaluating neuroprotective and neuroregenerative agents. Finally, this article outlines the expanding body of literature evaluating mean arterial pressure goals, cerebrospinal fluid drainage, and expansive duroplasty to further optimize vascularization to the spinal cord. Overall, this review aims to highlight evidence for SCI treatments and ongoing trials that may markedly affect SCI care in the near future.