Anatomy and physiology of the spinal cord

  • The spinal cord is part of the central nervous system and extends from the brainstem to the lower back
  • The spinal cord is surrounded by protective layers of bone, ligaments, and fluid
  • The spinal cord is responsible for transmitting sensory and motor information to and from the brain
  • Some common conditions that affect the spinal cord include spinal cord injury, spinal stenosis, and herniated discs

Mechanisms of spinal cord injury, including traumatic and non-traumatic causes

Classification of spinal cord injuries based on level and severity

  • The ASIA impairment scale is the most commonly used method for classifying spinal cord injuries
  • The ASIA impairment scale categorizes spinal cord injuries based on the level of neurological impairment, ranging from A (complete injury) to E (normal function)
  • Spinal cord injuries can also be classified based on the level of the injury (cervical, thoracic, lumbar, or sacral)
  • Understanding the classification of a spinal cord injury can help guide treatment and predict outcomes

Neurological assessment of spinal cord injuries including sensory and motor function

  • Neurological assessment is crucial in evaluating spinal cord injuries and monitoring recovery
  • Sensory and motor assessments can help determine the level and extent of neurological impairment
  • The ASIA sensory and motor scores are commonly used to quantify neurological function and track changes over time
  • Understanding the extent and distribution of sensory and motor deficits can help guide treatment and predict outcomes

Initial evaluation and management of spinal cord injuries including airway, breathing, and circulation

  • The initial evaluation of a patient with a suspected spinal cord injury should focus on assessing airway, breathing, and circulation
  • Immobilization of the spine may be necessary to prevent further injury during transport
  • Treatment of spinal cord injuries often involves a multidisciplinary team, including emergency medical personnel, neurosurgeons, and rehabilitation specialists
  • Early and aggressive management of spinal cord injuries can improve outcomes and prevent complications

Overview of Treatment of Acute Spinal Cord Injury

Rationale for Corticosteroid Use in Acute Spinal Cord Injury

Secondary Injury Mechanisms

  • Secondary injury causes physiologic changes and may continue for hours or days after the initial injury
  • Mediators of secondary injury include ischemia, increased intracellular calcium, extracellular glutamate, free radicals, inflammation, and apoptosis
  • Glucocorticoids were initially used to treat acute SCI with the hope of clinical benefit from an anti-inflammatory effect and inhibition of lipid peroxidation
  • Methylprednisolone has a potent maximal antioxidant effect, which may be important in clinical treatment decisions