Pathogenesis of Spinal Cord Injury and Newer Treatments

Many victims of traumatic spinal cord injury (SCI) suffer immediate paralysis as well as a subsequent progressive worsening of the cord pathology. Certain sensorimotor functions that might otherwise have returned are irreversibly lost because of this delayed response. An understanding of the pathophysiology behind this progressive, self-destructive sequence is yet to be acquired; however, numerous proposals have been set forth involving processes such as edema formation, vascular changes, an inflammatory reaction, and destruction of the neuronal plasma membranes. In this review, the authors outline many of the chemical, anatomic, and functional changes associated with SCI as well as a number of treatment regimens that have been found to improve recovery from SCI (including parenteral glucocorticoid therapy, localized cord cooling, calcium channel blockers, and opiate antagonism). From this, a number of mechanisms accounting for the mediation and/or prevention of the secondary destructive response are synthesized.