Acute Traumatic Spinal Cord Injury

Spinal cord injury remains one of the most important causes of trauma-related mortality as well as morbidity worldwide and imposes a substantial economic burden on society. Survivors not only suffer from life-altering motor and sensory deficits but are also vulnerable to acute and chronic complications affecting many organ systems. Since there currently exists no effective treatment to reverse the primary neurological injury, mitigation of secondary injury and avoidance of complications constitute the main goals of clinical management. Increasing evidence that timely intervention—including prompt transfer to specialized centers, early decompressive surgery, and emergent restoration of adequate oxygenation, ventilation, and mean arterial pressure—translate into improved long-term functional outcomes has led to growing recognition of the concept that “time is spine.” A number of neuroprotective and neuroregenerative therapies have also emerged in recent years and are under active investigation in clinical trials. In this chapter, we review key assessment principles, propose evidence-based critical care and surgical treatment strategies, and review promising approaches to protect and regenerate the traumatically injured spinal cord.