The Critical Management of Spinal Cord Injury: A Narrative Review

Clin. Pract., 2025 · DOI: https://doi.org/10.3390/clinpract15010002 · Published: December 26, 2024

Spinal Cord Injury Critical Care Neurology

Simple Explanation

Spinal cord injury (SCI) happens when there's physical damage that changes how the spinal cord works. Most of the time, this is due to accidents, falls, or violence. When someone has an SCI, getting them into intensive care quickly and doing surgery to relieve pressure on the spinal cord early on can really improve their chances of a good recovery. Researchers are also looking at medicines that might protect the nerves in the spinal cord. These medicines could help people with SCI have better results in the long run.

Study Duration

Not specified

Participants

50 publications

Evidence Level

Narrative Review

Key Findings

1
Early intensive care unit (ICU) monitoring improves patient prognosis, highlighting the importance of prompt ICU admission and early decompression surgery.
2
The current management of acute SCI should focus on standardized treatments addressing ventilatory, cardiopulmonary, and hematologic complications, all of which directly impact long-term neurological and functional prognosis.
3
Early decompression surgery for SCI has demonstrated improved neurological recovery, better prognosis, reduced intubation time, and shorter ICU stays in clinical trials.

Research Summary

Spinal cord injury (SCI) is defined as physical damage that alters the function and structure of the spinal cord. Traumatic causes, such as vehicle accidents, falls, and violence, account for 90% of SCI cases. The current management of acute SCI should focus on standardized treatments addressing ventilatory, cardiopulmonary, and hematologic complications, all of which directly impact long-term neurological and functional prognosis. As many articles mention, “time is spine” must become part of the Emergency Department and Intensive Care Unit mentality when treating spinal cord injury, as prompt surgical intervention and medical management affect a patient’s prognosis and quality of life.

Practical Implications

Prompt Surgical Intervention

Emergency departments should immediately inform ICU staff and consult neurosurgery teams for prompt surgical interventions within the first few hours post-injury.

Advanced Resuscitative Measures

Initial management must address the loss of ventilatory and cardiovascular function through advanced resuscitative measures.

Integration of Neuroprotective Agents

New neuroprotective agents, once approved, should be integrated into SCI treatment protocols. Both emergency and ICU teams must establish protocols to administer these medications during acute SCI management, as their timing may be critical to improving outcomes.

Study Limitations

1
The present narrative review has some methodological limitations, since it only concentrated the search for articles in two databases and excluded articles that were not written in English, that were older than 5 years, and that did not have specific topics.
2
due to its methodological nature, this review could exclude articles from other sources, languages, and topics relevant to the subject.
3
Although clinical trials, systematic reviews, meta-analysis, and animal model experiments were chosen, the degree of scientific evidence was variable among the articles chosen

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