An Update on the Pathophysiology of Acute Spinal Cord Injury

Spinal cord injuries can cause the catastrophic loss of motor and sensory function. The neurological deficits that result are the consequence of not only the primary injury to the spinal cord, but also a complex milieu of secondary pathological processes that are now beginning to be understood. The major mechanisms that underlie this secondary pathology are discussed in this literature review, and include vascular disruption, ischemia, oxidative stress, excitotoxicity, and inflammation. Although many of these processes remain incompletely understood, it is clear that they have the ability to cause bystander damage to neuronal and glial cells at the injury site. In light of this, the fact that this secondary pathology occurs after the initial impact makes it potentially amenable to therapeutic intervention. Pharmacotherapies may attenuate some of these processes and minimize secondary damage. Here we discuss several promising drug candidates that may be useful in this context.