Spinal cord trauma: pathophysiology, classification of spinal cord injury syndromes, treatment principles and controversies

Acute spinal cord trauma is a devastating injury which often leads to severe disability. The tissue response following the initial insult extends the cord damage, while there is limited repair potential with regards to axon regeneration resulting in permanent neurological deficits. Management of acute cord injury is an area of active research in order to stabilize the spine in a timely manner, minimize the secondary insult and promote regeneration. Methyl-prednisolone administration for limitation of the secondary injury phase and acute versus late operative treatment are areas of current debate among several authors. This article is an overview of all aspects of early and long term spinal cord injury management. It focuses on the patho-physiological mechanisms of the acute injury phase and the different clinical types of cord injury syndromes. The treatment principles are described along with an updated view on the controversial issues.