24 - Spinal cord injury

Summary

Various factors can result in non-traumatic cord injury including infection, tumours and ischaemia. The most common infections leading to spinal cord injury (SCI) are Staphylococcus or tuberculous abscesses and transverse myelitis. Trauma to the spinal cord results in primary and secondary injury. Primary injury occurs because of axonal and cell body disruption due to direct mechanical forces and haemorrhage into and around the spinal cord. A variety of complex changes are involved in the secondary injury process and include hypoxia/ischaemia, ionic shifts, free-radical production, lipid peroxidation, excitotoxicty, and apoptosis. Management of acute SCI involves prevention of complications from the sensorimotor deficit, monitoring and management of cardiorespiratory disturbances, spinal immobilization and consideration of surgical intervention, and management of systemic organ dysfunction. Majority of chronic SCI patients prefer to be managed for ongoing medical needs in a spinal injury unit and are therefore infrequently seen outside a small number of hospitals.