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Traumatic spinal cord injury

Nature Reviews Disease Primers volume 3, Article number: 17018 (2017) Cite this article

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Abstract

Traumatic spinal cord injury (SCI) has devastating consequences for the physical, social and vocational well-being of patients. The demographic of SCIs is shifting such that an increasing proportion of older individuals are being affected. Pathophysiologically, the initial mechanical trauma (the primary injury) permeabilizes neurons and glia and initiates a secondary injury cascade that leads to progressive cell death and spinal cord damage over the subsequent weeks. Over time, the lesion remodels and is composed of cystic cavitations and a glial scar, both of which potently inhibit regeneration. Several animal models and complementary behavioural tests of SCI have been developed to mimic this pathological process and form the basis for the development of preclinical and translational neuroprotective and neuroregenerative strategies. Diagnosis requires a thorough patient history, standardized neurological physical examination and radiographic imaging of the spinal cord. Following diagnosis, several interventions need to be rapidly applied, including haemodynamic monitoring in the intensive care unit, early surgical decompression, blood pressure augmentation and, potentially, the administration of methylprednisolone. Managing the complications of SCI, such as bowel and bladder dysfunction, the formation of pressure sores and infections, is key to address all facets of the patient's injury experience.

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Figure 1: Anatomy of the spinal column.
Figure 2: Annual incidence of spinal cord injury across reported countries, states or provinces and regions.
Figure 3: Pathophysiology of traumatic spinal cord injury.
Figure 4: Cervical and high thoracic spinal cord injuries disrupt the outflow of the sympathetic nervous system.
Figure 5: Spinal cord injury syndromes.
Figure 6: Surgical decompression and realignment of the injured spinal cord.
Figure 7: Post-spinal cord injury syrinx.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada

    Christopher S. Ahuja, Jefferson R. Wilson & Michael G. Fehlings

  2. Department of Orthopedic Surgery, Keio University, Tokyo, Japan

    Satoshi Nori

  3. Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK

    Mark R. N. Kotter

  4. Centrum für Muskuloskeletale Chirurgie, Universitätsmedizin Berlin, Berlin, Germany

    Claudia Druschel

  5. Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland

    Armin Curt

  6. Ordinarius for Paraplegiology, University of Zurich, Zurich, Switzerland

    Armin Curt

  7. Toronto Western Hospital, West Wing 4th floor, 399 Bathurst Street, Toronto, M5T 2S8, Ontario, Canada

    Michael G. Fehlings

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  1. Christopher S. Ahuja
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Contributions

Introduction (M.G.F., C.S.A., J.R.W., S.N., M.R.N.K. and C.D.); Epidemiology (S.N., C.S.A., J.R.W., M.R.N.K. and C.D.); Mechanisms/pathophysiology (M.G.F., C.S.A., J.R.W. and S.N.); Diagnosis, screening and prevention (C.S.A., J.R.W., S.N. and A.C.); Management (M.G.F., C.S.A., J.R.W., M.R.N.K., C.D. and A.C.); Quality of life (S.N., C.S.A., J.R.W., M.R.N.K. and C.D.); Outlook (C.S.A., J.R.W., S.N., M.R.N.K. and A.C.); Overview of Primer (M.G.F.). Co-first authors C.S.A. and J.R.W. contributed equally to this work.

Corresponding author

Correspondence to Michael G. Fehlings.

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Competing interests

M.G.F. has consulting agreements with Pfizer, Zimmer Biomed and InVivo therapeutics. All other authors declare no competing interests.

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Ahuja, C., Wilson, J., Nori, S. et al. Traumatic spinal cord injury. Nat Rev Dis Primers 3, 17018 (2017). https://doi.org/10.1038/nrdp.2017.18

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