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The first step taken to aid patients
of spinal cord injuries is to relieve the spinal cord compression
(10,
21,
22).
A 1995 in vivo study by Delamarter et al. showed that not all damage
to the spinal cord occurs at the time of the injury, and that the
extent of the damage is related to the length of time that the spinal
cord is compressed (10).
Pharmacological intervention is the
second step in treating spinal cord injuries. There is continued
research on substances that can reduce secondary damage, but currently
doctors administer methylprednisolone to reduce cellular damage.
In 1990 methylprednisolone was approved by the FDA for emergency
treatment of spinal cord injuries. It is a steroid that has been
shown to reduce inflammation, reduce excitatory amino acid neurotoxicity,
increase the blood flow to the spinal cord, prevent lipid peroxidation,
and slow the shift in ions that follow injury. It also suppresses
immune cells that damage nervous tissues and saves some nerve fibers
that would otherwise die. To be most affective, methylprednisolone
must be administered within eight hours of the injury. According
to Delamarter and Cole, "Patients should be given a 30-mg/kg bolus
does of methylprednisolone, followed by either a 23 hour or a 48
hour infusion at the rate of 5.4 mg/kg per hour (10)."
If the patient receives methylprednisolone within three hours after
injury it is usually continued for 24 hours. If the patient receives
methylprednisolone in 3-8 hours after the injury it is usually administered
for 48 hours (1). Hypoxia and ischemia
at the injury site should also be reduced. This is done by giving
patients oxygen supplements to maintain oxygen saturation as close
to 100% as possible; it should start as soon as the spinal cord
injury has been diagnosed. Doctors then treat neurogenic shock and
restore systolic blood pressure (10).
The patient should then be immobilized to prevent additional injury
to the nervous system. Often spinal cord injuries are associated
with other injuries which could be life threatening. In these cases,
the life threatening injuries are treated before the spinal cord
injury (10).
The purpose of the initial examination
is to establish the level of the injury and the extent of neural
damage. It serves as a guide for treatment and as a baseline for
following examinations. As part of secondary assessment, the patient
should be completely evaluated for radiological and neurological
damage. Fractured or misaligned vertebrae should be treated along
with the other cord treatments (10).
There is little debate that initial surgery to decompress the spine
is imperative, but the timing of secondary surgeries is a controversial
issue. According to Delamarter and Cole, the extent of neural damage
depends both on the damage from the initial injury, but also on
the duration of spinal cord compression. Therefore, it could be
possible to limit the extent of injury and reverse some of the damage
if the injury is treated soon after it occurs (10).
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picture
provided by
Neurosurgery://OnCall
This MRI is
the side view of a patient with an incomplete spinal cord injury.
Had the patient not been immobilized properly the injury could have
become complete
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picture
provided by
Neurosurgery://OnCall
This postoperative
x-ray shows the results of spinal cord surgery. The patient had
fustions performed on both the front and back of his neck, and his
fractured spinal bones were removed and replaced by pieces of bone
from his hip. The metal plates and screws can be seen on the front
and back of his neck.
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