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Critical Care of Spinal Cord Injury

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Abstract

Purpose of Review

Spinal cord injury (SCI) is a major cause of morbidity and mortality, posing a significant financial burden on patients and the healthcare system. While little can be done to reverse the primary mechanical insult, minimizing secondary injury due to ischemia and inflammation and avoiding complications that adversely affect neurologic outcome represent major goals of management. This article reviews important considerations in the acute critical care management of SCI to improve outcomes.

Recent Findings

Neuroprotective agents, such as riluzole, may allow for improved neurologic recovery but require further investigation at this time. Various forms of neuromodulation, such as transcranial magnetic stimulation, are currently under investigation.

Summary

Early decompression and stabilization of SCI is recommended within 24 h of injury when indicated. Spinal cord perfusion may be optimized with a mean arterial pressure goal from a lower limit of 75-80 to an upper limit of 90-95 mmHg for 3-7 days after injury. The use of corticosteroids remains controversial; however, initiation of a 24-h infusion of methylprednisolone 5.4 mg/kg/hour within 8 h of injury has been found to improve motor scores. Attentive pulmonary and urologic care along with early mobilization can reduce in-hospital complications.

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Data Availability

All data used in this work was obtained from previously published literature that is publicly available.

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Authors and Affiliations

  1. Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA

    Sabrina L. Zeller, Alan Stein, Ilya Frid, Austin B. Carpenter, Sauson Soldozy, Cameron Rawanduzy, Jon Rosenberg, Andrew Bauerschmidt, Fawaz Al-Mufti, Stephan A. Mayer, Merritt D. Kinon & John V. Wainwright

  2. Department of Neurosurgery, New York Medical College, Valhalla, NY, USA

    Sabrina L. Zeller, Alan Stein, Ilya Frid, Austin B. Carpenter, Sauson Soldozy, Cameron Rawanduzy, Jon Rosenberg, Andrew Bauerschmidt, Fawaz Al-Mufti, Stephan A. Mayer, Merritt D. Kinon & John V. Wainwright

  3. Department of Orthopedic Surgery, New York Medical College, 100 Woods Road, Valhalla, NY, 10595, USA

    Merritt D. Kinon & John V. Wainwright

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  1. Sabrina L. Zeller
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Contributions

SZ, AS, IF, AC, SS, CR, and JW wrote the main manuscript text, edited, reviewed, and approved the manuscript. JW, MK, JR, AB, FAM, and SM developed the concept, determined the included topics, edited, reviewed, and approved the manuscript.

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Correspondence to John V. Wainwright.

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Zeller, S.L., Stein, A., Frid, I. et al. Critical Care of Spinal Cord Injury. Curr Neurol Neurosci Rep (2024). https://doi.org/10.1007/s11910-024-01357-8

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