Introduction

Complete spinal cord injury is a catastrophic event with a substantial impact on the patient and the supporting infrastructure (e.g. family, health services). Unless adequately treated, complete spinal cord injury is associated with lifelong disability (chronic bedridden state), pulmonary infections and possibly ventilator dependence, incontinence, infected decubiti, osteomyelitis, renal failure, and eventually death. The etiological factors for spinal injury include motor vehicle accidents (40-50 per cent), falls (20 per cent), sports injuries (10-15 per cent), gunshot wounds, and industrial or agricultural injuries. The majority of victims are males aged between 15 and 40 years.

There is great variation in the mechanism of injury, mechanical damage, and clinical symptoms of spinal cord injury. The forces of the trauma may induce injury ranging from mild cord contusion with minimal neurological deficits to severe spinal cord contusion with transverse functional dissection to complete anatomical spinal cord transection. Spinal cord injury can be divided into the primary insult and secondary insults. The primary insult represents the immediate impact and its consequences on the vertebral column and the central nervous system structures between the time of injury and the initial medical treatment. Primary spinal cord injury can only be reduced using preventive strategies such as automatic protection devices (e.g. air bags, seatbelts, helmets), laws (alcohol and drug tests), identification of high-risk recreational activities, and education about risk-taking. Secondary insults occur in response to the initial (primary) impact. This type of injury is related to a combination of edema of neurons and glia, continuous mechanical compression of the traumatized spinal cord segment (bone fragments, hematoma, edema), hypoxia, ischemia, and the release of vasoactive and excitatory substances which further promote catabolic processes and neuronal necrosis. In contrast with the primary insult, secondary insults are subject to several therapeutic interventions in order to minimize neuronal damage and improve neurological outcome. The basis for understanding the prevention and treatment of secondary insults is knowledge of the anatomy and physiology of the vertebral column and spinal cord, the regulation of spinal cord blood flow, biomechanical aspects, and the pathophysiological cascade that is initiated following spinal cord injury.

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