Critical Care of Spinal Cord Injury

Authors

Sabrina L. Zeller, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Alan Stein, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Ilya Frid, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Austin B. Carpenter, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Sauson Soldozy, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Cameron Rawanduzy, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Jon Rosenberg, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Andrew Bauerschmidt, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Stephan A. Mayer, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
Merritt D. Kinon, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA.
John V. Wainwright, Department of Neurosurgery, Westchester Medical Center, Valhalla, NY, USA. john.wainwright@wmchealth.org.

Author Type(s)

Resident/Fellow, Faculty

DOI

10.1007/s11910-024-01357-8

Journal Title

Current Neurology and Neuroscience Reports

First Page

355

Last Page

363

Document Type

Article

Publication Date

9-1-2024

Department

Neurosurgery

Second Department

Neurology

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. 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.

Recommended Citation

Zeller, S. L., Stein, A., Frid, I., Carpenter, A. B., Soldozy, S., Rawanduzy, C., Rosenberg, J., Bauerschmidt, A., Al-Mufti, F., Mayer, S. A., Kinon, M. D., & Wainwright, J. V. (2024). Critical Care of Spinal Cord Injury. Current Neurology and Neuroscience Reports, 24 (9), 355-363. https://doi.org/10.1007/s11910-024-01357-8