||Demographic trends in the occurrence of injury
and improvements in the early management of spinal trauma are changing the
long-term profile of patients with spinal cord injuries. More patients are
surviving the initial injury, and proportionately fewer patients are sustaining
complete injuries. While preventive efforts to reduce the overall incidence
of spinal cord injury are important, a number of steps can be taken to minimize
secondary injury once the initial trauma has occurred. Recent efforts have
focused on understanding the biochemical basis of secondary injury and developing
pharmacologic agents to intervene in the progression of neurologic deterioration.
The Third National Acute Spinal Cord Injury Study investigators concluded
that methylprednisolone improves neurologic recovery after acute spinal
cord injury and recommended that patients who receive methylprednisolone
within 3 hours of injury should be maintained on the treatment regimen for
24 hours. When methylprednisolone therapy is initiated 3 to 8 hours after
injury, it should continue for 48 hours. In addition to the adoption of
the guidelines of that study, rapid reduction and stabilization of injuries
causing spinal cord compression are critical steps in optimizing patients'
long-term neurologic and functional outcomes.