Will improved understanding of the pathophysiological mechanisms involved in acute spinal cord injury improve the potential for therapeutic intervention?

At the dawning of the present decade, deemed appropriately the Decade of the Spine, acute spinal cord injury lingers as a formidable disorder affecting society. The enormous physical, emotional and socioeconomic impact of acute spinal cord injury on society is well known. Consequently, intensive clinical and laboratory research efforts have focused on furthering contemporary understanding of the mechanisms involved in primary and secondary injury following spinal cord injury. Additionally, research has been devoted to investigations concerning the treatment of acute spinal cord injury using a myriad of strategies, some of which involve rational targeting of known pathophysiological mechanisms. A recent surge of studies endeavoring to dissect the cellular and molecular mechanisms involved in the development and perpetuation of acute spinal cord injury appear particularly promising as a basis for identifying candidate pathways of injury for therapeutic manipulation. Meritorious investigations examining changes in gene expression, especially pertaining to pathways of cell death and inflammation, are increasingly reported. Molecular therapies harnessing knowledge gleaned from the aforementioned groundwork, including stem cell transplantation, likely represent the future direction of treatment for acute spinal cord injury. The Decade of the Spine is poised to be a phase of advancement in the treatment of acute spinal cord injury and the importance of further elucidation of underlying pathophysiological mechanisms to targeted, rational therapy will likely become clearly evident.