Commentary on the prevention of paralysis after traumatic spinal cord injury in humans: the neglected factor--urgent restoration of spinal cord circulation.

Although advances in the management of spinal injuries during the past 60 years have led to greatly increased life expectancy for paralysed patients, most remain disabled. Around the world, spinal injury centres have become specialized rehabilitation units, where staff accepts the inevitability of persisting paralysis. In part, this pessimism has been based on incorrect information about the anatomy and function of the circulation of the spinal cord. Since the publication of accurate descriptions of the segmental nature of spinal vasculature, research and clinical data suggest that reversal or prevention of paralysis after spinal injury may be possible in many patients. These improved outcomes will depend on the recognition that urgent correction of cord blood supply in patients with traumatic spinal injury is critical to the long-term results of treatment. The creation of specialist spinal units within trauma centres for the urgent treatment of patients following spinal injury will require considerable logistical change, but has the potential to lead to a revolution in spinal care, driven by the knowledge that spinal cord function can often be saved.