Badhiwala Jetan H, Ahuja Christopher S, Fehlings Michael G
1Division of Neurosurgery, Department of Surgery, and.
2Institute of Medical Science, University of Toronto; and.
J Neurosurg Spine. 2018 Dec 20;30(1):1-18. doi: 10.3171/2018.9.SPINE18682. Print 2019 Jan 1.
Acute traumatic spinal cord injury (SCI) is a devastating event with far-reaching physical, emotional, and economic consequences for patients, families, and society at large. Timely delivery of specialized care has reduced mortality; however, long-term neurological recovery continues to be limited. In recent years, a number of exciting neuroprotective and regenerative strategies have emerged and have come under active investigation in clinical trials, and several more are coming down the translational pipeline. Among ongoing trials are RISCIS (riluzole), INSPIRE (Neuro-Spinal Scaffold), MASC (minocycline), and SPRING (VX-210). Microstructural MRI techniques have improved our ability to image the injured spinal cord at high resolution. This innovation, combined with serum and cerebrospinal fluid (CSF) analysis, holds the promise of providing a quantitative biomarker readout of spinal cord neural tissue injury, which may improve prognostication and facilitate stratification of patients for enrollment into clinical trials. Given evidence of the effectiveness of early surgical decompression and growing recognition of the concept that "time is spine," infrastructural changes at a systems level are being implemented in many regions around the world to provide a streamlined process for transfer of patients with acute SCI to a specialized unit. With the continued aging of the population, central cord syndrome is soon expected to become the most common form of acute traumatic SCI; characterization of the pathophysiology, natural history, and optimal treatment of these injuries is hence a key public health priority. Collaborative international efforts have led to the development of clinical practice guidelines for traumatic SCI based on robust evaluation of current evidence. The current article provides an in-depth review of progress in SCI, covering the above areas.
急性创伤性脊髓损伤（SCI）是一种具有毁灭性的事件，会给患者、家庭乃至整个社会带来深远的身体、情感和经济影响。及时提供专科护理已降低了死亡率；然而，长期的神经功能恢复仍然有限。近年来，出现了一些令人振奋的神经保护和再生策略，并已在临床试验中积极开展研究，还有更多策略正处于转化阶段。正在进行的试验包括RISCIS（利鲁唑）、INSPIRE（神经脊髓支架）、MASC（米诺环素）和SPRING（VX - 210）。微观结构磁共振成像（MRI）技术提高了我们以高分辨率对受损脊髓进行成像的能力。这项创新技术与血清和脑脊液（CSF）分析相结合，有望提供脊髓神经组织损伤的定量生物标志物读数，这可能会改善预后，并有助于对患者进行分层以便纳入临床试验。鉴于早期手术减压的有效性证据以及对“时间就是脊髓”这一概念的日益认可，世界各地许多地区正在进行系统层面的基础设施变革，以提供一个简化的流程，将急性脊髓损伤患者转运至专科单位。随着人口持续老龄化，预计中央脊髓综合征很快将成为急性创伤性脊髓损伤最常见的形式；因此，对这些损伤的病理生理学、自然史和最佳治疗方法进行特征描述是一项关键的公共卫生重点工作。国际合作努力已促成基于对当前证据的有力评估而制定的创伤性脊髓损伤临床实践指南。本文对脊髓损伤的进展进行了深入综述，涵盖上述各个领域。
