Modern concepts of therapy and management of spinal cord injuries.

Trauma is the most common cause of spinal cord-related disability. There are approximately 52 new spinal cord injuries per million population per year in the U.S., and about 200,000 persons with post-traumatic paraplegia or quadriplegia require continuing medical care in this country at the present time. Management of the spinal cord-injured patient commences at the moment of injury and continues throughout the entire lifetime of the patient. While there is considerable consensus regarding the management of some problems related to traumatic myelopathy, other treatment concerns, mainly related to spinal fractures, are highly controversial, with a plethora of strongly held opinions, frequently supported by meager factual evidence or none at all. It is not generally recognized that whatever treatment the patient receives during the first days or weeks following injury is of considerably less importance, from a lifelong perspective, than that which occurs over subsequent months. Skillful physical rehabilitation to maximize the functional usefulness of remaining neurological function permits the return of most spinal cord-injured patients to their family and community able to function as an independent person. Paraplegic and quadriplegic patients acquire health risks unique to their condition, mainly related to pressure sore liability and altered bladder function, which requires continual, meticulous attention from the patient and his physician. The sudden transition from being an unimpaired to a permanently paralyzed person is a cataclysmic emotional experience. Unless psychic rehabilitation is undertaken in tandem with physical rehabilitation, a spinal cord-injured patient is likely to become an unhappy social recluse or denizen of a chronic care facility, rather than an independent productive member of his community. Centers dedicated to comprehensive spinal cord care have become generally available and provide optimal care for traumatic myelopathy.