Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
Section of Neurosurgery, GB1 - Health Sciences Centre, University of Manitoba, 820 Sherbrook Street, Winnipeg, MB, R3A 1R9, Canada.
Curr Neurol Neurosci Rep. 2019 Jul 30;19(9):65. doi: 10.1007/s11910-019-0984-1.
Spinal cord injury (SCI) shows an incidence of 10.4-83 cases/million/year globally and remains a significant source of morbidity and cost to society. Despite greater understanding of the pathophysiology of SCI, neuroprotective and regenerative approaches to treatment have had limited clinical utility to date. Here, we review the key components of supportive care that are thus the mainstay of therapy and that have improved outcomes for victims of acute SCI in recent decades.
Current management strategies for acute SCI involve early surgical decompression and fixation, the use of vasopressor medications for mean arterial blood pressure (MAP) augmentation to improve spinal cord perfusion, and corticosteroids. We highlight recent literature supporting the role of norepinephrine in acute SCI management and also an emerging neurocritical care strategy that seeks to optimize spinal cord perfusion pressure with the assistance of invasive monitoring. This review will highlight key pathophysiologic principles and targets for current acute clinical treatments in SCI, which include early surgical decompression, MAP augmentation, and corticosteroids. We discuss anticipated future research in these areas and focus on potential risks inherent to these treatments.
全球范围内脊髓损伤 (SCI) 的发病率为 10.4-83 例/百万/年，仍然是发病率和社会成本的重要来源。尽管对 SCI 的病理生理学有了更深入的了解，但迄今为止，神经保护和再生治疗方法的临床实用性有限。在这里，我们回顾了支持性护理的关键组成部分，这些护理是治疗的主要方法，并在最近几十年改善了急性 SCI 患者的预后。
急性 SCI 的当前管理策略包括早期手术减压和固定、使用升压药物升高平均动脉血压 (MAP) 以改善脊髓灌注，以及使用皮质类固醇。我们强调了最近的文献支持去甲肾上腺素在急性 SCI 管理中的作用，以及一种新兴的神经危重症护理策略，该策略旨在在侵入性监测的帮助下优化脊髓灌注压。本综述将重点介绍 SCI 中当前急性临床治疗的关键病理生理原则和目标，包括早期手术减压、MAP 升高和皮质类固醇。我们讨论了这些领域预期的未来研究，并侧重于这些治疗方法固有的潜在风险。
