Quinones Christian, Wilson John Preston, Kumbhare Deepak, Guthikonda Bharat, Hoang Stanley
Department of Neurosurgery, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA.
J Clin Med. 2024 Sep 25;13(19):5719. doi: 10.3390/jcm13195719.
The information contained in this article is suitable for clinicians practicing in the United States desiring a general overview of the assessment and management of spinal cord injury (SCI), focusing on initial care, assessment, acute management, complications, prognostication, and future research directions. SCI presents significant challenges, affecting patients physically, emotionally, and financially, with variable recovery outcomes ranging from full functionality to lifelong dependence on caregivers. Initial care aims to minimize secondary injury through thorough neurological evaluations and imaging studies to assess the severity of the injury. Acute management prioritizes stabilizing respiratory and cardiovascular functions and maintaining proper spinal cord perfusion. Patients with unstable or progressive neurological decline benefit from timely surgical intervention to optimize neurological recovery. Subacute management focuses on addressing common complications affecting the respiratory, gastrointestinal, and genitourinary systems, emphasizing a holistic, multidisciplinary approach. Prognostication is currently based on neurological assessments and imaging findings, but emerging biomarkers offer the potential to refine outcome predictions further. Additionally, novel therapeutic interventions, such as hypothermia therapy and neuroprotective medications are being explored to mitigate secondary damage and enhance recovery. This paper serves as a high-yield refresher for clinicians for the assessment and management of acute spinal cord injury during index admission.
本文所包含的信息适用于在美国执业的临床医生，他们希望对脊髓损伤（SCI）的评估和管理有一个全面的了解，重点是初始护理、评估、急性处理、并发症、预后以及未来的研究方向。脊髓损伤带来了重大挑战，在身体、情感和经济方面影响着患者，恢复结果各不相同，从完全功能恢复到终身依赖护理人员。初始护理旨在通过全面的神经学评估和影像学研究将继发性损伤降至最低，以评估损伤的严重程度。急性处理优先稳定呼吸和心血管功能，并维持适当的脊髓灌注。神经功能不稳定或进行性下降的患者可从及时的手术干预中获益，以优化神经功能恢复。亚急性处理侧重于解决影响呼吸、胃肠和泌尿生殖系统的常见并发症，强调采用整体、多学科的方法。目前，预后评估基于神经学评估和影像学检查结果，但新出现的生物标志物有可能进一步完善预后预测。此外，正在探索诸如低温疗法和神经保护药物等新型治疗干预措施，以减轻继发性损伤并促进恢复。本文为临床医生在初次住院期间评估和处理急性脊髓损伤提供了一份高效的复习资料。
