Spinal cord injuries are intricate medical conditions resulting from damage to the spinal cord which can be caused by trauma or non-traumatic factors like tumors and degenerative diseases. These injuries can lead to significant morbidity and permanent disability, with high spinal lesions often necessitating urgent intervention due to potential cardiorespiratory issues.
The pathological mechanisms behind SCIs are categorized into primarily and secondary injuries. Primary injuries direct damage to the spinal cord and are often irreversible. Secondary injuries result from cascading effects of the primary injury including inflammation and further neuronal damage. This disruption of nerve axons causes motor and sensory function loss below the level of the injury.
Diagnosis typically involves combination of clinical assessment and imaging studies. Treatment strategies may include conservative management, surgical intervention, rehabilitation, or a combination of these approaches. Emerging treatments such as stem cell therapy, are currently under investigation.
This educational activity for the medical students aims to improve the skills in the evaluation and management of SCIs. Participants will enhance their ability to apply best practice guidelines, implement emergency protocols, and seek timely consultations.
Treatment/Management of Spinal Cord Injury
Treatment of spinal cord injuries (SCIs) begins at the injury site with paramedics and emergency medical staff playing a crucial role in stabilizing and transferring the patient. Immediate stabilization is essential to prevent exacerbation of the injury and address life-threatening issues.
Maintaining a systolic blood pressure of at least 90mm Hg and a mean arterial pressure of between 85- and 90-mm Hg is recommended, despite limited evidence supporting these targets. Immediate surgical decompression may be necessary to relieve compression and stabilize the spine.
Steroid administration for SCIs remains controversial, with initial studies suggesting potential benefits that later research has not confirmed. Early intubation is advised for injuries above C5, especially with total paralysis or compromised lung function, and tracheostomy may be needed for prolonged ventilation.
Management of acute urinary retention involves catheterization with clean intermittent catheterization preferred to reduce complications. Deep vein thrombosis prophylaxis should start within 72 hours of injury with low-molecular -weight heparin recommended.
Neurological intensive care units are ideal for managing SCIs and intense rehabilitation therapy is crucial for optimal recovery. Trials of various other treatments have not demonstrated significant benefits making high-dose steroids the current standard for acute SCI treatment.
Role of Stem Cell Therapy in Spinal Cord Injury
Stem cell treatments for spinal cord injuries are divided into supportive and loading therapies. Supportive therapies use nonneural stem cells, like those from bone marrow, umbilical cord, or adipose tissue which are administered intravenously or intrathecally. These cells mainly release neurotrophic factors that aid in repair but have limited capacity for nerve cell replacement.
Most clinical trials focus on this approach due to its simpler preparation and regulatory ease. In contrast, loading therapies involve stem cells capable of differentiating into neural cells such as olfactory ensheathing cells and neural progenitor cells derived from embryonic stem cells. These cells offer a higher potential for replacing lost nerve cells but require more invasive transplantation techniques and complex preparation.
To learn more about the management of spinal cord injury, enroll in the Surgery MS course crafted by Prof. Dr. Nilay Mandal. This online platform helps medical students understand the concepts more effectively.
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