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Acute Spinal Cord Injury: Best Practices for Early SCI Management

acute spinal cord injury care and management

Acute spinal cord injury refers to the early stages following one’s injury.

If not properly cared for, the effects of an acute spinal cord injury can drastically reduce one’s quality of life.

To help you understand what acute spinal cord injury consists of, this article will guide you through its phases and treatment. Let’s get started!

What is Acute Spinal Cord Injury?

Acute spinal cord injury consists of 2 phases: primary and secondary.

The primary phase is the damage incurred by the initial blow to the spinal cord. This is what causes compression of the spinal cord.

The secondary phase is made up of the “cascade of pathophysiological events [that] result in impaired neuronal homeostasis, apoptosis, and tissue destruction.”

After a spinal cord injury, your body is knocked off balance. Inflammatory processes occur and cause further damage to the spinal cord.

Some of these harmful inflammatory responses include:

  • edema (swelling)
  • the formation of free radicals (unstable and highly reactive atoms that can damage cells)
  • the release of a neurotransmitter called glutamate (which causes excitotoxicity)

While not much can be done for primary damage, seeking immediate medical attention can help minimize secondary damage.

Acute Spinal Cord Injury Treatment

acute sci treatment

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Treatment for acute spinal cord injuries will vary from person-to-person depending on the severity of injury.

Some of the more controversial reasons behind a lack of standardization for treating spinal cord injuries include the timing of surgery and the use of methylprednisolone.

Timing of Surgery

Nearly 80% of spinal cord injuries require surgery. The goal of surgery following an SCI is to stabilize the spinal cord in order to reduce secondary damage.

Controversy over optimal timing of surgery revolves around two main arguments:

  1. Surgery should be performed immediately for less overall damage.
  2. The spinal cord is extremely fragile and immediate surgery may cause more harm than good. Surgery should be put off for a couple of days and to allow for spontaneous improvement.

While a consensus has yet to be established, recent studies appear to side in favor of early decompression to maximize functional outcomes after spinal cord injury.

The Use of Methylprednisolone

Historically, the use of a steroid called methylprednisolone was considered the standard of care for spinal cord injuries.

The anti-inflammatory properties of methylprednisolone can help stabilize the spinal cord after injury by reducing swelling.

However, over time, its use has become controversial.

Some believe the potential side effects of using methylprednisolone are not worth the moderate amount of healing.

In contrast, others believe that because spinal cord injuries are so time-sensitive, every bit of treatment can help optimize neurological outcomes.

What Happens After Acute Spinal Cord Injury?

life after acute spinal cord injury

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After your spinal cord is stabilized, you’ll have to learn how to adjust to your new body.

Depending on the severity of your SCI, the amount of paralysis you experience below your level of injury will vary.

Management interventions for spinal cord injuries typically include:

  • Physical therapy. At PT, you’ll work on maximizing functional outcomes through exercise. This can involve stretching spastic muscles, maintaining range of motion in the joints, and strengthening weakened muscles to relearn movements.
  • Occupational therapy. OT will prepare you for the transition back to everyday life by teaching you how to adjust and maximize your independence. It focuses on practicing activities of daily living like getting dressed, performing transfers, toileting, and eating.
  • Medications. Many spinal cord injury patients experience complications like chronic pain, depression, and spasticity. To help you manage them, a doctor may prescribe medications.
  • Orthotics. Orthotics are designed to reduce pressure on the joints and promote musculoskeletal alignment. Not all SCI patients will need to wear orthotics, but the extra support can be very beneficial for those that do.
  • Emotional support. Adjusting to life after spinal cord injury can be very overwhelming and take a toll on your mental health. Speaking to a psychotherapist or members of an SCI support group can be extremely helpful. They will understand what you’re going through so that you feel less alone and can share effective ways to cope.

Understanding Acute Spinal Cord Injury

management for acute sci

©iStock.com/xixinxing

Acute spinal cord injuries are time-sensitive.

Damage to the central nervous system is permanent because nerve cells cannot reproduce.

Therefore, it’s essential to seek immediate medical attention to minimize damage and reduce the risk of further complications.

Hopefully, this article helped you better understand what an acute spinal cord injury is and the importance of immediate care. Good luck!

Featured image: ©iStock.com/wavebreakmedia

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