Current concepts in the management of acute spinal cord injury

Acute injury to the spinal cord initiates a sequence of vascular, biochemic al, and inflammatory events that result in the development of secondary tis sue damage. Experimental studies and clinical trials in humans have demonst rated that the extent of this secondary tissue damage can be limited by pha rmacologic intervention at appropriate intervals after injury. High doses o f methylprednisolone sodium succinate (MPSS) improve the outcome of acute s pinal cord injury in humans if treatment is initiated within 8 hours of inj ury. Starting therapy more than 8 hours after injury is detrimental to outc ome. The clinical efficacy of methylprednisolone in improving the outcome o f canine spinal cord injuries has not yet been demonstrated and its use by veterinarians is controversial. Many dogs are not seen by a veterinarian wi thin the 8-hour window after injury, and these dogs frequently are treated with nonsteroidal anti-inflammatory drugs or large doses of dexamethasone o r prednisone before methylprednisolone treatment can be initiated, thus inc reasing the risk of severe adverse effects. Other drugs that may provide sa fer and more effective alternatives to methylprednisolone include thyrotrop in-releasing hormone (TRH), the 21-aminosteroids, and kappa opioid agonists . Recent studies suggest that modulation of the influx of inflammatory cell s and activation of endogenous microglial cells may provide another means o f improving the outcome of acute spinal cord injuries. Many drugs being dev eloped to treat acute spinal cord injury have shown promising results when evaluated experimentally. However, any proposed therapeutic strategy should be evaluated in prospective blinded clinical trials before being adopted i n clinics.