Acute spinal cord injury, part II: Contemporary pharmacotherapy

Spinal cord injury (SCI) remains a common and devastating problem of modem society. Through an understanding of underlying pathophysiologic mechanisms involved in the evolution of SCI, treatments aimed at ameliorating neural damage may be developed. The possible pharmacologic treatments for acute sp inal cord injury are herein reviewed. Myriad treatment modalities, includin g corticosteroids, 21-amino-steroids, opioid receptor antagonists, ganglios ides, thyrotropin-releasing hormone (TRH) and TRH analogs, antioxidants and free radical scavengers, calcium channel blockers, magnesium replacement t herapy, sodium channel blockers, N-methyl-D-aspartate receptor antagonists, alpha -amino-3-hydroxy-5-methylisoxazole-4-propionic acid-kainate receptor antagonists, modulators of arachadonic acid metabolism, neurotrophic growt h factors, serotonin antagonists, antibodies against inhibitors of axonal r egeneration, potassium channel blockers (4-aminopyridine), paclitaxel, clen buterol, progesterone, gabexate mesylate, activated protein C, caspase inhi bitors, tacrolimus, antibodies against adhesion molecules, and other immuno modulatory therapy have been studied to date. Although most of these agents have shown promise, only one agent, methylprednisolone, has been shown to provide benefit in large clinical trials. Given these data, many individual s consider methylprednisolone to be the standard of care for the treatment of acute SCI. However, this has not been established definitively, and ques tions pertaining to methodology have emerged regarding the National Acute S pinal Cord Injury Study trials that provided these conclusions. Additionall y, the clinical significance (in contrast to statistical significance) of r ecovery after methylprednisolone treatment is unclear and must be considere d in light of the potential adverse effects of such treatment. This first d ecade of the new millennium, now touted as the Decade of the Spine, will ho pefully witness the emergence of universal and efficacious pharmacologic th erapy and ultimately a cure for SCI.