Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Editor's preface
- PART I INTRODUCTION AND GENERAL PRINCIPLES
- PART II DISORDERS OF HIGHER FUNCTION
- PART III DISORDERS OF MOTOR CONTROL
- PART IV DISORDERS OF THE SPECIAL SENSES
- PART V DISORDERS OF SPINE AND SPINAL CORD
- 47 Spinal cord injury and repair
- 48 Myelopathies
- 49 Diseases of the vertebral column
- 50 Cervical pain
- 51 Diagnosis and management of low back pain
- PART VI DISORDERS OF BODY FUNCTION
- PART VII HEADACHE AND PAIN
- PART VIII NEUROMUSCULAR DISORDERS
- PART IX EPILEPSY
- PART X CEREBROVASCULAR DISORDERS
- PART XI NEOPLASTIC DISORDERS
- PART XII AUTOIMMUNE DISORDERS
- PART XIII DISORDERS OF MYELIN
- PART XIV INFECTIONS
- PART XV TRAUMA AND TOXIC DISORDERS
- PART XVI DEGENERATIVE DISORDERS
- PART XVII NEUROLOGICAL MANIFESTATIONS OF SYSTEMIC CONDITIONS
- Complete two-volume index
- Plate Section
47 - Spinal cord injury and repair
from PART V - DISORDERS OF SPINE AND SPINAL CORD
Published online by Cambridge University Press: 05 August 2016
- Frontmatter
- Dedication
- Contents
- List of contributors
- Editor's preface
- PART I INTRODUCTION AND GENERAL PRINCIPLES
- PART II DISORDERS OF HIGHER FUNCTION
- PART III DISORDERS OF MOTOR CONTROL
- PART IV DISORDERS OF THE SPECIAL SENSES
- PART V DISORDERS OF SPINE AND SPINAL CORD
- 47 Spinal cord injury and repair
- 48 Myelopathies
- 49 Diseases of the vertebral column
- 50 Cervical pain
- 51 Diagnosis and management of low back pain
- PART VI DISORDERS OF BODY FUNCTION
- PART VII HEADACHE AND PAIN
- PART VIII NEUROMUSCULAR DISORDERS
- PART IX EPILEPSY
- PART X CEREBROVASCULAR DISORDERS
- PART XI NEOPLASTIC DISORDERS
- PART XII AUTOIMMUNE DISORDERS
- PART XIII DISORDERS OF MYELIN
- PART XIV INFECTIONS
- PART XV TRAUMA AND TOXIC DISORDERS
- PART XVI DEGENERATIVE DISORDERS
- PART XVII NEUROLOGICAL MANIFESTATIONS OF SYSTEMIC CONDITIONS
- Complete two-volume index
- Plate Section
Summary
Many victims of spinal cord injury are young and will live a near-normal lifespan (Fig. 47.1). Therefore, the toll to individuals and society is high. The average lifetime cost of treating a person with traumatic spinal cord injury in the United States runs between $500000 and $2 million, depending on factors such as the extent of injury and where the cord is injured (higher levels correspond to greater disability and greater costs). Total direct costs of caring for Americans with spinal cord injury exceed $8 billion per year (DeVivo, 1997).
Current state of acute pharmacological treatment
This enormous human and economic toll calls for effective therapies. It was not until the 1990s, however, that the first proven therapy for spinal cord injury was introduced. A multicentre clinical study (National Acute Spinal Cord Injury Study, NASCIS 2) revealed that a high dose of the steroid methylprednisolone reduced disability when administered within 8 hours of the trauma (Bracken et al., 1990). Although the effectiveness of this drug was modest, the availability of any treatment for spinal cord injury was heartening. Subsequently, the multicentre NASCIS 3 trial compared treatment with methylprednisolone for 24 h (same treatment as in NASCIS 2) vs. treatment for 48 h. All patients treated with methylprednisolone within 3 hours of injury showed essentially identical rates of motor recovery. When treatment was initiated between 3 h and 8 h of injury, patients receiving the 48-hour protocol showed significantly more improvement in motor function. Therefore, the US standard of care is administration of methylprednisolone (bolus 30 mg/kg) within the first 8 h after injury. Treatment initiated within the first 3 h is continued (5.4 mg/kg/h) for 24 h, whereas treatment initiated between 3 h and 8 h is continued for 48 h.
Despite these studies, methylprednisolone remains controversial in other countries (Short et al., 2000). Additional experimental drugs, including SYGEN (GM-1 ganglioside), naloxone, and trilizad, have been tested in multicentre clinical trials, but primary endpoints were never achieved.
More recently, cellular and molecular advances in neurobiology have provided powerful insights into the nature of spinal cord injury and opened up new horizons for neural repair and restoration of function. In this chapter we describe how this rapidly burgeoning knowledge might be harnessed to help individuals with spinal cord unjury regain lost functions.
- Type
- Chapter
- Information
- Diseases of the Nervous SystemClinical Neuroscience and Therapeutic Principles, pp. 695 - 712Publisher: Cambridge University PressPrint publication year: 2002
- 1
- Cited by