Secondary injury mechanisms in acute spinal cord trauma

There have been many recent advances in the understanding of the pathophysiology of acute spinal cord trauma which have influenced the approach to case management. Although the clinician has no control over the initial trauma, medical and surgical treatment regimens may be able to influence neuronal survival by interrupting the ensuing pathophysiological events. Acute spinal patients should always be regarded as emergencies. Intravenous access lines can normally be established during the initial patient evaluation and medical therapy instituted. At present, a short‐term, intensive methylprednisolone sodium succinate protocol is advocated. This regimen is aimed at maintaining tissue concentrations of the drug at a level consistent with the inhibition of free radical induced lipid peroxidation. Decisions can be made following further diagnostic work‐up as to the necessity for decompressive surgery or spinal stabilisation.