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Online ISSN 1827-1707
Santaguida C. 1, Wilson J. R. 1, Vaccaro A. 2
1 Department of Surgery, Division of Neurosurgery and Spinal Program, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada;
2 Department of Orthopedic Surgery, Division of Spinal Disorders, Thomas Jefferson University, Philadelphia, PN, USA
The early treatment of spinal cord injury (SCI) has become increasingly complex as the field evolves and more research becomes available. With this review, we aimed to summarize preclinical and clinical research on pharmacologic, supportive, and surgical therapies of SCI, as well as provide an interpretation on how these treatments apply to clinical practice. Observational studies and expert opinion support aggressive management of respiratory and cardiovascular systems in an intensive care environment following SCI. Although multiple trials evaluating several purported neuroprotective drugs have been completed, the available phase III data does not support the routine use of any of these agents in the postinjury setting. In spite of this, there are a number of drugs in various stages of clinical development that appear poised to overcome the limitations of previously investigated agents. With respect to surgery, the best available non-randomized evidence supports the safety and efficacy of decompressing the spinal cord with 24 hours postinjury. Finally, the current status of cellular transplantation therapy is briefly addressed.