Traumatic spinal cord injury: the relationship between pathology and clinical implications

Abstract

The pathological effects of traumatic spinal cord injuries (SCI) encompass the pathology affecting the spinal cord. As a result of the interruption of spinal cord conduction, one or more pathological and patho-physiological processes affect almost every system of the human body. Knowledge of the pathological processes that affect the spinal cord and the various systems of the body is essential for the safe and good management of these patients. The small incidence (10-15 per million per year) of these highly complex conditions makes it difficult for skills and experience to develop in District General Hospitals in the management of these patients. The associated sensory impairment or loss present diagnostic challenges to the clinician in almost every aspect of paralysis and throughout the patient’s life. In the acute stage simultaneous good management of the multi-system impairments and malfunctions giving equal attention to all systems including that of the traumatized spine is the key to good quality outcome. Concentrating resources at any one time on any one particular aspect of paralysis is unlikely to yield a similarly good outcome. The neurological outcome does not depend only on the quality of the management of the SCI. The traumatized physiologically unstable spinal cord is vulnerable and unable to protect itself from non-mechanical complications outside the spinal canal, many of which can easily develop in patients with SCI adding to the threats from the biomechanical instability. To date there are many controversies in the management of many aspects of paralysis at all stages following injury. One of the main current controversies is in the management of the SCI itself. There are many reasons that seem to perpetuate this controversy. Some of the reasons may be related to different interpretations of the pathological processes that affect the vertebral axis and the spinal cord as well as their effects on neurological outcome. The natural history of neurological recovery following SCI is not always duly acknowledged.