Acute spinal cord injury, part I: Pathophysiologic mechanisms

Randall J. Dumont, David O. Okonkwo, Subodh Verma, R. John Hurlbert, Paul T. Boulos, Dilantha B. Ellegala, Aaron S. Dumont

Research output: Contribution to journalArticle

499 Scopus citations

Abstract

Spinal cord injury (SCI) is a devastating and common neurologic disorder that has profound influences on modern society from physical, psychosocial, and socioeconomic perspectives. Accordingly, the present decade has been labeled the Decade of the Spine to emphasize the importance of SCI and other spinal disorders. Spinal cord injury may be divided into both primary and secondary mechanisms of injury. The primary injury, in large part, determines a given patient's neurologic grade on admission and thereby is the strongest prognostic indicator. However, secondary mechanisms of injury can exacerbate damage and limit restorative processes, and hence, contribute to overall morbidity and mortality. A burgeoning body of evidence has facilitated our understanding of these secondary mechanisms of injury that are amenable to pharmacological interventions, unlike the primary injury itself. Secondary mechanisms of injury encompass an array of perturbances and include neurogenic shock, vascular insults such as hemorrhage and ischemia-reperfusion, excitotoxicity, calcium-mediated secondary injury and fluid-electrolyte disturbances, immunologic injury, apoptosis, disturbances in mitochondrion function, and other miscellaneous processes. Comprehension of secondary mechanisms of injury serves as a basis for the development and application of targeted pharmacological strategies to confer neuroprotection and restoration while mitigating ongoing neural injury. The first article in this series will comprehensively review the pathophysiology of SCI while emphasizing those mechanisms for which pharmacologic therapy has been developed, and the second article reviews the pharmacologic interventions for SCI.

Original languageEnglish (US)
Pages (from-to)254-264
Number of pages11
JournalClinical Neuropharmacology
Volume24
Issue number5
DOIs
StatePublished - Oct 9 2001
Externally publishedYes

Keywords

  • Pathophysiologic mechanisms
  • Secondary injury
  • Spinal cord injury

ASJC Scopus subject areas

  • Pharmacology
  • Clinical Neurology
  • Pharmacology (medical)

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  • Cite this

    Dumont, R. J., Okonkwo, D. O., Verma, S., Hurlbert, R. J., Boulos, P. T., Ellegala, D. B., & Dumont, A. S. (2001). Acute spinal cord injury, part I: Pathophysiologic mechanisms. Clinical Neuropharmacology, 24(5), 254-264. https://doi.org/10.1097/00002826-200109000-00002