Spinal Cord Injury: A Systematic Review of Current Treatment Options

Background Spinal cord injury (SCI) is a devastating event often resulting in permanent neurologic deficit. Research has revealed an understanding of mechanisms that occur after the primary injury and contribute to functional loss. By targeting these secondary mechanisms of injury, clinicians may be...

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Published in:Clinical orthopaedics and related research Vol. 469; no. 3; pp. 732 - 741
Main Authors: Cadotte, David W., Fehlings, Michael G.
Format: Journal Article
Language:English
Published: New York Springer-Verlag 01.03.2011
Lippincott Williams & Wilkins Ovid Technologies
Subjects:
Animals
Conservative Orthopedics
Decompression, Surgical
Disease Models, Animal
Drug Evaluation, Preclinical
Enzyme Inhibitors - pharmacology
Humans
Medicine
Medicine & Public Health
Neuroprotective Agents - pharmacology
Orthopedics
Recovery of Function
rho-Associated Kinases - antagonists & inhibitors
Riluzole - pharmacology
Spinal Cord Injuries - complications
Spinal Cord Injuries - physiopathology
Spinal Cord Injuries - therapy
Spine
Sports Medicine
Surgery
Surgical Orthopedics
Symposium: Current Concepts in Cervical Spine Surgery
Trauma, Nervous System - etiology
Trauma, Nervous System - physiopathology
Trauma, Nervous System - therapy
American Spinal Injury Association
Amyotrophic Lateral Sclerosis
Riluzole
Spinal Cord Injury
Traumatic Spinal Cord Injury
ISSN:0009-921X, 1528-1132, 1528-1132
Online Access:Get full text
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Summary:Background Spinal cord injury (SCI) is a devastating event often resulting in permanent neurologic deficit. Research has revealed an understanding of mechanisms that occur after the primary injury and contribute to functional loss. By targeting these secondary mechanisms of injury, clinicians may be able to offer improved recovery after SCI. Questions/purposes In this review, we highlight advances in the field of SCI by framing three questions: (1) What is the preclinical evidence for the neuroprotective agent riluzole that has allowed this agent to move into clinical trials? (2) What is the preclinical evidence for Rho antagonists that have allowed this group of compounds to move into clinical trials? (3) What is the evidence for early surgical decompression after SCI? Methods We conducted a systematic review of MEDLINE and EMBASE-cited articles related to SCI to address these questions. Results As a result of an improved understanding of the secondary mechanisms of SCI, specific clinical strategies have been established. We highlight three strategies that have made their way from bench to bedside: the sodium-glutamate antagonist riluzole, the Rho inhibitor Cethrin, and early surgical decompression. Each of these modalities is under clinical investigation. We highlight the fundamental science that led to this development. Conclusions As our understanding of the fundamental mechanisms of SCI improves, we must keep abreast of these discoveries to translate them into therapies that will hopefully benefit patients. We summarize this process of bench to bedside with regard to SCI.
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ISSN:0009-921X
1528-1132
1528-1132
DOI:10.1007/s11999-010-1674-0